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Saturday, September 1, 2018

Media Still Floundering on Responsible Reporting of Suicide


The news media still does not have a firm grasp on how to report on suicide to mitigate the “contagion” effect that may prompt others to take their own lives, new research indicates.
Various groups, including the World Health Organization, have developed recommendations to help guide journalists report on suicide in a way that does not censor or compromise the news, while at the same time does not glamorize it and make it attractive to someone who may be considering suicide.
However, new research, led by Mark Sinyor, MD, FRCPC, assistant professor of psychiatry, University of Toronto, Canada, found that five major Canadian newspapers, a news magazine, and three news websites failed to adhere to the guidelines.
In addition, the use of certain harmful elements in stories about suicide was associated with an increase in suicide in Toronto in the week after articles containing such elements were published.
The study was published online July 30 in the Canadian Medical Association Journal.

Graphic Reporting Leads to Harm

In the survey of articles published from 2011 to 2014, the investigators found that certain factors were associated with increased odds of death by suicide. These factors included statements that suicide is inevitable (1.97 odds ratio); identifying the method of suicide in the headline (1.41); and reporting on suicide by celebrities (1.27).
Other factors that increased risk included mention of asphyxia other than by car exhaust, but not hanging (1.72); jumping from a building (1.70); and a suicide pact (1.63).
Interestingly, suicide by use of firearm was described in 13% of articles, but that method was responsible for fewer than 5% of deaths in Toronto. Articles that described a suicide death by firearm was associated with 1.28 increased odds of later suicide.
Reports of suicide in older adults (1.25) also increased risk. Stories in newspapers may disproportionately affect older adults, who are more likely to get their news from the print or online versions of publications, Sinyor told Medscape Medical News.
But older adults are also overrepresented among suicide deaths, which could make the effect easier to detect, the investigators note.
The stories also had few of the factors that the investigators labeled as “protective” against suicide contagion — a finding that Ian Colman, PhD, called “disheartening” in an accompanying commentary.
Colman, associate professor and Canada Research Chair in Mental Health Epidemiology at the University of Ottawa, Ontario, noted that fewer than one in five articles discussed alternatives to suicide, and fewer than 2% mentioned community resources for those considering suicide.
It has not been definitively proven that including protective factors can lead to fewer suicides, but it is clear that the media can educate the public about suicide and provide information about how to get help, said Vasilis Pozios, MD, a psychiatrist who advises the media on mental health issues through the consulting practice, Broadcast Thought.

No Inclusion of Protective Factors

Pozios told Medscape Medical News that he found it surprising that so few of the Canadian articles studied included the putatively protective factors.
“I don’t expect journalists to be clinicians, but they could avoid hurting people at the least,” agreed Praveen Kambam, MD, who practices with Pozios and is on the communications committee of the American Psychiatric Association.
The Canadian study reported some positive changes — such as a reduction in stories about suicide on the front pages — “but, on the other hand, the putative protective factors were not happening as much as we’d like. Journalism and news reporting have changed in some ways, but there’s other ways we could be better,” Kambam told Medscape Medical News.
Colman noted that one of the most striking features of the Sinyor study is “how commonly media reports on suicide described the method used, despite clear guidelines to avoid this practice.”
Almost half of the 6367 articles that reported on suicides identified the method used, and 13% described the method in specific detail.
The group Reportingonsuicide.org recommends against mentioning many of the harmful factors described in the Sinyor study.
“Risk of additional suicides increases when the story explicitly describes the suicide method, uses dramatic/graphic headlines or images, and repeated/extensive coverage sensationalizes or glamorizes a death,” according to the group, which compiled reporting guidelines through a collaborative effort led by the American Foundation for Suicide Prevention (AFSP). A number of government agencies, journalism schools, patient advocates, and psychiatry experts participated.
The media outlet NPR told Medscape Medical News that NPR follows those AFSP-led guidelines when reporting on suicide. Other outlets did not return requests for comment. News organizations seem to be imperfect at best at covering suicide.

Kate Spade

A late August New York Times article about the death of a 9-year-old boy in Colorado said that he “committed suicide.” Number one on the AFSP’s list of recommendations: “Do not use the word ‘committed’; instead, use ‘died by suicide’ or ‘took his/her life.’ ”
Many media outlets did not responsibly report on the death of New York–based fashion designer Kate Spade, who took her own life in June 2018. The New York Times was among the first to report Spade’s death, on June 5. The story adhered somewhat to reporting guidelines, citing information regarding the method of suicide as coming from the police and also mentioning that a note was being reviewed by the police without saying what was in the note, as is recommended.
The New York Times’ article also mentioned that Spade was being treated for depression and did not speculate as to why she had taken her life. The article ended with an italicized note: If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) or go to SpeakingOfSuicide.com/resources for a list of additional resources.
In contrast, People magazine described the manner of her death — “suicide by hanging” — in the headline of a June 7 story and quoted Spade’s husband as saying, “There was no indication or warning.”
Reportingonsuicide.org urges against such “no warning” statements. “Most, but not all, people who die by suicide exhibit warning signs,” said the group, which also recommends including lists of warning signs and what-to-do lists in stories. People did include a note of assistance at the end of the story: “If you or someone you know is considering suicide, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).”
The New York Daily News had the most lurid and harmful story, complete with the headline, “Kate Spade found dead in her NYC home, leaves heartbreaking suicide note telling daughter it’s not her fault.” In addition, the first sentence of the story stated that Spade “hanged herself with a scarf in the bedroom.” The story also described the contents of the note that was found and contained no reference to the National Suicide Prevention Lifeline.
Past studies have shown that news reports that include positive elements — such as talking about alternatives to suicide or how to approach someone who is depressed — can lead to positive behaviors in despondent readers.
The Canadian study reported that contagion was less likely if a person took their life by stepping in front of a train or by cutting or stabbing, or if the suicide involved someone who might be considered unsavory or had participated in a murder-suicide.

Education, Not Censorship

Mental health professionals do not want news outlets to censor coverage of suicide, said Sinyor.
“The goal is not to hide that a suicide has happened but to contextualize it and to use it as an opportunity to dispel myths as well as to educate the public,” he told Medscape. “The key is to present the story for what it is — a tragic, missed opportunity to have gotten help in someone who was unwell,” he said.
Sinyor would like to see more stories about effective treatments for those mental illnesses that are associated with suicide and about people who have overcome a suicidal crisis.
The journalist’s job becomes more difficult when suicide involves celebrities or others who might be viewed sympathetically. “Commonly, people who have died by suicide will be portrayed in ways that some readers will identify with, and it is in these situations that journalists need to take great care to prevent harm to vulnerable readers,” Sinyor told Medscape.
Pozios said that journalists should include statements to the effect that treatment works or that there is hope. “I don’t think that’s overly burdensome to ask,” he said.
An evolving challenge: that journalism is changing as social media eats into territory that used to be owned by traditional outlets such as newspapers. “The whole model is built on sensationalism and getting clicks,” said Pozios. The need to draw in audiences makes it harder for journalists to tell the story in a responsible way, said Kambam.
Both Sinyor and Kambam note that social media’s impact on suicide is understudied and is not well understood. On the one hand, a post on social media from someone who is in crisis could bring a rapid response. But such sites also have the potential to spread suicide contagion quickly. In addition, Pozios notes, a message — even a positive one — on social media is difficult to control.
Sinyor said he is currently working on a study of social media. He said that despite the limitations of his traditional media study, it does provide some data specific to Canada to help inform working journalists.
The research should be viewed as definitive in an important way, said Colman. “Sinyor and colleagues’ new paper must close the book on whether the media may do harm when reporting on suicide, and whether there is sufficient justification for guidelines on reporting on suicide,” he writes.
The study was supported by the American Foundation for Suicide Prevention (AFSP). Dr Sinyor receives grant support from the AFSP and the Physicians’ Services Incorporated Foundation, the Dr. Brenda Smith Bipolar Fund, the University of Toronto Department of Psychiatry Excellence Fund, and the Innovation Fund of the Alternative Funding Plan from the Academic Health Sciences Centres of Ontario. Co-author Jane Pirkis, PhD, receives grant support from the AFSP.
CMAJ. Published online July 30, 2018. Full textCommentary

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