Suicide: Talking About It, Hearing About It, and Reporting It

Suicide

The World Health Organization (WHO) reported that 800,000 people worldwide died by suicide in 2015. This figure indicates that one person dies by suicide every 40 seconds worldwide. WHO predicts that this number will exceed one million in 2030. Suicide attempts are approximately 20 times more frequent. When we also consider the psychological pain experienced by the loved ones of those who die by suicide, it is clear that suicide is a serious public health problem affecting a substantial proportion of society. Every country therefore needs sustained, nationwide suicide prevention programs that encompass the whole population, have measurable targets, and can be evaluated for effectiveness. Prevention programs in this field must therefore be multidisciplinary rather than left solely to psychiatrists. Governments, mental health professionals, educators, the media, families, and friends must work together to prevent suicide. Prejudice prevents timely access to mental health services [1].

Myths and Misconceptions About Suicide

There are many misconceptions about suicide in society today, and sometimes even among healthcare professionals. Indeed, some approaches that healthcare professionals once applied as scientifically sound have subsequently been shown by research to be mistaken. It is worth giving a few examples of these misconceptions. For example:

Myth: Asking people we believe to be at risk about suicidal thoughts puts the idea of suicide into their minds and encourages them to act on it.

Fact: When someone senses that a person may be suicidal, they should be able to discuss this openly and explore how strong these thoughts are. All suicidal thoughts must be taken seriously. The subject can be introduced with gentler questions, such as “What are your hopes for the future?” [2]. When we identify a risk, the person should be referred to a psychiatrist as soon as possible.

Myth: A person who dies by suicide has usually made up their mind in secret and acts suddenly.

Fact: When we examine suicide deaths, we find that a substantial proportion of those who died had made at least one previous attempt and had tried at least once to seek professional support or communicate their distress to loved ones.

Myth: It is impossible to tell who is more vulnerable to suicide.

Fact: Although there is currently no blood test or other test that can precisely assess suicide risk, research has shown that the most important indicator of suicide risk is hopelessness [3]. The more hopeful a person’s aspirations for the future, the lower their suicide risk tends to be. This is why assessments of suicide risk specifically include questions about future plans and hopes.

Suicide in the Media and the Press

The media and media professionals also have important responsibilities in suicide prevention. Detailed reporting of suicide, dramatization, and portrayals of suicide as a normal response to a crisis adversely affect individuals at high risk. Wherever possible, suicide should not be reported in the media; if it is reported, coverage should comply with Article 20 of the Press Law, avoid encouraging imitation, and be as straightforward as possible, with the aim of directing people with suicidal thoughts to appropriate services. The Turkish Journalists’ Association’s Declaration of Rights and Responsibilities states: “Coverage of suicide must not go beyond the scope of factual reporting in a manner or to an extent that could influence readers or viewers. Photographs, images, or footage depicting the incident must not be published.” Unfortunately, this declaration is often not followed. [4]

The following World Health Organization guidelines on media reporting of suicide must be implemented as soon as possible! [5]

· Reports should clarify the psychosocial factors that contributed to the decision to die and mention any underlying psychiatric disorder. They should emphasize that conditions associated with suicide, such as depression and substance dependence, are treatable and provide information on how to obtain help. Coverage should offer guidance, using examples to illustrate ways of resolving interpersonal difficulties and conflicts.

· Suicide should not be presented in news reports as a courageous act. Reports should not appear on front pages, include photographs or color images, or describe the method of suicide in detail.

· The incident should not be portrayed as a romantic or mysterious act.

· Suicide should not be presented as a solution.

· Serious physical consequences that may follow suicide attempts—brain damage, paralysis, etc.—should be described and used as a deterrent.

· Suicides should not be presented as a way of solving problems. Reports should explain that various other effective solutions exist and that this outcome occurs when people are unable to access them.

· Portrayals that attribute enviable qualities, striking characteristics, or special status to the deceased should be avoided.

· The person should not be made famous through their suicidal behavior, and the message that suicide is a route to fame should not be conveyed.

· Reports should provide information about organizations and treatment options that can help individuals cope with suicidal thoughts.

· Preferably, only suicidal acts resulting in death should be reported, and reports should be brief, without images or details of the suicide method.

• Detailed reports illustrating how to die by suicide should be avoided.
• The incident must not receive extensive or repeated coverage in any form.
• Ongoing dialogue should be maintained between local media and healthcare institutions.
• Suicide and Learning

People tend to adopt practices and ideas that are common within their group. According to social learning theory, people have a learning system that may be at least as important as acquiring information and learning through experience. Through mirror neurons, we can learn many skills simply by observing. Learning through observation and imitation… [6] Another risk of exposure to suicide reports and descriptions of methods is coming to view suicide as a solution and seeing it as feasible. We know that many of our patients with suicidal thoughts, such as those with depression, research painless death. Because there is no genuinely easy way to achieve this and there is also a risk of disability, even at the lowest point of depression a person may decide not to act simply because of these difficulties. Such obstacles—the perceived infeasibility of suicide and the inability to find a method—may protect a person from acting during periods of heightened risk. Presenting suicide reports as though they offer a solution for people who feel hopeless, publicizing methods, and creating the false impression that other members of the group (society) can readily carry it out are among the most significant risks of harmful media coverage.

Although the media constitute only a small part of the social environment in which suicidal behavior can be learned, they are nevertheless likely to play an important role in the social construction of reality when considered alongside other psychosocial risk factors for suicide. Some individuals are thought to be at greater risk when they are in a period of heightened vulnerability to the idea and act of suicide and are searching for a method [7]. Many studies have suggested that suicide contagion affects only certain vulnerable groups. In other words, we can say that harmful media reporting poses a greater risk of suicide death particularly for vulnerable people who are already at risk. Some countries and organizations (such as the World Health Organization and the American Foundation for Suicide Prevention) are working to educate and empower media professionals. The vast majority of studies support the view that media coverage of suicidal behavior and actual suicide is associated with suicidal ideation. Mass media research shows that this influence can also work in the opposite direction, through positive role models, as suggested by imitation theory. Six research articles observed a protective effect and a reduction in suicide following a newspaper reporting blackout implemented through relevant guidelines, a reduction in the amount of coverage, or a change in the quality of media reporting. The term “Werther effect” was coined by Phillips decades ago to describe the negative and provocative effects of media portrayals. Conversely, the term “Papageno effect” was proposed more recently by Niederkrotenhaler and colleagues to describe a preventive effect. [7]

An important issue that cannot be overlooked when assessing media influence is reporting on specific suicide methods. Research on the newsworthiness of suicide has found that media reports do not reflect official suicide data and tend to overrepresent certain types of suicide, such as celebrity suicides and those involving unusual circumstances or methods. Media reports are not an objective sample of official suicide data and tend to sensationalize suicides. Most studies have focused on the short-term effects of media reports (for example, from 1–2 days to 3–4 weeks), a period particularly conducive to triggering fatal and nonfatal suicidal acts. However, suicidal ideation in the community has been found to remain affected by the suicide of a well-known celebrity for approximately one year [7]. Long-term effects are likely to be even more important in today’s world. [3]

Copycat Suicide (‘Werther Effect’)

The ‘Werther effect’ can be defined as people imitating suicidal behavior and turning to suicide after a suicide is depicted and publicized through the media or similar sources in a way that encourages imitation [8]. The term ‘Werther effect’ entered the literature through inspiration from Goethe’s book “Genç Werther’in Acıları” (The Sorrows of Young Werther), published in Germany in 1774. People who perceive themselves as sharing characteristics with a person—often a celebrity—whose suicide receives extensive news coverage or social media attention are more vulnerable. In the 1970s, a suicide by self-immolation in Britain received extensive international media coverage. During the following 12 months, there were 60 more suicides by self-immolation in Britain than would normally have been expected, attributed to imitation. A study in Australia found that the suicide rate among Australian men rose after suicide reports appeared in the country’s two national newspapers. In 1985, four films intended to prevent youth suicide were produced in the United States and broadcast in different weeks to raise awareness of suicidal behavior among families and young people. However, the number of young people attempting suicide increased after these films were shown. [4] Examples such as the decline in suicide attempts after reporting of attempts on the Bosphorus Bridge was discontinued years ago, and the reduction in suicides in Austria after restrictions on suicide reporting, demonstrate the relationship between media coverage and the occurrence of suicide. [4]

Suicide Contagion

Discussions of suicide contagion following newspaper reports of suicides have appeared in articles since the 19th century. This phenomenon has been studied under terms such as suicide contagion, imitation, and suicide clusters [4]. Media-related contagion has been found to be greater among young people and particularly among older adults. It has been suggested that this may be related both to neurobiological characteristics and to the active roles people hold in life.

Mental Health Promotion

The concepts of "mental health promotion" and "prevention of psychiatric disorders" overlap in some respects but also differ. Prevention focuses on avoiding illness or reducing its impact, whereas mental health promotion is founded on health and well-being. Mental health promotion focuses on improving, developing, and valuing mental health as an integral part of overall health. [9] Promoting health requires easier access to healthcare, economic empowerment of society, reduced unemployment, stronger fundamental and democratic rights, and policies sensitive to mental health across the media, politicians, local authorities, journalists, law enforcement, and even the toy industry. As a member of society, a child, a parent, a friend, a colleague, or a neighbor, you can contribute to promoting mental health and preventing suicide!

For example, coming together, strengthening civil society, standing alongside one another, and showing solidarity are critically important in preventing suicide! Suicide prevention requires the efforts of many people. It involves families, friends, colleagues, community members, educators, religious leaders, healthcare professionals, political authorities, and governments. Suicide prevention requires integrated strategies that encompass work at the individual, system, and community levels [9].

If you are concerned that someone may be suicidal, you should know the following (WHO) [10]

• Suicide is preventable.

• You can talk about suicide.

• Asking questions about suicide does not cause suicidal behavior. It often reduces anxiety and helps people begin to feel understood.

Warning signs that someone is seriously considering suicide:

• Threatening to kill themselves

• Making statements such as “No one will miss me when I’m gone.”

• Looking for ways to kill themselves, such as pesticides, firearms, or medications, or researching the subject online

• Saying goodbye to close family members and friends, giving away valuable possessions, or writing a will

• Who is at risk of suicide?
• People who have previously attempted suicide
• People with depression or alcohol or drug problems

• People experiencing severe emotional distress following the death of a loved one or the end of a relationship

• People experiencing chronic pain or illness
• People exposed to war, violence, trauma, abuse, or discrimination
• People who have become socially isolated
• What can you do?

• Choose an appropriate time and a quiet place to talk about suicide with the person you are concerned about. Let them know that you are there to listen.

• Encourage the person to seek help from a professional, such as a doctor, mental health professional, counselor, or social worker. Offer to accompany them to an appointment.

• If you think the person is in immediate danger, do not leave them alone. Seek help from emergency services, a crisis helpline, a healthcare professional, or family members.

• If the person you are concerned about lives with you, make sure they cannot access items in the home that they could use to harm themselves, such as pesticides, firearms, or medications.

• Stay in contact with the person to check how they are doing

REMEMBER: If you know someone who is considering suicide, talk to them about it. Listen without judgment and offer your support.

References

1. http://www.psikiyatri.org.tr/basin/545/intihar-onemli-bir-halk-sagligi-sorunudur
2. Öztürk, M. O., & Uluşahin, A. (2014). Ruh sağlığı ve bozuklukları. Nobel Tıp Kitabevleri.
3. Dilbaz, N., & Seber, G. (1993). Umutsuzluk kavrami: Depresyon ve intiharda önemi. Kriz Dergisi, 1(3).
4. Sisask, M.; Värnik, A. Media Roles in Suicide Prevention: A Systematic Review. Int. J. Environ. Res. Public Health 2012, 9, 123-138
5. O’Connor, R. C.; Platt, S. and Gordon, J. (Ed.) (2011), International Handbook of Suicide Prevention Research, Policy and Practice, West Sussex, UK: Wiley-Blackbell Publication
6. COŞKUN, B. (2011). Koruyucu Psikiyatri Açısından Ruh Sağlığının Güçlendirilmesi. Turkiye Klinikleri Psychiatry-Special Topics, 4(4), 110-119.

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This article was first published in a 2020 issue of Bilim ve Ütopya.