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Position statement and guideline on media coverage of suicide

2014; Medknow; Volume: 56; Issue: 2 Linguagem: Inglês

10.4103/0019-5545.130473

1998-3794

Chittaranjan Andrade, Smitha Ramadas, Praveenlal Kuttichira, C Reader John, Mohan Isaac, RoyAbraham Kallivayalil, Indira Sharma, TV Asokan, Asim Mallick, NN Mallick,

Child and Adolescent Psychosocial and Emotional Development

Suicide is a major public health problem across the world. It is a multidimensional event which results from a complex interaction of biological, psychological, and environmental factors. Recent Indian studies suggest suicide rates of about 10/100,000 population, though this is likely to be an underestimate because of underreporting.[1] The risk of suicide can be attenuated in many ways. These include the early identification and management of persons suffering from mental and substance use disorders, improved delivery of health and social services to persons at risk (especially youth), and restriction of access to means of suicide, such as toxic substances and firearms. In this context, responsible reporting of suicide by the media is a niche but important preventive measure that has been relatively neglected in India. This article summarizes a position statement and guideline on media coverage of suicide, prepared by the Indian Psychiatric Society Task Force on Position Statements (Appendix) and approved at the 65th Annual National Conference of the Society, held in Bangalore during January 2013. THE EFFECT OF PRINT MEDIA COVERAGE ON SUICIDE RATES: THE WERTHER EFFECT In 1774, Goethe published the novel "The Sorrows of Young Werther" in which the protagonist, a young man named Werther, kills himself because of unrequited love. The publication of this novel led to a spate of suicides across Europe. Such a spike of copycat suicides following publicity given to one suicide has come to be known as the Werther effect.[2] There is good reason to believe that media coverage of suicide can promote a Werther effect in the population. There is also reason to believe that description of suicide methods can increase suicide risk in the population. For example, the book "Final Exit" written by Derek Humphry in 1991 describes methods of suicide. This book triggered suicides in New York that used the methods described.[3] Phillips[4] published a seminal study of the impact of suicide reporting by the print media. This study spanned a 20-year period of newspaper reporting in the USA. In this study, he compared the suicide rates in the months in which newspapers provided front page coverage of suicide with the rates in months in which no such articles were published. He found a significant spike in suicides in the months in which front page reports on suicide appeared. Systematic reviews of research have established that media reporting of suicides triggers imitative suicides.[2] Important research findings are briefly summarized in this paragraph. The risk of imitative suicide is the highest during the first 3 days of reporting and levels off after about 2 weeks. Educated persons, who have greater access to the media, are at greater risk. Celebrity suicide, repeated news coverage, and sensational stories enhance the risk. A dose-response effect is also evident from increased suicide rates after front page suicide coverage, use of large headlines, and publication of pictures. Description of the method of suicide increases suicidal behavior by the same method. Copycat suicides are less likely to follow television reports than newspaper reports, perhaps because newspapers can be preserved for reading and re-reading. Imitation is more likely when the reader is young, mentally disturbed, or identifies with the person who committed suicide. THE EFFECT OF PRINT MEDIA COVERAGE ON SUICIDE RATES: THE PAPAGENO EFFECT Mozart's opera "The Magic Flute" features a young man, Papageno, whose suicidality due to unhappiness in love was offset by support from friends. Hence, might responsible media coverage reduce suicide risks? Research suggests as much. For example, the introduction of media guidelines on Viennese subway suicide reporting resulted in reduced sensationalist reporting, a 75% decrease in the rate of subway suicides, and a 20% decrease in the overall suicide rate in Vienna.[5] A systematic review of six systematic reviews on multilevel suicide prevention strategies concluded that training journalists in responsible reporting about suicide and imposing of media blackouts on suicide reporting were both effective in population-level suicide prevention.[6] THE INFLUENCE OF OTHER MEDIA COVERAGE ON SUICIDE RATES What has been stated so far with regard to the print media applies to other media, as well, such as films, television, and the internet.[78] Given the decreasing use of the print media and the increasing use of the visual and electronic media among youth, efforts to desensationalize suicide are necessary across all media. MEDIA AND SUICIDE REPORTING: THE WAY FORWARD Suicide is newsworthy, and the media have a duty to report such news. The way forward, therefore, lies in a collaboration between mental health professionals and the media with a view to sensitize media personnel about the issues involved and to provide guidelines for safer reporting. Such guidelines already exist in countries such as the USA.[9] Guidelines have also been issued by the World Health Organization.[10] Efforts towards engaging the media in the responsible reporting of suicide have been made in South India, as well, such as by the National Institute of Mental Health and Neurosciences, Bangalore; by the Department of Psychiatry at the Government Medical College, Thrissur; by the Department of Psychiatry, Medical College, Kottayam, and by nongovernmental organizations such as Sneha in Chennai, and Maithri in Kochi.[111213] SUMMARY A large body of research spanning several decades has consistently demonstrated that imitative suicides may follow media coverage of suicide. The risk of such imitative suicides depends on the form, content, and duration of the news coverage, on the celebrity status of the suicide completer, and on the emotional vulnerability of the news consumer. The risk of imitative suicide can be attenuated by responsible reporting. Media guidelines for suicide reporting are now available in many countries across the world. RECOMMENDATIONS No national guidelines are available on the subject of media reporting of suicide. The Indian Psychiatric Society therefore offers simple and easy-to-implement suggestions that the media can adopt. Whereas these recommendations were prepared with the print media in mind, parallels can easily be drawn for the visual media. For example, it has been suggested that news coverage should be discreet, with avoidance of front page reporting, presentation in boxes, use of large headlines, and presentation of lengthy reports. For the television media, this could translate to the avoidance of prime time coverage, lengthy coverage, repeated coverage, excited commentaries by the reporters on the spot, and graphic visual imagery. The guidelines that have been prepared are similar to those in other countries[910] and are listed below: 1. News coverage should be neutral Present facts in matter-of-fact language, without sensationalism; be objective rather than emotional. Do not romanticize or glorify the event, or imply martrydom. Do not indicate blame unless clearly justified; instead, acknowledge that a combination of triggers and vulnerabilities were probably responsible. Comments The purpose of neutral media coverage is to ensure that emotionally vulnerable persons do not find a morbid fascination in the content of the news report; and that such individuals do not begin to think of suicide as a desirable act that will elicit admiration and respect. It is important that blame is not indicated, as in a headline that reads "Student caned by headmaster, drowns himself" or "Student fails in examination, hangs herself". There are plenty of students who are caned or who fail in examinations, and who do not afterwards commit suicide by drowning, hanging, or any other means. In effect, suicide implies a stressor (e.g. the caning or the failure in the examination), a vulnerability of the affected individual (e.g. presence of other life stresses, ongoing emotional disturbance, and/or poor coping skills), and an absence of adequate family and social support that could help the individual in buffering these stresses. If blame is stated, not only is it an injustice (such as to a headmaster who may have caned a student), but it may also suggest to an emotionally disturbed student that being caned or failing in an examination is a valid reason to attempt suicide. 2. News coverage should be discreet Avoid front-page reporting, presentation in boxes, large headlines, lengthy reports, and photographs of the deceased. Do not provide detailed descriptions of the method of suicide. Do not publish suicide notes. Comments The purpose of discreet media coverage is to ensure that the news coverage is not eye-catching to emotionally vulnerable persons; that such persons do not find personal details in the coverage with which they may empathize; that such persons do not find information that might suggest to them ways and means to attempt suicide; that such persons are not drawn over and over again to the subject of suicide; and that the report does not leave a deep and lasting impression on vulnerable persons. 3. News coverage should be sensitive Consider how the news coverage might occasion psychological and social harm to the survivors of the event. Respect the privacy of the survivors. Comments The purpose of sensitive news coverage is to avoid collateral damage. For example, it could be socially harmful for a news report to imply that a husband or a headmaster was responsible for a suicide when the person who completed suicide actually had a psychiatric illness which was associated with suicidal thoughts and impulses. It would also, certainly, be distressing for bereaved family members to have their personal situation, including family disputes and disagreements, exposed to the public gaze. In this context, it could be helpful for the news coverage to instead indicate how devastated the family or other survivors are. This would help an individual who has suicidal ideation to consider how a suicidal act may grieve his near and dear ones, thereby discouraging him from attempting suicide. 4. Other matters Do not repeatedly play on the event or theme. Do not allow readers to form the impression that suicide is a way of coping with a personal problem, or a way to teach others a lesson. Exercise particular caution when reporting celebrity suicides. Comments A special point here is that a vulnerable person may obtain the idea that it could be good to attempt suicide because not only would he escape from the current stress, but he would also be able to settle a score with a family member, class teacher, or other person whom he dislikes by making it seem that the person in question was responsible for the suicide. A stressed, depressed, or otherwise emotionally-vulnerable person should not read a media report and form the impression that he can teach somebody whom he dislikes a lesson by committing suicide and implicating the disliked person in a suicide note. The Indian Psychiatric Society also offers simple suggestions for positive reporting: When reporting suicide, use the opportunity to improve public awareness about issues related to mental health and suicide, and sources of help. Possibilities include the provision of tips on early warning signs of suicidal behavior and assistance that can be provided to those at risk. List suicide helplines and counselling services. Destigmatize the experience of stress, emotional difficulties, depression, and suicidal ideation so that help-seeking behavior is encouraged. Promote the awareness that problems can be solved and depression and mental illness can be overcome. Describe how people have overcome suicidal thoughts and coped with stress. Comments Readers who are interested in an example of positive reporting are referred to the article by Chhakchhuak (2014).[14] Balanced reporting could also hint at other issues that might have been responsible for the suicide (that is, issues other than the stress or the trigger that seemed to be the cause) and what the affected person might have been able to do to avert the terminal event. Concluding notes The need for, utilization of, and impact of these guidelines can be best communicated through interactive meetings between experienced mental health professionals and media representatives. The Indian Psychiatric Society Task Force on Position Statements (Appendix) therefore recommends that these guidelines be circulated among mental health professionals and the media in order that the guidelines may be implemented for the benefit of society as a whole.