The Role of Media Reporting in Suicide Behaviours

In 1999 New Zealands Ministry of Health was prompted by evidence of associations between media reporting and suicide to publish guidelines warning of the risks of influencing and normalising suicide behaviour through media coverage. The Ministry challenged media organisations to weigh up for themselves the balancing of the freedom of the press with the need to minimise risks of suicide among more vulnerable members of the community (Ministry of Health [MOH], 1999, p. 9). The Coroners Act 2006 imposed further restrictions on reporting methods, causes, or circumstances leading to suicide. Despite these constraints, New Zealand youth suicide rates are amongst the highest in the developed world. Mori youth are particularly vulnerable with a rate 2.5 times higher than non-Mori (MOH, 2012). Evidently something more complex is occurring than media coverage normalising suicidality. If media coverage can be linked to positive outcomes, then restrictions on suicide reporting in New Zealand may constrain the opportunity for positive outcomes, rather than minimising the risks. The challenge then becomes how reporting can initiate wider debate and contribute to a reduction in suicidality, without normalising suicidal behaviours.

Method PsychInfo and Scopus databases were searched for English-language research studies, published since 2006, containing the words suicide and media in their abstracts. Ten peerreviewed journal articles were selected and classified into two types. Ecological studies had outcomes, such as suicide rates, for one group of participants that were compared with those for another group, with data analysed at an aggregate level. Individual-level studies had outcomes (typically self-reported attitudes regarding behaviours) that could be analysed at an individual

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level. Meta-analyses were excluded to avoid the possibility that different authors analysed the same primary research sources.

Discussion Ecological Studies Contagion theory suggests that vulnerable individuals resort to suicidal behaviours following exposure to media characterisations of suicide acts as a way of resolving lifes problems used by celebrities or people others can identify with (Pirkis & Blood, 2001). Chen et al. (2012) studied whether media coverage of a young female celebrity suicide induced suicide contagion amongst young Taiwanese females, by analysing suicides for two weeks after the celebrity suicide, and comparing these with weekly suicides for the previous two years. The researchers identified a significant increase in suicides, particularly for young people and females, supporting the hypothesis that detailed reporting of a celebrity suicide might spark a contagion effect. However the authors did not quantify media reporting for the previous two years and failed to show that those who committed suicide were exposed to the coverage. They were also unable to isolate the effects of the celebrity status of the young celebrity from other suicidality factors, so it is questionable whether the results can be more widely applied. Rather than assessing outcomes from a single celebrity suicide, Chen, Chen and Yip (2011) investigated associations between media reporting and suicides over three years. The launch of a new Taiwanese daily newspaper in 2002 changed the dynamics of suicide reporting as various newspapers jockeyed for readership over the following three years. The authors evaluated daily news reports covering suicides between 2002 and 2005, and modelled the effect of these reports on the incidence of next-day suicides. They concluded that an increase in the

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rate of suicides was correlated with an increase in the frequency and intensity of reporting, providing empirical support for the contagion effects of media coverage of non-celebrity suicides on vulnerable people. However, the study has several limitations. Chen et al. (2011) acknowledged that suicide rates were rising rapidly before the newspaper launch, and their findings may have been an artefact of the complicated modelling they used to compensate for this. Changing readership demographics between the various newspapers added another potential confound. The study excluded electronic media such as television and the researchers did not evaluate the length or content of daily coverage, yet these evaluations would have been useful in understanding the extent to which suicides were sensationalised during reporting. Another study of suicide contagion over four months in six U.S. cities found different contagion effects across different media. Romer, Jamieson, and Jamieson (2007) observed that while television reporting of suicides of various ages was associated with suicides of people aged under 25 years, press coverage of the same acts were associated with suicides of under25s and those over 44 years as well. The authors also found a protective effect from television reports for people aged 25-44 years, bringing into question the universality of contagion theory, both in terms of the types of media used, and their effects on different age-groups. Because the study occurred in late summer and early autumn there may have been some seasonality effect that limits its wider application. The study was also limited to major cities so does not reflect suicidal behaviours in smaller communities. In contrast to contagion theory, imitation theory suggests that vulnerable individuals imitate methods of suicide described in media reports. Pirkis, Burgess, Francis, Blood, and Jolley (2006) studied imitative suicides in Australia and found males associated with reports of individual suicides, whereas females associated with mass-suicides and murder suicide. But

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explicit media descriptions of methodology could not be correlated with increases in imitative suicides. This inconsistency suggests that the relationships between media reporting and suicidality are more complex than the simple act of imitation might suggest. Imitation theory was also studied by Kunrath, Baumert, and Ladwig (2011) following a railway accident in Germany. In a widely covered, dramatic event which received extensive coverage, several people were killed during the investigation of a presumed suicide. The authors concluded that media coverage of the railway accident acted as an invitation to die using railways as a method of suicide for vulnerable individuals, even though reporting only obliquely touched on the presumption of suicide. However, despite the dramatic nature and widespread coverage of the accident, the analysis doesnt establish that reporting was a specific trigger for imitative behaviours, as information on subject exposure to media was not available. Niederkrotenthaler, Till, Kapusta, et al. (2009) examined how social status influenced imitative behaviours in a ten year study of suicides in Austria. The authors found the social status of reported suicides were positively correlated with subsequent suicides, but if the suicide was portrayed as a criminal then this effectively predicted reduced suicides, suggesting that reporting can reduce imitative behaviours if it engenders social disapproval. However factors other than media reporting may have contributed to post-event changes in suicide rates. As the study was limited to print media and Austria, there is a risk in generalising the findings. If contagion and imitation reliably explain acts of suicide, then the social characteristics of actual suicides should reflect media reports of suicides. But when Niederkrotenthaler, Till, Herberth, et al. (2009) compared the social characteristics of 1,392 suicides in Austria with the social characteristics of suicides reported by media over a twelve-month period, they found significant discrepancies between reality and reporting. Suicides by adolescents, foreigners, and unusual methods were substantially over-represented in reporting, while suicides by the elderly

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were barely mentioned. The study covered only one year of print media coverage in Austria, and a longer period incorporating electronic media would have provided more reliable outcomes. However the discrepancies between actual and reported characteristics suggest that contagion and imitation may not be risk factors for all suicides. Niederkrotenthaler et al. (2010) further explored reporting content and found that some reporting appeared to have protective effects; particularly reporting that focused on people who adopted positive coping mechanisms rather than adopting suicide plans in adverse conditions. This outcome, which Niederkrotenthaler termed the Papageno effect, suggests that sensitively prepared media reporting may have a constructive role in preventing suicides. However it is difficult to generalise the findings to electronic and emerging media as the study was limited to print media. Unfortunately the study did not investigate how the Papageno effect changes over time, which would be useful for the timing of protective media commentaries. Other criticisms can be made of ecological studies of contagion and imitation. Aside from the difficulty ascribing cause and effect, there is a potential risk of reporting-bias, as studies that fail to reject the null hypothesis, or that fail to draw strong conclusions, may be less likely to be published. Most of these studies focused on short-term outcomes of traditional media reporting, with experimental periods of two to four weeks following publication (e.g., Chen et al., 2011). However suicide ideation can linger for many months after highly publicised suicides (e.g., Fu & Yip, 2007; Schmidtke & Schaller, 2000). Given web-based news reports of suicides are cached indefinitely by internet search engines, it is impossible to control for the time lags between initiating suicides, exposure to reporting, and subsequent suicides. Moreover while reporting suicide methods may trigger imitation, the outcome may simply be the replacement of one method for another by people intent on committing suicide anyway.

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Individual-level studies Many of the criticisms of ecological studies are overcome by individual-level studies in which researchers control for exposure to the stimuli before interviewing participants. Pan (2008) focused on the response of young people to media reports when he asked over 2,500 Taiwanese high school students to describe their feelings after the suicide of a celebrity in 2005. Many reported that they felt negatively influenced by media reports of the suicide, with more feelings of depression, anxiety, suicidal thoughts and negative attitudes towards life. Rather than examining feelings and attitudes, Collings et al (2011) studied the sources of information for suicidal behaviours during interviews of 71 young New Zealanders, with histories of self-harm, who were engaged with clinical services. Participants nominated important people from their social context as their first source of information, and television movies, the internet, songs and music videos as common sources of exposure to portrayals of suicidal behaviours. However participants claimed that there was minimal impact on their behaviours from print media, and that emerging media were used for gaining or sharing information, rather than as an introduction to the concept of self-harm. The study is important for its focus on young New Zealanders who are most at risk from acts of self-harm, and for its exploration of emerging media and interactive technology such as the internet and mobile phones. Neither Pans nor Collings study evaluated the content, frequency or the extent of sensationalism of suicide depictions in the respective media mentioned by their participants, and this would have been useful for evaluating the relative influence that each medium had in the participant behaviours. Moreover it is questionable whether the findings of either study can be generalisedPans participants were drawn from a normal population (Pan, 2008), and it is likely that at-risk students were under-represented in the sample, whereas Collings focused

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exclusively on participants with past histories of self-harm or suicide attempts (Collings et al., 2011). Individual-level studies may overcome many issues in ecological study methodology, but the perceptions, attitudes, recollections and self-assessments used may have little bearing on the underlying causes of suicidality. Conclusion From this critique it can be concluded that the association between media reporting and suicidality is complex. Although much evidence supports an association, there are still many questions over how that relationship operates. Causality is unclear, methodological issues abound, and findings are inconsistent from study to study. There is even doubt over the universality of contagion and imitation theories (e.g. Niederkrotenthaler, Till, Herberth, et al., 2009). While many studies highlight negative outcomes in the relationship between media reporting and suicidality, some studies demonstrate that it is not the intensity of reporting, but the content of reporting that is critical (e.g. Niederkrotenthaler, Till, Kapusta et al., 2009). Indeed, media portrayal of the act of suicide can be associated with positive outcomes when reporting sensitively focuses on positive outcomes in times of adversity, such as coping with suicide ideation (Niederkrotenthaler et al., 2010). Studies of the protective aspects of media reporting are still in the minority, and more research is needed into how the content and focus of media reporting can be used for positive outcomes. Print media has been widely studied and is frequently associated with suicidal behaviours but doesnt feature in the media habits of young New Zealanders (Collings et al., 2011). However there has been little evaluation of the effects of emerging media or interactive technologies, and more needs to be done to understand the roles these communications

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techniques have in the behaviours of vulnerable youth. Furthermore, little research has been conducted into the effects of media reporting on the diverse attitudes towards suicide held by different cultures and religions/spiritual beliefs, and more is needed to understand how media reporting can provide culturally relevant and affirmative perspectives, through an appropriate lens for each such audience in our community. Chief Coroner Judge Neil MacLean has commented that we need to gently bring the issue of suicide from out of the shadows (Office of the Chief Coroner, 2012, p. 2). While the benefits of publicising individual tragedies are debatable, much can be gained by facilitating public debate through sensitive and thoughtfully framed media reporting. Rather than continuing to constrain media reportage of suicidality, it may be more appropriate to remove regulatory constraints so that media may constructively engage in this debate.

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