The effect of the media on suicideThe effect of the media on suicide

Armin Schmidtke

Paper presented at the

Meeting on Suicide and Suicide ResearchOn the occasion of the opening of the

Beijing World Health Organization Coordination Centre

8th of March 2009Unit for Clinical Psychology, Department of Psychiatry and Psychotherapy,

University of Würzburg, GermanyNASP Karolinska, Stockholm

WHO/EURO Network on Suicide Research and PreventionPrevention

WHOResearch Group

of Suicidal BehaviourWürzburg

Although the research results are not unequi-vocal, the majority of research findings demon-strates that suicidal behaviour can be learnt by imitation.

Therefore, today most suicidologists also agree that media coverage of suicidal behaviour can lead to imitation of this behaviour.

The divergent results of studies can be explained by the theory of social learning by Bandura and various differences of the studies.

There exist already early clues for the influence of print media on attitudes towards and imitation of suicidal behaviour

„The sorrows of young Werther“, by J. W. Goethe, first published in 1774. Often quoted as „first case“ of suicide imitation caused by print media. First reported prevention measures.WHO

Research Groupof Suicidal Behaviour

Würzburg

Elisabeth Charlotte von der Pfalz wrote in 1718 that the French started to adopt „English manners“ (to commit suicide) and in 1722, that suicidal behaviour started also to be fashionable in Paris.

Media also influence the attitudes towards suicidal behaviour.

Positive presentation in the media correlates with a greater acceptance of suicidal behaviour (also “assisted” suicide) and higher suicide rates.

(Schmidtke & Fekete, 1996; Fekete, Schmidtke et al., 1998, 2001, Fekete et al., 1999, Niederkrotenthaler & Sonneck, 2007))

WHOResearch Group

of Suicidal BehaviourWürzburg

In the development of suicidality there exists a phase of suggestibility

Consideration Ambivalence

Suggestible period for imitation of suicidal behaviour

Decision to commitsuicideP

hase

s

WHOResearch Group

of Suicidal BehaviourWürzburg

Also in this suggestible period media can influence

- the attitudes towards suicidal behaviour,

- the contemplation of suicidal behaviour,

- the choice of method and

- the “suicidal acting” itself

WHOResearch Group

of Suicidal BehaviourWürzburg

The divergent results of empirical studies can be explained by the theory of social learning by Bandura and various differences of the studies.

Newer studies of suicide imitationNewer studies of suicide imitation

In total 29 studies in Hong Kong, the United States, UnitedKingdom, Austria and Germany(Pirkis et al. 2005, Schmidtke, Schaller & Wasserman, 2007)

They differ in:

Methodology (design of the study)

Kind of data

- Focussing on population data

- Focussing on clinical data

Kind of suicidal behaviour (suicide or suicide attempt(s)

Method of suicide or suicide attempt

Similarity of model and recipient (observer)

Sample(s)WHO

Research Groupof Suicidal Behaviour

Würzburg

SUICIDE

SUICIDE-IDEAS

REAL FICTIONAL TYPE OF P

RESENTATION

ELECTRONIC

MEDIA, IN

TERNET

FILMS

OTHER

Classification of Model Behaviourand Type of Presentation

SUICIDE-ATTEMPT

MUSIC

PRINT

MEDIA

WHOResearch Group

of Suicidal BehaviourWürzburg

Paintings

Photos

Theatre

Operas

TV Reports

Films

Video Clips

Blogs

The suicide of Lucretia, 1512

„Beautiful suicide“, blog

One picture is more worth than 1000 words

Google search in the Web (February 2009):

17.900.000 „suicide images“

2.340.000 Suicide photos

47.400 Suicide paintings

Kind of visual media depicting suicidal behaviourKind of visual media depicting suicidal behaviour

Media imitation effects depend onMedia imitation effects depend on

Understandable vs. incomprehensible(Schmidtke & Häfner, 1988; Fekete & Schmidtke, 2004)

Amount of publication(Phillips, 1974; Schmidtke &Häfner, 1988; Etzersdorfer, 2000,Niedertrkrotenthaler & Sonneck, 2007)

Number and type of recipients(Hassan, 1995; Schmidtke & Häfner, 1988,Etzersdorfer, 2000; Marsden & Attia, 2005;Niederkrotenthaler & Sonneck, 2007) (

WHOResearch Group

of Suicidal BehaviourWürzburg

0

100

200

0 1 2 3 4NUMBER OF DAYS ON PAGE 1OF THE NEW YORK DAILY NEWS

PERCENT INCREASE

1. Broadcasting 2. Broadcasting

Incr

ease

in % Number of watchers

Increase in suicides

Imitation effects depend onImitation effects depend on

Similarities between model and observer (possible imitator): (Bollen & Phillips, 1982; Phillips, 1974; 1977; Gould & Shaffer, 1986; Phillips & Carstensens, 1986; Schmidtke & Häfner, 1988ab; Stack, 1987, 1999)

Age: Youngsters (Gould & Shaffer, 1986; Schmidtke & Häfner, 1988ab)

Ethnic origin: Same ethnicity

(Stack, 1996)

Sympathetic vs. unsympathetic: (Schmidtke & Häfner, 1988; Stack, 1999)

•

WHOResearch Group

of Suicidal BehaviourWürzburg

Imitation effects depend onImitation effects depend on

Method: The more „bizarre“ the method the greater the probability of imitation.

Examples Self-burning, „parachuting“, „subway suicides“, jumping from high places

WHOResearch Group

of Suicidal BehaviourWürzburg

Summary of recommendations for „old media“

Avoid sensationalizing or glamorizing suicide, or giving it undue prominence

Avoid providing specific detail about the suicide

Recognize the importance of role models

Take the opportunity to educate the public

Provide help/support to vulnerable readers/viewers

Consider the aftermath of suicide

Acknowledge that journalists are vulnerable too

(WHO Media recommendations, 2008; Media recommendations of various counties

Proposed Solutions in Detail

for the portrayal of suicidal behaviour

WHO (1993, 2008):

Toning down reports in the media

- No sensational reporting

- No frontpage reporting

- No reporting of details

- No photos

WHOResearch Group

of Suicidal BehaviourWürzburg

Proposed Solutions

Recommendations for media reporting or the portrayal of suicidal behaviour

No „advertising“ of methodsand places

No reporting as „understandable way of problem solving“

Reporting of offers for help

WHOResearch Group

of Suicidal BehaviourWürzburg

Evaluation studies

Evaluation studies of the effect of media campaigns to seek help are not very convincing.

Campaigns did not influence attitudes or intentions to seek help (Gaigle et al., 2006).

Example of evaluation studies

Evaluation studies of the implementation of media recommendations are rare

Switzerland: The implementation of media guidelines led to less sensational and higher quality reporting (exception one yellow press) . No effect on suicide rates was studies (Michel et al., 2000)

Austria: Studies on subway suicides (Sonneck et al., 1994)

and on the effectivity of media recommendations (Niedekrotenthaler & Sonneck, 2007)

Example of positive effects of sensible press reports: suicides and suicide attempts in the

Vienna subway system 1980 - 1993

SOURCE: DEISENHAMMER ET AL. (1997)WHOResearch Group

of Suicidal BehaviourWürzburg

Introduction of media recommendations

New MediaNew Media

Songs/Clips

Visual Media

- Videoclips

- Blogs

- Films

SMS

Videoconferences

Internet

- Web Sites

- Chatrooms

- Counselling

Survey:

The portrayal of suicidal behaviour in films is widespread. It increased over time.

Young people are disproportionately overrepresented

The act(s) shown becomes lengthier

The act(s) is/are more extensively modelled

The act(s) is/are more likely to involve firearms (in USA)

The act(s) is/are more romanticised, glorified and condoned

(Pirkis et al., 2005; Schmidtke, Schaller & Wasserman, 2007)

Survey:

How people perceive the depiction of suicide in films

„Overexaggerated“

Sometimes „as a joke“

„Rude“ language

„Not real life“

„Not the whole truth of the life of the „ill“ person“

(Hartig, 1999; Finzen, 2000; Kissling, 2003; Pirkis et al., 2005)

Survey:

11 European Film Academies or Film Schools

8 German Film Academies or Film Schools

Up to now no answer indicates that „suicide„ is a special topic in the curriculum“ or indicates that there is material about this theme available

Answer from an English film school:

„Although we do not teach this topic in our curriculum, films are made which touch upon this topic. We are happy to make the films available to you for your research. One example of our films would be the animation film 'Apart'.

Exception:

Curriculum Resources for Australian Universities (The Response Ability Project)

Multi media package which includes case study material, hypothetical video scenarios and examples of recent news reports on suicide.

(Pirkis et al., 2007)

Recommendations for films:

No glamorising

No romanticising

Not approved and/ or otherwise positively reinforced

No depiction of positive consequencesof the suicidal act

(Pirkis et al., 2005; Schmidtke et al., 2007)

There is one report about the use of videoconferencing in suicide risk assessment in a rural community in Canada.

In a videoconference a psychiatrist, a nurse and/or counsellors assessed the suicidality. The service was evaluated by patients and mental health providers as highly satisfactory.

(Jung, 2004)

VideoconferencesVideoconferences

There are some programmes using e-mail communication in suicide prevention(Wilson & Lester, 1998; Bale, 2001; Howlett & Langdon, 2004)

Large scale studies about the effect do not exist. The feedback from help-seekers and volunteers is positive

(Howlett & Langdon, 2004; Krysinska & DeLeo, 2007)

SMS and e-mailSMS and e-mail

Information about suicide in the InternetInformation about suicide in the Internet

Language Number of hits

English/French (suicide) 65.500.000

Chinese ( 自殺 ; zìshā) 46.800.000

( 自殺者 ; zìshāzhě) 1.920.000

( 自滅 ; zìmiè) 1.590.000

Japanese ( 自殺 ; jisatsu) 18.700.000

( 自害 ;Jigai ,histor. word) 373.000

Russian (Суицид) 1.330.000

Spanish (suicidio) 4.630.000

German (Suizid) 752.000

(Selbstmord) 1.740.000

Polish (Samobójstwo) 1.920.000

(Google search 28. 02. 2009)

Forms of information provided on the Internet

Forms of information provided on the Internet

Non-interactive

Professional „Lay“ system

Web-sites of associations Web-sites of individualsand organizations and self-help groups

Web-sites of psychotherapists

Forms of information provided on the Internet

Forms of information provided on the Internet

Interactive

Professional „Lay“ system

Moderated news groups News groups Mailing lists Mailing lists

(normally by experts in the (normally unmoderated; field) by people with similar

problems)

E-therapy/“cybertherapy“(organisations and individual therapists)

Possibility of suicide pacts

“Cyber Suicides”

Possibility of suicide pacts

“Cyber Suicides”

Von:Toc (smg5388@yahoo.com)Betrifft:Exit Partner Wanted am lookng for someone who wants to exit in approx. 10 to 15 years. There are 2 reasons why I have that time limit set. 1. I have a dog now who is the pleasure of my life and will not exit while she is under my care. So she will have to exit first then I can exit. 2. I don't want to exit with just anyone. I want it to be with a good friend. That will take time. So I will spend that time until my best friend passes (my dog) and attempt to find another soul who would want to exit at I that time. I have the method all planned (painless) but it takes 2 to really party. I want it to be in a party setting with good music and refreshments (pot or drinks) or whatever you choose is up to you. my preference will be pot as it makes me rather silly and I think that is the way to exit (happy). I am not a circus freak. I have been trying for almost 2 years now to find someone who is of extremely high moral calibre (no cons,crooks,liars etc.) You have to be honest and honorable. I can't tolerate anything less. If you have these qualities, please contact me and let's talk. I have at least 10 years to get to know you and vice-versa. I am a retired concert pianist and auto mechanic and a fanatical Pink Floyd fan and classic rock also (Hendrix,Doors,Cream,Eagles, etc.) I enjoy oil painting and chess and ragtime and above all, Animals. Because they are truly a gift beyond measure. If more people had the morals of a dog, what a world this could have been. Thats it I guess. Lets meet online and get to know each other. Any sarcastic comments about my idea will be totally ignored by me. I only want to know those of unquestionable honor and integrity.

 

View this article onlysgNewroups:alt.suicide.holidayDatum:2003-03-31 23:03:50 PST

Is anyone here prepared to die to the point of having a planned method, place and time? If you are please e-mail me. I am. I would like to go together with someone else though to share the experience. I have researched extensively. If I was going on my own then I would use CO tank with gas mask in my own bed - but I want to experience drowning - the sensations will be wonderful. Pain if any will be irrelevant. Please note that suicidal drowning is not painful since the pain caused by holding breath and CO2 build up does not occur - since you do NOT hold your breath! I have included a previous e-mail content partly describing the experience from another friend who nearly drowned.

DiUK

Von:DiUK (drowning_in_uk@hotmail.com)Betrifft:Ready to die? Drowning?

Problems of interactive imitation: Internet-requests for suicide pactsObservation period: 08. 01. 01 – 06. 01. 02 Source: Moderated suicide forum/archives

0

1

2

3

4

Week

Number of calls

Contract for"mass suicide"

Same Person

36. - 42. Week: In total 10persons, of these 3 withmore than 1 call

Suicide cluster

WHOResearch Group

of Suicidal BehaviourWürzburg

0

1

2

3

4

5

6

7

8

1 11 21 31 41 51 61 71 81 91 101 111 121 131 141 151 161 171 181 191 201 211

Week

Personsper pact

2001 2003 20042002 2005

Problems of interactive imitation: Internet-based clusters for joint suicides in Japan („Cyber suicides“)

Observation period: 01. 01. 2001 – 30. 11. 2005 Source: Japanese newspaper archives

Suicide clusters

Comparison of different mediaComparison of different media

Kind of media Effect

Telephone Hotline Internet Groups IG > by Youths more accepted

Telephone Hotline Chat Online Support Group More suicide threats in the OSG

Gilat & Shara 2007

Controlling the effects of the Internet is difficult

Reasons:

Design of the Internet

Use of the Internet

Interactive possibilities

Information is unlimited

Do only predisposed people seek information in the media?

or

Can emotions and suicidal behaviour also be induced through the media?

Investigations show that on / through the Internet emotions can be induced

(Göritz, 2002)

Suicide prevention

on the

Internet?

Arguments pro and con the use of the Internet in suicide prevention

Pro Con

Emotional support No need to resolve problemsSense of community Stuck were they areInclusiveness Secondary gainFeeling less isolated Do not develop skills for „real“

relationshipsNo training in therapeutic technicsSparse mechanisms for dealing with hostile contributorsDiffusion of dependency

(Finn, 1995; Stoney, 1998, Lebow, 1998; Zuckerman, 2003; Hsiung, 2007)

Advantages

Low thresholds = low level access possible

Communication on the Internet is more disinhibited than in real life – clients get earlier to the point

Available to populations that currently have limited or no access to therapy, e.g.

• Handicapped people, deaf people

• People in rural or remote locations

• People ambivalent about treatment

(Dunaway, 2000)

The newsgroups on the internet can provide an opportunity to suicidal persons to anonymously express the despair, hopelessness and feelings of being trapped, and to get a reaction under circumstances when they feel they cannot confide in people physically close to them or do not wish to meet face to face with professional counselors such as doctors and psychologists.

Here suicidal persons may find- without having to reveal anything – an acceptance and understanding of their experience that they cannot expect in real life. In real life they are afraid of misunderstanding, stigmatization, hospitalization, and monitoring.

Lindner & Fiedler 2001

Pros

Recommendations for news (support) groups after the suicide of a member

Recommendations for news (support) groups after the suicide of a member

The recommendations are the same as for print media:

Not idealizing or romantizing the deceased member

Not describing the method and location

Not presenting the suicide as inexplicable or as a means to an end

(Hsiung, 2007)

Recommendations for news (support) groups

Recommendations for news (support) groups

Not allowing encouragement of self-harm

Not allowing posting of instructions for suicide

Not allowing false reports of suicidality or suicides

Providing support and education

Suggesting online-line and real-life resources, including qualified treatment

Obtaining IP addresses for the possible identification of people at risk

In case of apparent imminent risk, alerting local emergency services

(Hsioung, 2007).

Examples of professional interactive suicide prevention on the Internet

Befrienders International: since 1994 e-mail contacts

In e-mail ca 80 % described themselves as suicidal compared with 25 % in phone contacts

(Farmer & Borton, 1995)

Several hotlines in Germany (e.g. Cologne, Krefeld):most e-mail writers are young, suicidal, hopeless, with ambivalent feelings toward psychotherapy.

(Dorrmann, 1998)

Suicide-preventive organizations should increase their presence in the Internet to provide valid information and professional help.

Lowering the threshold for help-seeking but ambivalent people by providing e-mail contact can possibly be life-saving.

WHO FORSCHUNGSGRUPPEWÜRZBURG

Thank you for your attention

EU/WHO Research Group

Dr. C. Löhr

DP K. Benkelmann

DP J. Wohner

DP I. Sell