Association between suicide reporting in the media and suicide: systematic review and meta-analysisBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m575 (Published 18 March 2020) Cite this as: BMJ 2020;368:m575
- Thomas Niederkrotenthaler, associate professor1 2,
- Marlies Braun, postgraduate researcher1 2,
- Jane Pirkis, professor3,
- Benedikt Till, associate professor1 2,
- Steven Stack, professor4,
- Mark Sinyor, associate professor5 6,
- Ulrich S Tran, senior lecturer2 7,
- Martin Voracek, professor2 7,
- Qijin Cheng, assistant professor8,
- Florian Arendt, assistant professor2 9,
- Sebastian Scherr, assistant professor10,
- Paul S F Yip, professor11,
- Matthew J Spittal, associate professor3
- 1Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria
- 2Wiener Werkstaette for Suicide Research, Vienna, Austria
- 3Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- 4Department of Criminology and Department of Psychiatry, Wayne State University, Detroit, MI, USA
- 5Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- 6Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- 7Department of Basic Psychological Research and Research Methods, School of Psychology, University of Vienna, Vienna, Austria
- 8Department of Social Work, Chinese University of Hong Kong, Hong Kong, China
- 9Department of Communication, University of Vienna, Vienna, Austria
- 10School for Mass Communication Research, KU Leuven, Leuven, Belgium
- 11Centre for Suicide Research and Prevention, and Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
- Correspondence to: T Niederkrotenthaler
- Accepted 4 February 2020
Objective To examine the association between reporting on suicides, especially deaths of celebrities by suicide, and subsequent suicides in the general population.
Design Systematic review and meta-analysis.
Data sources PubMed/Medline, PsychInfo, Scopus, Web of Science, Embase, and Google Scholar, searched up to September 2019.
Review methods Studies were included if they compared at least one time point before and one time point after media reports on suicide; follow-up was two months or less; the outcome was death by suicide; and the media reports were about non-fictional suicides. Data from studies adopting an interrupted time series design, or single or multiple arm before and after comparisons, were reviewed.
Results 31 studies were identified and analysed, and 20 studies at moderate risk of bias were included in the main analyses. The risk of suicide increased by 13% in the period after the media reported a death of a celebrity by suicide (rate ratio 1.13, 95% confidence interval 1.08 to 1.18; 14 studies; median follow-up 28 days, range 7-60 days). When the suicide method used by the celebrity was reported, there was an associated 30% increase in deaths by the same method (rate ratio 1.30, 95% confidence interval 1.18 to 1.44; 11 studies; median follow-up 28 days, range 14-60 days). For general reporting of suicide, the rate ratio was 1.002 (0.997 to 1.008; five studies; median follow-up 1 day, range 1-8 days) for a one article increase in the number of reports on suicide. Heterogeneity was large and partially explained by celebrity and methodological factors. Enhanced funnel plots suggested some publication bias in the literature.
Conclusions Reporting of deaths of celebrities by suicide appears to have made a meaningful impact on total suicides in the general population. The effect was larger for increases by the same method as used by the celebrity. General reporting of suicide did not appear to be associated with suicide although associations for certain types of reporting cannot be excluded. The best available intervention at the population level to deal with the harmful effects of media reports is guidelines for responsible reporting. These guidelines should be more widely implemented and promoted, especially when reporting on deaths of celebrities by suicide.
Systematic review registration PROSPERO CRD42019086559.
Contributors: Substantial contributions to the conception or design of the work (MJS, TN, and JP); acquisition of the data (JP, BT, MB, SS, TN, and MJS); data extraction (MJS, TN, and MB); statistical analyses (MJS); interpretation of the data (all authors); drafting the work (TN, MJS, and MS); revising it critically for important intellectual content (all authors); final approval of the version to be published (all authors); agreement to be accountable for all aspects of the work (all authors). The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. TN and MJS act as guarantors.
Funding: No specific funding for this study. MB is funded by the Austrian Science Fund (FWF), grant No KLI627-B30. MJS is a recipient of an Australian Research Council Future Fellowship (project No FT180100075) funded by the Australian Government. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: Not required.
Data sharing: No additional data available.
The lead author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as originally planned (and, if relevant, registered) have been explained.
Dissemination to participants and related patient and public communities: The study findings will be disseminated via conference presentations, press releases, and social media. A companion opinion article in The BMJ will serve to further stimulate discussion on the research. The authors will also disseminate findings to media organisations and press councils, and also national and international health organisations that have been instrumental in the development of media recommendations for suicide reporting. The wider public will be informed via media and in lectures and seminars on suicide prevention that target the broader public. Discussions on how the findings will be used to the benefit of the community will involve media professionals, individuals with personal experience of suicidal ideation or suicide attempt, individuals with experience of bereavement from suicide, mental health professionals, and the broader interested public.
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