The media coverage on suicide has substantially increased over recent decades, with 6,859 suicides reported in the UK and Republic of Ireland in 2018, a rise of 11.8% compared to the previous year, according to the Office of National Statistics (ONS, 2018).
In February 2020, the suicide of a British public figure attracted global attention including extensive media coverage. Hannah Scott reviewed two studies on the experiences of people bereaved by the media reporting after the suicide and concluded that “providing a media spokesperson to the families of people who die by suicide to work with the press […] could be an effective solution, but this would be practically difficult. […] A more achievable solution could be to update existing guidelines”.
Current media guidelines focus on avoiding the revelation of explicit details on the suicide, in order to prevent copycat behaviour. Thinking of the Werther effect, in which following the publication of Goethe’s novel in 1774 a spike in suicides was reported amongst young men in Germany and across Europe. Stack et al. (2005) combined 55 studies examining non-fictional reports of suicides as a predictor of suicide, and found that only 36% identified an apparent Werther effect.
Consequently, guidelines are now being used as standard modules for many national and regional suicidal prevention policies. However, they do not include suggestions to provide helplines and support groups that can positively contribute to suicide prevention. Journalists and media professionals have defended themselves, arguing that the body of evidence is not convincing enough to warrant changes to the way suicide is reported.
Niederkrotenthaler et al. (2020) aimed to examine and quantify the findings from the Werther effect literature. The authors aimed to evaluate the effects of three types of media reporting on suicide on the subsequent incidence of suicide:
- The association between media reporting of deaths of celebrities by suicide and total suicides over a short period of time (up to two months)
- The association of media reporting on information about specific methods used by the celebrities and subsequent suicides by the same method
- The association of general reporting of suicide and the total number of suicides.
The authors used the term “intervention” to refer to media reporting of suicide. They excluded studies on whether there are positive (e.g. help services) and negative (e.g. pro-suicide websites) effects of searching for suicide related information online. Afterwards, they used a robust process with inclusion/exclusion criteria for studies that were categorised as “eligible” for their meta-analysis.
A primary analysis of the studies estimated the pooled rate ratio for the effects of media reporting on suicide deaths by a celebrity on the total suicides in the population. Then, two secondary analyses were conducted to estimate the pool rate ratio for the method used in a suicide by a celebrity on suicide by the same method, and for general reporting of suicide on the total suicides.
The researchers used the Knapp-Hartung method to estimate the all the pooled rate ratios and the meta–regression with random effects model and standard errors. The ratio ratios and 95% confidence intervals can be shown in each category of a variable due to the combine coefficients.
The risk of bias was assessed on each study based on the Robins-I tool, by which studies were either considered low, moderate or critical risk of bias. Of those, studies with critical risk of bias were excluded.
8,823 studies retrieved and 143 studies were assessed via screening titles and abstracts. Out of those, 31 studies met the inclusion criteria. Twenty studies were assessed as moderate risk of bias, and the remaining 11 studies were assessed as being at serious risk of bias.
All 31 studies published between 1974 and 2016 were examined. Of those, 10 studies collectively were shown to have had examined the total number of suicides as the outcome and increases in suicides by the same method reported in the media.
Overall, the results showed that there was an increase in total suicides in the period after the reporting of a celebrity death by suicide. When the suicide method used by the celebrity was reported, there was evidence to show an increase in the number of suicides by the same method in correspondence.
The authors acknowledged three mechanisms that could explain why there is a rise in the number of suicides associated with the suicide reported in media (Niederkrotenthaler et al. (2009); Niederkrotenthaleret al. (2014) ; Stack et al (1991) :
The identity of the deceased
The identity of the deceased may influence the numbers of total suicides, depending if the deceased has high social standing. It has been suggested that the deceased celebrity has a great influence, beyond the knowledge of the suicide method.
“Normalisation” of suicide
Rise in the number of media reporting of suicide, eventually leading to the “normalisation” of suicide as an “acceptable” method of coping with difficulties.
Release of information of suicide methods
Publishing information about the way in which someone took their own life may influence the choice of suicide method by a vulnerable individual. The results suggest that there is relevance in association with that “transfer of information”.
Associations for suicide deaths might include factors such as the distinction and attention of the deceased in the media reports, the population’s connections with the deceased, and the extent to which the death is reported responsibly by the media in the region where the study was conducted.
General reporting of suicide did not appear to be associated with an increase in total suicides; however the evidence was based on a small number of studies from the same region.
The rise in total suicides, and the exponential rate in suicides by the same method reported in the media, suggest that media reports on suicide deaths by celebrities might:
- Increase suicidal thoughts
- Contribute to planning suicide with a specific method.
Strengths and limitations
The meta-analysis featured a “wide-ranging systematic search strategy” which ensured, along with careful checks for duplicate data, that this review was robust. in addition, a comprehensive quality assessment of the primary studies was conducted.
However, there are a number of limitations in this review:
- The 31 studies included in this review were assessed as having a moderate to severe risk of bias, which means that the findings must be viewed with some caution
- Causality cannot be tested because of the before-and-after and interrupted time series designs of the original studies
- There is a high level of heterogeneity across the included studies, which means that we might be comparing apples with oranges
- There is possible publication bias in this field, so unpublished studies not included may have skewed the actual results
- It’s impossible to generate absolute risk estimates because the included studies mostly did not report the baseline risk of suicide in their respective settings
- Studies on fictional suicides were not included.
Finally, the outcome data “suicide” was of highest relevance to suicide prevention, but the authors noted that media reports on suicide can impact on other domains, including “malingering and stigmatisation that had not been reviewed in this meta-analysis”.
Implications for practice
The findings of this study support the necessity for journalists and others who work in the media to use and promote guidelines on responsible media reporting of suicide. The authors claim that caution should be applied in reporting suicides by celebrities in particular. They also suggest collaboration between suicide prevention experts and media professionals, to implement these guidelines, as part of an essential suicide prevention strategy.
However, I would argue that the current guidelines from the Samaritans and UK Press Complaints Commission need to be revised and updated, to better respect the privacy of the bereaved relatives. Furthermore, suicide prevention helplines should be highlighted as part of any media reporting of suicide.
Do we underestimate the emotional impact that media reporting of suicide can have on vulnerable consumers of news? As highlighted by Dr. Allan House in the BJPsych Bulletin, we need a debate on whether people (especially young adults) who have mental health problems and are prone to self-harm, are at higher potential risk when searching for suicide methods that they would seem “effective” and “successful”.
Keep in mind, news posts are easily accessibly at the click of a button. We must ensure that suicidal prevention helplines and mental health crisis services are equally accessible.
Statement of interests
Niederkrotenthaler T, Braun M, Pirkis J, Till B, Stack S, Sinyor M et al. (2020) Association between suicide reporting in the media and suicide: systematic review and meta-analysis BMJ 2020; 368 :m575 https://doi.org/10.1136/bmj.m575
Suicides in the UK: 2018 registrations (2018). Retrieved from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2018registrations
Scott, HR (2020). Media reporting of suicide loss: learning from family and friends who have been bereaved by suicide. Mental Elf. Last accessed: 27 June 2020.
Samaritan UK Media Guidelines (2018). Retrieved from: https://media.samaritans.org/documents/Samaritans_Media_Guidelines_UK_Apr17_Final_web.pdf
Niederkrotenthaler T, Till B, Kapusta ND, Voracek M, Dervic K, Sonneck G. Copycat effects after media reports on suicide: a population-based ecologic study. Soc Sci Med 2009;69:1085-90. 10.1016/j.socscimed.2009.07.041 19682782
Niederkrotenthaler T, Reidenberg DJ, Till B, Gould MS. Increasing help-seeking and referrals for individuals at risk for suicide by decreasing stigma: the role of mass media. Am J Prev Med 2014;47(Suppl 2):S235-43. 10.1016/j.amepre.2014.06.010 25145745
Stack S. Social correlates of suicide by age: media impacts. In: Leenaars AA, ed. Life span perspectives of suicide. Plenum Press, 1991: 187-21310.1007/978-1-4899-0724-0_14
Stack S. Suicide in the media: a quantitative review of studies based on nonfictional stories. Suicide Life Threat Behav 2005;35:121-33. 10.1521/suli.220.127.116.11877 15843330
Royal College of Psychiatrists, 30th March 2019. Retrieved from: https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2019/03/30/psychiatrists-should-consider-impact-of-social-media-on-all-children-they-assess-leading-medical-body-says-for-first-time?searchTerms=psychiatrists%20impact%20of%20social%20media