Little Strokes Fell Big Oaks: How Repeated Recommendations for Suicide Reporting Drive the Quality of Suicide News in South Korea.

This study investigates how far repeated releases of recommendations for responsible reporting on suicide (RRS) are associated with changes in the quality of suicide reporting. A content analysis was conducted on suicide news articles (N = 606) by the Korean newspapers Hankyoreh Sinmun and Chosun Ilbo in four six-month periods from 2004 to 2019, which covered the periods before and after the releases of three versions of suicide reporting guidelines. Elements for RRS served as a proxy for the reporting quality, which includes both avoiding negative elements and providing positive ones. Not only the number of suicide news stories reduced by half in the last two observation periods, overall RRS scores and most individual RRS elements increased in the third period, compared to the first or second period. The avoidance RRS for headline, however, was not significantly improved. Korean news media also tended to be sensationalistic in using photos.

The Role of the Narrative in Educative Suicide Awareness Materials: A Randomized Controlled Trial.

There has been a debate about the suitability of different narratives in educative suicide prevention materials. Whereas some suicide prevention experts recommend raising awareness of suicide by highlighting its prevalence, others argue that this approach may normalize suicide and advocate focusing on help resources instead. Unfortunately, empirical evidence regarding this question is lacking. This randomized controlled trial aimed to test the impact of educative news articles that conveyed different narratives of suicide prevention. One article focused on the prevalence of suicide, one article highlighted professional help resources, and one article emphasized on how everyone can help to prevent suicide. We randomized n = 334 participants to read either one of these three articles or an article unrelated to suicide. Data on suicidal ideation, stigmatizing attitudes toward suicidal individuals, attitudes toward suicide prevention, and help-seeking intentions were collected with questionnaires, and implicit measures were used to assess participants' mental accessibility of concepts related to suicide and suicide prevention. Participants exposed to the article highlighting the high prevalence of suicide tended to show a higher accessibility of potentially detrimental cognitive concepts related to suicide. In contrast, the accessibility of the concept of "helping" and that "suicide is preventable" was higher in participants' memory when exposed to materials focusing on help. It seems that the impact of educative suicide awareness materials on readers' access to suicide- and suicide-prevention-related concepts in memory varied depending on the narrative featured in the article.

The role of monocausal versus multicausal explanations of suicide in suicide reporting: A randomized controlled trial.

BACKGROUND: Media guidelines for reporting on suicide recommend that journalists should avoid monocausal explanations of suicide, but it is unclear if media items with monocausal explanations elicit different effects as compared to multicausal portrayals. METHOD: Using a web-based randomized controlled trial (n = 969), we tested five versions of a news article about the suicide of a teenage girl with varying portrayals of reasons for the suicide: (1) bullying as the sole (external) factor (i.e., monocausal), (2) several external social factors, (3) a combination of internal and external factors, (4) a combination of internal and external factors along with a focus on suicide prevention, or (5) no reason for the suicide (control group). We measured perceptions about the cause of suicide, attitudes toward suicide and suicide prevention, and identification with the suicidal protagonist with questionnaires. RESULTS: Readers of articles that portrayed suicide as being caused by one specific reason or exclusively social factors tended to adopt these misconceptions. Identification with the suicidal protagonist did not vary between interventions groups, but was lower in the control group. CONCLUSION: Highlighting the multifactorial etiology of suicide in news articles may help to avoid the misconception that suicide is a monocausal issue.

News Framing and Preference-Based Reinforcement: Evidence from a Real Framing Environment During the COVID-19 Pandemic.

COVID-19 is a news issue that can be covered from many different angles. When reporting, journalists have to select, accentuate, or exclude particular aspects, which, in turn, may evoke a specific, and possibly constricted, perspective in viewers, a phenomenon termed the news-framing effect. Guided by the reinforcing spiral framework, we conducted a multi-study project that investigated the news-framing effect's underlying mechanism by studying the dynamic of self-reinforcing effects. Grounded in a real-life framing environment observed during the pandemic and systematically assessed via a content analysis (study 1) and survey (study 2), we offer supporting evidence for a preference-based reinforcement model by utilizing a combination of the selective exposure (i.e., self-selected exposure) and causal effects (i.e., forced exposure) paradigms within one randomized controlled study (study 3). Self-selection of news content by viewers was a necessary precondition for frame-consistent (reinforcement) effects. Forced exposure did not elicit causal effects in a frame-consistent direction.

Suicide among soldiers and social contagion effects: An interrupted time-series analysis.

BACKGROUND: Suicide has become an increasingly concerning problem among soldiers in recent years. Previous research has hypothesized that media-related social contagion effects, termed "Werther effects," may contribute to military suicide numbers. Unfortunately, there is limited empirical knowledge on such social contagion effects in soldiers. We contribute to the literature by investigating this phenomenon in the context of a specific historical suicide case, allowing us to provide a longitudinal assessment: Crown Prince Rudolf, heir to the Imperial throne of the Austro-Hungarian Empire, who died by suicide in January 1889. His death was a well-known news story that shook the monarchy to its foundations. Notably, soldiers of the late nineteenth century were an especially vulnerable portion of the population, proven by the fact that the Austro-Hungarian military had one of the highest suicide rates at the time compared to other European countries. METHODS AND RESULTS: An interrupted time-series analysis, relying on annual military suicide rates between 1873 and 1910, indicated a significant increase in the suicide rate the year of Rudolf's death, a pattern consistent with a social contagion effect. In fact, time series analysis estimated that there were about 30 excess suicides per 100,000 population within the year of Rudolf's death. Additionally, we identified a substantial change in the trend after Rudolf's death, pointing to a long-term decrease in military suicide rates. The latter was not observed in the general population but appeared to be unique to soldiers. DISCUSSION: Although we are very careful when interpreting causal effects with our historical data, we discuss the latter finding by questioning whether a change in military culture, that is, the establishment of better conditions for soldiers in the aftermath of Rudolf's suicide, contributed to decreasing suicide numbers. Although tentative, these findings are also highly relevant for the study of military suicide today.

Suicide of a Tenor Amidst the Stage Setting of the Werther Opera's Death Scene.

Background: Reporting on suicide can elicit an increase in suicides, a phenomenon termed the "Werther effect." The name can be traced back to an alleged spike in suicides after the publication of Goethe's novel The Sorrows of Young Werther in 1774, in which the protagonist Werther dies by suicide. Aims: Acknowledging the importance and primacy of systematic ecological and individual-level studies, we provide a historical single-case report of the suicide of a "late arrival of the Werther epidemic," as the death was headlined in a news report in 1927. Method: Archival research on tenor Paul Vidal's suicide was conducted. Results: Vidal reconstructed the scene of the final act of the opera Werther in his apartment and died by a gunshot, as did Werther. Limitations: Causal interpretations must be made with caution. Conclusion: Striking similarities between Werther's and Vidal's deaths support the idea of strong identification with the fictional narrative and suggest causal effects. Considering the repeated high level of immersiveness and the intense emotions of opera performances, it is likely that performing the role of Werther increases identification processes, contributing to detrimental effects. The lack of knowledge regarding the role of fictional suicide stories on artists' suicides is discussed.

Celebrity Suicide and Forced Responsible Reporting in the Nineteenth Century: Crown Prince Rudolf and the Absence of a Werther Effect.

Crown Prince Rudolf, heir to the Imperial throne of the Austro-Hungarian Empire, died by suicide in 1889. His death is a prime example of a historical celebrity suicide. Although news coverage about celebrity suicide has been shown to be linked to increases in suicides - a phenomenon known as the Werther effect -, censorship and/or journalists' anticipatory obedience back then may have led to a form of "forced responsible reporting" that may have prevented a Werther effect. A content analysis was conducted, and civil death registers were used to identify suicides before and after Rudolf's suicide. We compared Rudolf's case with another historical celebrity suicide case (Colonel Redl) for which there is already empirical evidence consistent with a Werther effect. As expected, the press heavily reported on Rudolf's death, but did not give undue prominence to suicide and rarely gave details on the method. Importantly, there was no evidence of an increase in suicides. This is in stark contrast to the Redl case in which the press reported irresponsibly. The Rudolf case emphasizes the importance of current media guidelines on responsible reporting. Thus, a high amount of news coverage does not necessarily translate into a Werther effect.

Family involvement in medical decision making in Europe and the United States: A replication and extension in five Countries.

BACKGROUND: In 2018, Alden et al. showed that the desired degree of family involvement in medical decisions is an individual preference that is largely independent from East-West cultural stereotypes. At the same time, individual-level interdependence influenced whether patients preferred more individual or more family involvement in their decision making together with their medical care provider. The present study provides empirical evidence and adds evidence for Europe for which no such data previously existed. METHODS: The present study is a direct replication and extension of the original Alden et al. (2018) study (N = 2031; Australia, China, Malaysia, India, South Korea, Thailand, United States [U.S.]), however, using survey data from four European countries (Austria, Belgium, Germany, Netherlands) and the United States (U.S.) with a total sample size of N = 2750. RESULTS: Random effects within-between models replicated the original primary finding that those with higher self-involvement in medical decision making preferred less family involvement. Furthermore, patients with lower self-independence, higher relational interdependence, and stronger beliefs in social hierarchy are more likely to want their families involved in medical decisions besides their health care provider. CONCLUSIONS: These observed relationships are largely consistent both within and across the four European countries and the U.S. In conclusion, the results point to the importance of avoiding cultural stereotypes and instead, recognizing that patient desires for family involvement in medical decision making vary dramatically within cultures depending on multiple individual differences. Furthermore, a growing body of evidence suggests that these antecedents of family involvement as well as the construct itself may be measurable in diverse cultures with high levels of confidence in their reliability and validity.

Effects of media stories of hope and recovery on suicidal ideation and help-seeking attitudes and intentions: systematic review and meta-analysis.

BACKGROUND: There is strong evidence that suicides increase after media stories about suicides by celebrities, particularly those that highlight the suicide method (the Werther effect). Much less is known about the Papageno effect-the protective effects of media stories of hope and recovery from suicidal crises. A synthesis of the retrievable evidence is lacking. We aim to summarise findings from randomised controlled trials about the effects of stories of hope and recovery on individuals with some degree of vulnerability to suicide. METHODS: For this systematic review and individual participant data meta-analysis, we searched PubMed (including MEDLINE), Scopus, Embase, PsycInfo, Web of Science, and Google Scholar published from inception to Sept 6, 2021, without language restrictions. We included trials that reported suicidal ideation (the primary outcome) or help-seeking attitudes or intentions (the secondary outcome) and tested a media narrative of hope and recovery. Studies were excluded if they did not feature a clearly positive story of hope and recovery, or had a control group exposed to suicide-related stimulus material. We contacted the lead or senior authors of all original studies to obtain participant-level data for this study. The primary analysis was restricted to individuals with some vulnerability to suicide. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomised trials. The study is registered with PROSPERO, number CRD42020221341. FINDINGS: Our search yielded 7347 records. 3920 records were screened by title and abstract, and 25 full-text records assessed for eligibility. There were eight eligible studies with 2350 participants for which individual participant data were sought. For suicidal ideation, six studies met the inclusion criteria for the primary analysis. Follow-up responses were available for 569 (90%) of 633 participants who were randomised with high vulnerability (345 [55%] allocated to the intervention group and 288 [45%] to the control group). The pooled standardised mean difference (SMD) indicated a small reduction in suicidal ideation of -0·22 (95% CI -0·39 to -0·04, p=0·017; six studies) in the intervention group. For help-seeking attitudes and intentions, four studies met the inclusion criteria and follow-up data were available for 362 (86%) of 420 participants (247 [59%] allocated to the intervention group and 173 [41%] to the control group). The pooled SMD showed no evidence of a difference between the groups (SMD=0·14, 95% CI -0·15 to 0·43, p=0·35; four studies). Low levels of cross-study heterogeneity effects were observed for both analyses (I2=5% [suicidal ideation] and I2=36% [help-seeking attitudes and intentions]). We found no evidence of publication bias. INTERPRETATION: Media narratives of hope and recovery from suicidal crises appear to have a beneficial effect on suicidal ideation in individuals with some vulnerability, but there is insufficient evidence regarding help-seeking attitudes and intentions. These findings provide new evidence about narratives for suicide prevention. FUNDING: None.

Celebrity Suicide of a Pre-World War I Spy.

Background: Alfred Redl, a colonel in the Imperial and Royal General Staff and Deputy Director of Military Intelligence for the Austro-Hungarian Empire, was a leading figure of pre-World War I spying. The "spy of the century," as he has been called, died by suicide in Vienna on May 25, 1913. It was a big news story based on espionage, sex, and betrayal. Aim: We aimed to test whether this celebrity suicide elicited an increase in suicides - a phenomenon consistent with the "Werther effect." Method: Given daily suicide numbers were not available, we conducted archival research. Civil death registers for the city of Vienna were used to identify suicides before and after Redl's suicide. Results: The analysis indicated that more people died by suicide in the immediate aftermath and that the quantity of news reporting on Colonel Redl predicted the number of suicides per day - a pattern that is consistent with the Werther effect. Limitations: Causal interpretations are limited. Conclusion: Given the fact that the "Redl affair" is relevant for many scientific disciplines, we discuss multiple contributions to suicide research, history, media research, and research on intelligence and counter-intelligence.

Coronavirus Disease (COVID-19) Pandemic and Stock Price Crashes: A Cross-National Correlational Approach.

The coronavirus disease (COVID-19) pandemic is a serious threat to public health and the economy. Importantly, there was a stock price crash on Monday, March 9, 2020, followed by a similar crash one week later. Leading global indices substantially dropped. Based on previous research indicating that the news media may elicit effects on stock prices, we hypothesized that the amount of news coverage about COVID-19 within a given country would predict the size of the stock price drop in that country. Using data for N = 58 nations from five continents, we observed average stock price drops of 6.57% (week 1) and 6.43% (week 2). Using a cross-national correlational approach, we found a positive relationship between the amount of news coverage about COVID-19 and the extent of the stock price drop. Actual severity within a given country (indicated by the number of confirmed cases and deaths, based on data provided by the World Health Organization) and public attention (indicated by COVID-19-related Internet search engine volume) did not predict the extent of the stock price drop in multivariate analyses. Correlational evidence is consistent with the idea that intensive media reporting on a threatening pandemic with uncertain negative consequences on health, social life, and the economy may provoke substantial reactions in the market, with as yet unknown indirect effects on public health. However, the causal order of media attention and stock price drops should be assessed with caution.

Uncovering Blind Spots in the Intention to Provide Adequate Help to Suicidal Individuals.

Background: An adequate reaction from families, friends, and colleagues who can provide help to suicidal individuals is a preventive factor. Despite the logical assumption that the mere presence of risk factors in individuals needing help may affect others' helping intentions, empirical evidence is lacking in this regard. Method: We tested whether the presence of various risk factors influences the intention to provide help to suicidal individuals. Individuals (N = 890) were exposed to a vignette in which they were asked to imagine meeting a distant acquaintance. Such persons talk about serious problems and suddenly use the word "suicide." In a one-factorial between-subjects design with 21 groups, we manipulated person-related attributes corresponding to risk factors for suicide. Results: Some attributes increased helping intentions: male gender, very young and old age, homosexuality and transsexuality, terminal illness, previous nonsuicidal self-injury, previous suicide attempt, and seeking out lethal means. However, some attributes did not: female gender, major depression, chronic pain, different stressful life events, previously experienced violence, a family history of suicide, and a cry for help. Limitations: We measured self-reported behavioral intentions. Conclusions: Although people seem to adapt their helping intentions in response to some attributes, there seem to be many blind spots.

The Relationship Between Crime-Related Television Viewing and Perceptions of the Death Penalty: Results of a Large Cross-Sectional Survey Study.

Background: According to cultivation theory, distorted representations of social reality on television can lead to distorted perceptions of reality among viewers. For example, the death penalty has been abolished in most Western countries a long time ago, but is often portrayed or mentioned in US crime shows, which are very popular outside the United States. Previous research suggests that the amount of television viewing can be associated with erroneous perceptions of the use of the death penalty-even when the death penalty is not used in the respective country. Unfortunately, available evidence on this association is inconclusive. Methods: In a cross-sectional web-based survey, we used quota-based sampling techniques to recruit 1,002 individuals representative of the Austrian population in terms of gender, age, education, and region of residence. We asked about their weekly amount of television viewing and use of US crime dramas and measured their beliefs on the use of the death penalty in Austria. Results: Although television viewing in general was not associated with erroneous perceptions of the death penalty (i.e., no overall across-the-board cultivation effect), data analysis provided supporting evidence for the idea of a genre-specific cultivation effect: The more US crime shows participants watched, the more likely they were to mistakenly believe that the death penalty is used in Austria. This association held true even after controlling for the gender, age, and education of participants. Conclusion: The finding that watching US crime shows, which are based on social reality in the United States, is associated with Austrian viewers' confusion with regards to perceptions of the death penalty is consistent with the genre-specific cultivation hypothesis. Some viewers may be guided more by mediated reality than by actual social reality.

How search engines may help reduce drug-related suicides.

BACKGROUND AND AIMS: Numbers of drug-overdose deaths, both intentionally and unintentionally, have been increasing in the United States. Of interest, Google spotlights counselling services as helpful resources when users query for suicide-related search terms. However, the search engine does so at varying display rates, depending on terms used. Display rates in the drug-overdose deaths domain are unknown. METHODS: We emulated suicide-related potentially harmful searches at large scale across the U.S. to explore Google's response to search queries including or excluding additional drug-related terms. Employing agent-based testing we conducted 215,999 search requests with varying combinations of search terms. RESULTS: Counseling services such as helpline telephone numbers were displayed at high rates after suicide-related potentially harmful search queries (e.g., "how to commit suicide"). While this is a desirable outcome, display rates were substantially lower when drug-related terms, indicative of users' suicidal overdosing tendencies, were added (e.g., "how to commit suicide fentanyl"). Importantly, the addition of any drug-related search term to the suicide-related queries decreased the display frequency of helpful prevention-related resources substantially. CONCLUSIONS: Search queries such as "easy way to commit suicide fentanyl" may indicate acute suicidal crises. Helpful resources should be displayed right in such search moments. Search engines should adjust their algorithms to increase these display rates to direct users to such resources. By doing this, search engines may contribute to the prevention of drug-related suicides.

Effects of media portrayals of alleged malpractice in psychiatry and response strategies to mitigate reputational damage: Randomized controlled trial.

Media allegations about malpractice in psychiatry are not uncommon, but little is known about their effects and how clinic management can effectively mitigate reputational damage. This study explored the impact of footage from a TV documentary raising allegations against a psychiatric clinic and assessed the effectiveness of different public response strategies from clinic management. N = 615 adults were randomized to one of four intervention groups watching allegations of malpractice in a psychiatric clinic or unrelated footage (control). Each intervention group further included one specific fictitious public response from clinic management: Denial, attack the accuser, apology, or decline to respond. The primary outcome was attitudes toward psychiatry, assessed before and after the intervention. Secondary outcomes (attitudes toward the staff of the clinic, intentions to recommend the clinic) were measured post-intervention. There was a decrease of favorable attitudes toward psychiatry across intervention groups (F = 14.46, p < .001, ηp2 = .102). Favorable attitudes toward the clinic staff (MD = 0.49, 95% CI = 0.02-0.96, p < .05) and intentions to recommend the clinic to a friend (MD = 0.42, 95% CI = 0.02-0.81, p < .05) were greater when accusations were denied as compared to no response. Media portrayals featuring allegations of psychiatric malpractice cause reputational damage not only to the specific clinic facing allegations, but also to the entire field. Public responses can partially mitigate the reputational damage and are preferable to no response.

Investigating Suicide-Related Subliminal Messages on Instagram.

Background: Suicide is the second-leading cause of death among 15-29-year-olds and Instagram is one of the most popular and fastest-growing social media platforms among this age group. A previous study presented preliminary evidence for suicide-related "subliminal messages" on Instagram, defined as very brief presentations of suicide-related content in video posts that users have no conscious awareness of. Aim: A systematic quantitative study was pending. Method: We conducted a quantitative content analysis of 100 Instagram video posts. A frame-by-frame coding procedure allowed for an assessment of whether suicide-related content was depicted in very brief segments, even when this content could not be consciously recognized when watched at regular speed. Results: Analysis indicates that a substantial amount of suicide-related content is presented in very brief shots. We identified 67 very brief shots that appeared in 21 video posts. Of interest, 13 of these video posts presented more than one very brief suicide-related shot. Limitation: The subjective threshold of conscious awareness differs inter-individually. This complicates the operationalization of subliminal messages. Conclusion: Subliminal messages are ethically highly problematic. There is a need for a greater awareness of possible suicide-related subliminal messages on Instagram.

The Opioid-Overdose Crisis and Fentanyl: The Role of Online Information Seeking via Internet Search Engines.

Opioid abuse is a severe public health threat. Recent evidence points to a disturbing increase in the illicit use of fentanyl, a potent synthetic opioid, with abuse often involving illicitly produced opioids mixed with heroin. Public health experts have emphasized that there is an urgent need for new, effective harm-reduction strategies and technologies. We asked whether Internet search engines could contribute toward this goal. Using state-level data from the USA, we provide evidence for a cross-sectional and longitudinal statistical relationship between opioid-related overdose deaths and the number of Google searches using the term "fentanyl." This finding points to the relevance of Internet search engines: Users - who may be non-addicted vulnerable individuals, addicts, addicts' friends and family members, or physicians - do in fact search for fentanyl online. We argue that during such searches, an info box including a warning (i.e., awareness material to educate users about the risks) and a help message (i.e., references to professional help) can be presented to target users and possibly prevent both unintentional and suicidal overdoses. Even if this info box only helps some users, the high number of daily Google searches renders this a promising public health intervention to supplement other opioid harm-reduction strategies.

Assessing responsible reporting on suicide in the nineteenth century: Evidence for a high quantity of low-quality news.

The press may have contributed to suicide as a mass phenomenon during the nineteenth century. There is limited knowledge on how the press reported on suicide. We utilized a content analysis of suicide news during the time period of suicide rate's strong increase in Austria (1855, 1865, 1875, 1885), assessing variables related to the responsible reporting on suicide (RRS). Analyses indicate that the press showed low levels of RRS and the quantity of low-quality reporting increased during the observation period. Although causal claims should be made with caution, the findings are consistent with the idea of a long-term Werther effect.

COVID-19 pandemic, government responses, and public mental health: Investigating consequences through crisis hotline calls in two countries.

RATIONALE: The coronavirus disease (COVID-19) pandemic is an immense global health threat that has invoked unheard-of containment measures in numerous countries to reduce the number of new infections. OBJECTIVE: The sequential introduction of severe measures, intentionally aiming at reducing the number of new infections, also imposes sharp restrictions on populations with potentially unintended, detrimental effects on public mental health. METHOD: We used observational data reflecting the number of phone calls made to national crisis hotlines in Austria and Germany during the COVID-19 pandemic (January 2020-April 2020) to investigate the impact of government restrictions as well as their later revocations on public mental health. Importantly, both countries have comparable health care systems, are similar in their political and socio-economic idiosyncrasies, and took similar restrictive government measures in order to contain COVID-19-but implemented them at different points in time. RESULTS: Analysis indicated that the number of crisis hotline calls increased in both countries. This increase seemed to occur at around the same time as the implementation of restrictive governmental responses. Importantly, the revocation of these governmental restrictions (i.e., re-opening the economy, allowing more social contact) seemed to occur at around the same time as the decrease in the number of calls. CONCLUSIONS: The present study supports the notion that the implementation of severe measures affects public mental health. However, the negative mental health effects of COVID-19 may be reduced if severe governmental restrictions are kept in place as briefly as possible.