Psychiatrists Create Initiative to Educate Media About Suicide Contagion

A handful of concerned psychiatrists attending APA’s 2018 Annual Meeting in New York gathered at an informal roundtable with reporters and editors from major media and entertainment outlets and the nation’s leading suicide prevention organizations.

The subject was grave: media reporting about suicide and its link to suicide contagion, especially among the young.

The problem encompassed how news outlets described real suicides by individuals and nationally known celebrities, but also how entertainment outlets depicted suicide fictionally. One year prior, the popular Netflix drama “13 Reasons Why” became one of the most talked about—and controversial—series of 2017 because of its depiction of the fictional suicide of a 17-year-old girl. The series included a three-minute graphic scene of her death and audiotapes made by the teenager prior to her death describing the reasons for the suicide.

Within three weeks of its release, Google searches for “how to commit suicide” and “how to kill yourself” increased 26% and 9%, respectively, according to a report published in JAMA Internal Medicine in October 2017. In February 2020, a study in the Journal of the American Academy of Child and Adolescent Psychiatry reported that the suicide rate among youth spiked 29% above historical trends in the month after the release of “13 Reasons Why.”

Organized by Steven Adelsheim, M.D., director of the Stanford Center for Youth Mental Health and Wellbeing, and Victor Schwartz, M.D., a clinical associate professor of psychiatry at New York University School of Medicine (and at that time the chief medical officer at The Jed Foundation), the 2018 meeting included reporters, editors, and representatives from the Wall Street Journal, the Associated Press, MTV, and other media and entertainment outlets. Representatives from APA and the American Academy of Child and Adolescent Psychiatry also attended.

The roundtable discussion was wide ranging and highlighted the work of national suicide prevention organizations including the American Association of Suicidology, American Foundation for Suicide Prevention, SAVE (Suicide Awareness Voices for Education), National Action Alliance for Suicide Prevention, The Trevor Project, and the National Suicide Hotline.

“It was a first attempt to create some kind of nationwide, coherent approach, driven by the psychiatric community, to address the benefits and risks of media reporting on suicide,” Schwartz told Psychiatric News.

Today, Adelsheim, Schwartz, and other collaborators from that 2018 meeting are expanding their media education and partnership effort through the development of the Media and Mental Health Initiative in the Department of Psychiatry at Stanford University. They envision the initiative as a national project to promote public education about mental health and suicide through proactive, sustained engagement with content producers in the news media, entertainment media, and social media.

“This collaborative project will systematically embed evidence-informed guidelines across all media platforms to advance narratives that promote hope, help seeking, and awareness about mental health and suicide while mitigating harmful ones,” Adelsheim said.

“This is a real problem with real-world consequences for our young people that has been documented extensively by the research community,” he continued. “We want to invite psychiatrists to join us in helping to change the culture around how suicide is reported and depicted in the media. It is also an opportunity for them to actively decrease suicide risk in their own communities by educating the media and the public about suicide and the risk for suicide contagion.”

Data Link News Reports to Suicide Contagion

An enormous body of research from American and international researchers—some of it dating back to the 1980s—has firmly established the role that media reporting on suicide can play in suicide contagion.

Madelyn Gould, Ph.D., M.P.H., the Irving Philips Professor of Epidemiology in Psychiatry at Columbia University, specializes in the epidemiology of youth suicide, as well as the evaluation of interventions to prevent youth suicide. In one representative study in The Lancet (April 2014), Gould and colleagues reviewed newspaper coverage of teenage suicide deaths between 1988 and 1996, comparing coverage that was followed by a cluster of “copycat” suicides and coverage that was not.

Gould found that the mean number of news stories about suicidal individuals published after an index cluster suicide was significantly greater than the mean number of suicide stories published after a noncluster suicide. Several story characteristics, including front-page placement, headlines containing the word “suicide” or a description of the method used, and detailed descriptions of the suicidal individual and act, appeared more often in stories published after the index cluster suicides than after noncluster suicides.

Based on the extraordinary amount of data linking media reporting and suicide contagion, the World Health Organization, in collaboration with the International Association for Suicide Prevention (IASP), formulated guidelines to promote responsible reporting about suicide. Other American-based institutions and organizations including the Centers for Disease Control and Prevention and SAVE have formulated similar guidelines.

The guidelines are summarized in a draft position statement by APA’s Council on Communications and the Council on Children, Adolescents, and Their Families now under review by the Joint Reference Committee. (Position statements become official APA policy only after they are approved by the Board of Trustees.)

As summarized in the draft statement, the WHO/IASP guidelines are as follows:

• Provide accurate information about where to seek help.

• Report stories of how to cope with life stressors or suicidal thoughts, and how to get help.

• Be cautious when reporting celebrity suicides.

• Be cautious when interviewing bereaved family and friends.

• Avoid prominent placement and undue repetition of stories about suicide.

• Don’t use language that sensationalizes or normalizes suicide or presents it as a constructive solution to problems.

• Don’t explicitly describe the method used.

• Don’t provide details about the site/location.

• Don’t use sensational headlines.

• Don’t use photographs, video footage, or social media links.

Adelsheim and Schwartz said that reporting about suicide—and about mental illness generally—has improved, but there are examples of major publications that have portrayed suicide in a particularly egregious way. Adelsheim cited a 2015 article in The Atlantic about a cluster of suicides by teenagers and young adults in Silicon Valley that, he said, “was an example of just about everything you shouldn’t do.”

Schwartz acknowledged that the recommendations about how to report on suicide deaths often cut against the way journalists naturally approach a story. “Nearly every instinct a journalist has in reporting can be exactly what you don’t want to do when reporting about suicide,” he said. “Journalists want to tell a story that is emotionally compelling, and they want to get the reader to identify with the individual they are writing about—which is exactly the problem.”

But the culture around reporting about suicide—and movie and television presentations about issues related to mental illness—is changing and can change more. Adelsheim and Schwartz said that the nascent initiative at Stanford can be a catalyst.

“The good news is that there is more in the media today than ever before about mental health,” Schwartz said. “It is an opportunity for psychiatrists to help educate journalists and the public about suicide risks and suicide contagion and about mental health and mental illness generally.” ■