Media and Suicide

International Perspectives on Research, Theory, and Policy

Thomas Niederkrotenthaler, Steven Stack

• Publisher: Taylor & Francis
• Year: 2017
• Print ISBN: 9781412865081
• eBook ISBN: 9781351295222
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

Somewhere in the world, in the next forty seconds, a person is going to commit suicide. Globally, suicides account for 50 percent of all violent deaths among men and 71 percent for women. Despite suicide prevention programs, therapy, and pharmacological treatments, the suicide rate is either increasing or remaining high around the world.

Media and Suicide holds traditional and emergent media accountable for influencing an individual's decision to commit suicide. Global experts present research, historical analysis, theoretical disputes (including discussion on the Werther and Papageno effects), and policy regarding the media's impact on suicide. They answer questions about the effects of different types of media and storytelling, show how the impact of social media can be diminished, discuss internet bullying, mass-shootings and mass-suicides, show the effects of recovery stories, and much more.

The editors also present examples of suicide policy in the United States, Switzerland, the United Kingdom, Ireland, and Hong Kong on how to best communicate reporting guidelines to decrease the copycat effect, especially in less developed nations where most of the world's nearly one million suicides occur each year. Although there is much work to be done to prevent media-influenced suicide, this innovative volume will contribute a large piece to this complex puzzle.

1
Introduction

Thomas Niederkrotenthaler and Steven Stack

Significance of Suicide

Recent data from the World Health Organization report that suicide took the lives of approximately eight hundred and four thousand people in 2012, representing a global suicide rate of 11.4 per 100,000 (15.0 for males and 8.0 for females). Put another way, there is a suicide someplace in the world every forty seconds. In addition, it is estimated that for every death by suicide there are more than twenty additional persons who attempt suicide. Globally, suicides account for 50 percent of all violent deaths among men and 71 percent of such deaths for women. Among youth, persons aged 15–29, suicide is the second leading cause of death. Younger persons are considered to be the most susceptible to media impacts, including copycat suicides. While there is a high level of suicidality in the world, of the over two hundred nations only twenty-eight are known to have national suicide prevention strategies. Promoting responsible media reporting of suicide is part of many strategies for the reduction of suicide (World Health Organization, 2014).

Female suicide rates are highest in South Korea (23.4/100,000), a nation with evidence of sensationalism in its suicide reporting (Lee et al., 2014). Male suicide is highest in South Korea (49.9/100,000), Lithuania (59.5/100,000), and Guyana (50.8/100,000). Little is known about the frequency or quality of suicide reporting in the latter two nations.

Focusing on the United States, suicide is one of top ten causes of death. There are now more deaths from suicide than motor vehicle accidents; in 2013 the respective numbers were 41,149 and 35,369 (Xi et al., 2016). Generally, many Americans fear death by homicide more than death by suicide. However, the chances of such deaths are much lower for homicide, with 5.1 homicides per 100,000 population, than for suicide, with 13.0 suicides per 100,000 population (Xi et al., 2016). There is evidence of possible cohort effects such as that for the postwar baby boomer generation. While the suicide rate in the United States increased by 19.2 percent between 1999 and 2013, the increase was much larger for baby boomer cohorts: 41.7 percent for ages 45–54 and 48.3 percent for ages 55–64 (Xi et al., 2016). With suicides rates being the highest for the elderly, it is anticipated that as this cohort continues to enter its retirement years, suicide rates will trend higher for that demographic group, perhaps reaching all-time records for those over 65. For example, the suicide rate for 55–64-year-olds (18.1/100,000) already exceeds that of those aged 65–74 (15.0/100,000). Available evidence notes that the elderly are susceptible to media suicide stories, especially if the story is about an elderly celebrity (Stack, 2005).

In the United States and many nations of the world the suicide rate is increasing or remaining stubbornly high. This is in spite of the efforts of suicide prevention programs, psychological therapy, and pharmacological treatments. For example, the accelerated reliance on pharmacological treatments, including the widespread use of anti-depressants (Maris, 2015), has not been sufficient to stem the tide of suicide in the United States. In this context, interventions through the media are gaining attention as a possible low-cost and far-reaching partial solution to the suicide problem. Web-based help outlets such as suicide prevention blogs are among the possible prevention strategies being discussed and researched (World Health Organization, 2014).

Brief Review of the Literature on Media Impacts on Suicide

Research has often indicated that communications in the media can alternatively increase or decrease suicidality in at-risk individuals (Niederkrotenthaler et al., 2010; Stack, 2005). Much research and public attention has been drawn to documenting increases in suicide due to the “copycat” effects of the media. Over 150 studies to date have explored media influences on suicide. Many have often found evidence of a rise, and a few evidence of a fall, in suicide after widely publicized suicide stories. This body of evidence has resulted in several additional scholarly themes: (1) what are the specific mechanisms and contexts accounting for a copycat or “Werther” effect (Phillips, 1974), or (2) a “Papageno” effect in cases of a decline in suicide (Niederkrotenthaler et al., 2010), and (3) the development of media guidelines for the reporting of suicide in order to minimize copycat effects. Of the three streams of research, the study of possible copycat or “Werther” effects has attracted the most attention.

The first systematic study of the Werther effect analyzed thirty-three nationally publicized American suicide stories that occurred between 1947 and 1968. On average, there were 39.3 additional or excess suicide stories in the month following the suicide story (Phillips, 1974). Substantially greater increases have been recorded in high-risk contexts. One such context involves the reporting of the suicides of well-known celebrities, especially entertainment celebrities (Stack, 2005).

The largest known reported copycat effect involved the suicide of the popular Korean actress, Jin-Sil Choi in October, 2008. Controlling for socio-demographic factors, there were 429 additional suicides during the massive media publicity concerning her suicide. In comparison, although also a marked high increase in suicide, the widely publicized suicide of American actress Marilyn Monroe in 1962 was associated with an additional 197 suicides in the month after her death. South Korea has a population less than a fourth of the United States, but the suicide of a popular actress was followed by twice as many suicides. Such findings suggest the presence of factors that condition the size of copycat effects. These may include the amount and type of media publicity concerning the suicide and cultural differences in the susceptibility of audiences to suicide stories. Even in the case of high-risk stories concerning the suicides of well-known actresses, the size of copycat effects can vary across cultures (Lee, Lee, Hwang, & Stack, 2014).

In general, research based on media coverage of celebrities is the most apt to uncover copycat effects. The largest quantitative review of 419 findings from 55 studies found that findings based on the suicides of entertainment or political celebrities are 5.27 times more likely to report a copycat effect than findings based on other types of stories (Stack, 2005).

As we shall see in this book, the association between media and suicide is complex and not fully understood. It is important to note that media coverage of suicide is often not associated with increases in suicide rates (Stack, 2005). Further, in contrast to findings of a copycat effect, there is also growing evidence of a “Papageno effect.” Sometimes media stories concern a once suicidal individual who mastered their personal angst and troubled environment. After the media’s presentation of such positive role models, there is evidence that suicide rates decline (Niederkrotenthaler et al., 2010).

In most research, exactly why there is or is not an association between exposure to suicidality in the media and suicidality in the audience is not well understood. A lot depends on specifying the conditions under which a link may or may not be found. Mediators include the characteristics of the audience, including the extent to which they are marked by suicidal predispositions and how exposure affects audience mood. Work has been progressing at the concrete level of individual reactions to media-based suicidal stimuli. Laboratory experiments, many carried out in Austria, have been shedding light on how different categories of the audience react differently to different modalities of suicidal media stimuli (e.g., Till, Niederkrotenthaler, Herberth, Vitouch, & Sonneck, G., 2010; Till, Niederkrotenthaler, Herberth, Voracek, Son-neck, & Vitouch, 2011; Till, Strauss, Sonneck, & Niederkrotenthaler, 2015). The present volume contains the recent contribution by this cutting-edge group to the understanding of the mechanisms operating between media and suicidality.

Given that under certain conditions media stories on suicide can increase suicide risk, researchers and policy makers have been developing suicide guidelines for the reporting of suicide (e.g., Fu, Chan, & Yip, 2011; Jamieson, Jamieson, & Romer, 2003; Pirkis et al., 2006). Such guidelines have been available for distribution and implementation by the media for several decades. However, there have been many challenges in finding the most effective ways for communicating recommendations for the reporting of suicide to media officials and frontline reporters. Media representatives are not always enthusiastic in implementing such guidelines. There are many issues that sometimes prevent implementation. These include freedom of the press issues as well as concerns to give the public what they presumably want— newsworthy stories, stories which may need to actually violate some of the guidelines that prevent copycat effects. Other issues in guideline implementation include the mode of communication between suicide prevention groups and media professionals. Modalities have included merely mailing the guidelines to media officials, to engaging media representatives in long-term meaningful dialogs. Nevertheless, there is evidence that when the media effectively complies with such guidelines, suicide rates fall. However, there is much more work to be done in securing the trust and cooperation of the media in many nations. These challenges are discussed in the final section of the present volume.

Overview of This Book

The book presents recent developments in research, theory, and policy. Its nineteen chapters are written by members of the Media Task Force of the International Association for Suicide Prevention (IASP). The volume is an international, multidisciplinary collection of new developments. Disciplines include sociology, psychiatry, journalism, mass communications, literature, and law. Chapters include several systematic literature reviews, quantitative analyses, qualitative work, historical analyses, theoretical or conceptual contributions, and case studies of policy initiatives in six nations.

The book is broken down into three parts. Part I deals with eight new contributions to the research on media and suicide. These include research studies on traditional media, emergent media, and historical analyses. Part II is a critical review of the state of theories of media impacts on suicide. Much of the discussion deals with the Werther and the Papageno effects. Depending on contexts, including story characteristics, the media can alternatively be expected to increase or decrease suicide risk. Finally, Part III is composed of a series of chapters on efforts to influence the responsible reporting of suicide in the national media. These chapters include work by renowned suicide prevention specialists in a variety of different nations including Austria, Germany, Hong Kong, Ireland, Switzerland, the United Kingdom and the United States.

Part I: Research on Media Impacts on Suicide

This section of eight chapters is divided into three modalities of media: traditional, emergent, and historical.

Traditional Media. Traditional media include film, as well as news coverage in newspapers and television. This section provides two new research works on these media. In addition, there is an innovative structural review of selected works on the media coverage of tragic mass shootings/suicide.

Recent work has shown that traditional media play an important role in the selection of suicide methods. For example, research on persons who have attempted suicide has found that 77 percent reported getting their information on methods of suicide from the movies (Biddle, Gunnell et al., 2012). The second chapter suggests that the gendering of the choice of suicide methods in society is related to the gendering of suicide method portrayed in the movies.

Compared to news stories, there has been relatively little work on film impacts and even less on how the presentation of cinematic suicides shift over a century of film. Stack and Bowman’s chapter links a century of exposure to the gendered portrayal of gun suicides in film to the “gender paradox.” While the level of psychological distress among women is equal to or exceeds that of men, women have a much lower incidence of suicide. The central question is: is the 4 to 1 American male to female ratio related to the gender differential in use of guns in the suicide movies? Data are drawn from 1,191 suicides in American films from 1900 to 2014. The results of a multivariate logistic regression analysis show that, controlling for the other predictor variables, men were 3.9 times more apt than women to use firearms in their cinematic suicides. The cinema provides cultural scripts to reinforce the gendering of lethal suicide methods and the resulting gender differential in suicide.

Newspaper depictions of suicide have been the main focus of content analyses. These analyses generally show the extent to which the news stories depart from suicide reporting guidelines, departures which presumably increase suicide risk. Placing suicide in the headline, failing to give information on sources of help (e.g., a hotline number), and sensationalizing suicide are story characteristics thought to increase copycat effects. However, most of the research on the content analysis of suicide news stories is done outside of the United States (e.g., Machin, Pirkis, & Spittal, 2013).

The third chapter by Canetto and Tatum provides the first rigorous study of the relative frequency of suicide versus homicide stories in the American press. Of 2,528 media stories on violent deaths analyzed, only 5 percent of the stories focused on suicide, while 95 percent involved homicides. In contrast, 64 percent of violent deaths in the United States are suicides, only 36 percent are homicides. The large overrepresentation of homicide stories in the United States may help to distract public attention from suicide and, hence, minimize resources available for suicide prevention. In addition, the analysis found that suicide stories misrepresented suicide by failing to connect it to mental illness 93 percent of the time and giving disproportionate attention to rare forms such as homicide followed by suicide.

The fourth chapter by Gould and Olivares explores suicidality among the perpetrators of mass killings. Fourteen studies met the criteria for inclusion in the systematic review. A large study of fifty-five rampage killings found that fully 46 percent ended with a suicide. Eight of twelve school rampage shooters themselves referred to the classic reported case of the Columbine murder-suicides and five imitated aspects of that event. Five studies focused on copycat effects after a widely publicized mass-murder/suicide event. Four found at least some evidence of a copycat effect after the event.

Emergent Media. New media channels, such as the Internet and Facebook, can act as both risk and protective factors for suicide. While there are many studies of the impacts of traditional bullying on suicidality, there are few to date on cyber bullying. The Internet provides technological resources for new forms of bullying. The degree of shame involved in cyber-based bullying can be multiplied by the sheer size of the audience reached by way of the Internet.

The question of whether the exposure to Internet-based bullying may act as a key additional stress factor in generating suicides is raised in the fifth chapter by Stack. An analysis of data from the 2013 Youth Risk Behavior Survey on 13,583 students determined that fully 52.2 percent of those who attempted suicide reported having been victims of Internet bullying compared to 15 percent of the total sample. Further, even after controlling out the influence of socio-psychiatric confounding variables such as an eating disorder and major depression, Internet bullying was 50 percent more common among attempters than persons just considering suicide. The results suggest that suicide prevention efforts should be enhanced for those at-risk students experiencing Internet bullying. This is the first systematic investigation suggesting that Internet bullying is a pathway from suicide ideation to a suicide attempt.

The sixth chapter deals with the emergent phenomenon of cyber-based memorials to the dead. Bell and Bailey report the results of in-depth interviews with nine persons who have had the experience of creating, maintaining, and utilizing the social media platform Facebook as an online memorial page for a significant other who suicided. They discuss how Facebook is an important part of the therapeutic process of managing trauma in the aftermath of a death by suicide. However, negative aspects of memorialization are noted including several subsequent suicide attempts among the friends of the deceased, unwanted requests from unknown persons to join the memorial group, and the page manager’s return to loneliness as the number of hits on the memorial page grind down to near zero.

Pirkis, Mok, and Robinson provide a systematic literature review of thirty-four studies on the effects of the Internet-based media on suicidality. The research is mixed. Some Internet-based materials can do “good” by providing resources for those seeking help. Other sites are “the bad” through promoting suicidality by offering detailed information on methods of suicide, with some emphasis on reporting methods that minimize pain and disfigurement. The “googly” sites are ones that include both positive and negative content simultaneously. The chapter synthesizes the findings from these studies and discusses where future research is heading.

Historical Artistic Media. Two chapters follow on historical work on the portrayal of suicide in art and plays. The eighth chapter by Krysinska and Andriessen traces how the meanings and visual representations of suicide have been changing over centuries. The changes reflect the evolving cultural and philosophical understanding of the behavior and attitudes toward it. However, frequently there are coexisting contradictory meanings and representations. To better understand the links between suic...

Table of contents

• Cover Page
• Half title
• title
• copy
• preface
• 1 Introduction
• Part I Research on Media Impacts on Suicide
• Part II Theories of Media Impacts
• Part III Policy
• About the Authors
• Senior Author Index
• Subject Index