Suicide and the media. Part I: Reportage in nonfictional media

Numerous studies have considered the association between media reporting and portrayal of suicide and actual suicidal behavior or ideation. This review considered 42 studies that have examined the nonfiction media (newspapers, television, and books). Consideration was given to the extent to which inferences could be made about the relationship between portrayal of suicide in the given media and actual suicidal behavior in terms of: the strength of its association; and the extent to which it could be considered causal. The review demonstrated that there is an association between nonfictional media portrayal of suicide and actual suicide. The association satisfies sufficient of the criteria of consistency, strength, temporality, specificity and coherence for it to be deemed causal.     

The privilege and responsibility of suicide prevention

Each year about a million people worldwide take their lives, and a further unknown number, but probably no less than 20 million, attempt suicide. In addition, for every person who engages in suicidal behavior, another five or six will be associated with them in some way, making a conservative total of 100 million people worldwide who are affected each year--and to whom we have some degree of responsibility. There is no one approach to suicide prevention, and probably more so than for any other human condition, we are privileged to be able to collaborate with many different disciplines in our endeavors. However, there is a considerable responsibility to ensure that whatever our own area of expertise and interest may be, we should apply universal principals of objective analysis to these diverse contributions. This is addressed by examining research from four broad areas. First, there are studies that irrevocably bring together the sociological and biological approaches to suicide. Second, there are reports that support the notion of the universality of suicide. Third, despite considerable attention paid to the media, its influence on suicide is very limited. And finally, although there have been pessimistic reviews, there are persuasive data from innovative research designs that have documented that we can prevent suicide.     

Maytree: A respite center for the suicidal: an evaluation

This paper evaluates the contribution to suicide prevention made by an innovative project, Maytree, a respite center for the suicidal. Maytree offers a distinctive brief period of sanctuary for four nights for suicidal people; within this limited time it aims to provide opportunities through talking, reflecting, and relaxing for reducing the intense feelings that lead to suicidal behavior. The focus of this paper is on evaluating the first 3 years of Maytree's operation, exploring how Maytree works, and its effects on the people who stay there as "guests". This shows that Maytree reaches people who are at significant risk of suicide. Guests report both short term relief and longer term benefits. These changes are understood, through applying crisis intervention theory, as being generated by the opportunities for change in the Maytree approach. Thus, there is the potential for a benign cycle to be established. Maytree's model is different from that of mainstream, statutory services; we conclude that Maytree complements these services and also challenges the values and frameworks of statutory provision in the field of suicide prevention.     

Social modeling in the transmission of suicidality

Evidence from twin, adoption, and family studies suggests that there is strong aggregation of suicidal behaviors in some families. By comparison, the role of social modeling through peers has yet to be convincingly established. This paper uses data from four large studies (the WHO/EURO Multicentre Study on Suicidal Behaviour, the WHO/SUPRE-MISS, the CASE study, and the Queensland Suicide Register) to compare the effects of exposure to fatal and nonfatal suicidal behavior in family members and nonfamilial associates on the subsequent suicidal behavior of male and female respondents of different ages. Across all studies, we found that prior suicidal behaviors among respondents' social groups were more important predictors of suicidal behavior in the respondents themselves than previous research had indicated. Community-based suicide attempters in the WHO SUPRE-MISS had higher rates of exposure to prior suicide in nonfamilial associates than in family members. In an adolescent population, exposure to prior fatal suicidal behavior did not predict deliberate self-harm when exposure to nonfatal suicidal behavior (both familial and social) were controlled for, but exposure to nonfatal suicidal behaviors in family and friends was predictive of deliberate self-harm and suicide ideation, even after controlling for exposure to fatal suicidal behavior. The potential impact of "containment" of information regarding suicidal behaviors as a prevention initiative is discussed, in light of information behavior principles of social marketing.     

Suicide among indigenous peoples: the usefulness of the Human Relations Area Files

The present note describes the resource for studying suicide in indigenous peoples provided by the Human Relations Area Files and describes three ways in which these files can illuminate suicidal behavior: testing theories of suicide, exploring the linguistics of suicide, and challenging myths about suicide.     

Child and adolescent survivors of suicide

Suicide in a family is distressing for each and every member. Children and adolescents bereaved by suicide are known to be more at risk of suffering from a variety of psychiatric problems, especially affective disorders. A group of children and adolescents who experienced a suicidal death in the family were assessed for psychiatric problems as well as for social adjustment. The findings suggest that the bereaved children and adolescents are at elevated risk for major depressive disorder, posttraumatic stress disorder, and impaired social adjustment.     

Suicide in developing countries (3): prevention efforts

Until now, suicide prevention efforts have been limited in developing countries, although there are pockets of excellent achievement. Various universal, selective, and indicated interventions have been implemented, many of which target a different pattern of risk factors to those in developed countries. In the absence of sufficient mental health services, developing countries rely heavily on nongovernment organizations (NGOs) to provide crisis interventions for suicidal individuals, as well as proactive interventions aimed at raising community awareness and building resilience. Often these NGOs work within a social and public health framework, collaborating with others to provide nested suicide prevention programs that are responsive to local community needs. There is a clear need to develop appropriate, relevant and effective national suicide prevention plans in developing countries, since, to date, only Sri Lanka has done so. These plans should focus on a range of priority areas, specify the actions necessary to achieve positive change in these priority areas, consider the range of collaborators required to implement these actions, and structure their efforts at national, regional, and local levels. The plans should also promote the collection of accurate data on completed and attempted suicide, and should foster evaluation efforts.     

Suicide and the media. Part II: Portrayal in fictional media

The association between the portrayal of suicide in fictional media and actual suicide has been debated since 1774, when it was asserted that Goethe's The Sorrows of Young Werther had led people to take their own lives. Since that time, a plethora of studies considering the association has been conducted. This review considered 34 studies examining the impact of fictional portrayal of suicide (in film and television, music, and plays) on actual suicidal behavior. It asked the question: "Is there any association, and if so, can it be considered causal?" Using strict criteria to establish causality, we found that the evidence was more equivocal than was the case for nonfictional reporting.     

Beyond risk theory: suicidal behavior in its social and epidemiological context

The effect of exposure to risk factors for suicidal behavior varies from place to place and from period to period. This may be due to contextual influences, which arise if individuals' suicide risk depends not only on their personal exposure to risk or protective factors, but also on how these are distributed in their social, cultural, economic, or even physical environments. There has been relatively little explicit attention in suicide research for such contextual influences even though they are an important component of the cross-level bias, which can arise when aggregate level associations are assumed to also apply in individuals and vice versa. Contextual effects are conceptually related to the issues of social selection vs. causation, population density, and network effects. Because of a lack of prospective multilevel research, it is unclear exactly which mechanisms underlie the phenomenon that the distribution of risk factors in an individual's context may affect their suicide risk above and beyond their personal exposure. A number of mechanisms, like deviancy amplification, formalization of restraints, and buffering effects of social support are proposed. Contextual effects may result in a concentration of suicide risk in persons when the risk factors they are exposed to become rare--whether spontaneously or through focused prevention. This has important but mostly overlooked implications for population-based prevention strategies.     

The pattern of suicide in Pakistan

There is paucity of information on suicide from Pakistan, an Islamic country in which data collection poses formidable challenges. A variety of social, legal, and religious factors make reporting and diagnosing suicide difficult. Paradoxically, incidents of suicide are regularly reported in newspapers in Pakistan. In the absence of other means these reports serve a useful, though basic information source for suicidal deaths. A 2-year analysis of all such reports in a major newspaper in Pakistan showed 306 suicides reported from 35 cities. Men (n = 208) outnumbered women by 2:1. While there were more single than married men, the trend was reversed in women. The majority of subjects were under 30 years of age and "domestic problems" was the most common reason stated. More than half the subjects used organophosphate insecticides, while psychotropics and analgesics were used infrequently. The study challenges the widely held belief that suicide is a rare phenomena in an Islamic country like Pakistan, and underscores the need for more culture specific research on this important public health problem.     

Gender and cultural patterns of suicidal behavior: young Hindustani immigrant women in the Netherlands

Patterns of suicidal behavior vary among cultures and along gender. Young Hindustani immigrant women attempt suicide four times more often than young Dutch women. This article explores multi-disciplinary explanations for suicidal behavior in this group. The interconnection of Durkheimian concepts of social integration and regulation with ecological insights into family relations and psychological and psychiatric theories on individual distress are relevant. It is suggested that young Hindustani women who display suicidal behavior possess certain personality and cognitive constellations that are interlocked with specific parenting styles in stressful family environments. These families are embedded in a context of moral transformations resulting from migration to a Western culture and may be facing difficulties accompanying the transitional processes encountered in the West, particularly those regarding gender roles. Durkheimian fatalistic and anomic suicides elucidate this. The Hindustani women who appear most at risk are those facing contradictory norms and overregulation, which prevent them from developing autonomy.     

The phenomenon of suicide bombing: a review of psychological and nonpsychological factors

This article reviews the literature on the phenomenon of suicide bombing. It addresses the question of just how much a psychological understanding of the individuals involved can aid in prevention. The article looks at historical, epidemiological, and cultural perspectives and compares the nonpsychological and psychological approaches to suicide bombing. On the basis of the material available it seems that social processes such as group-dynamic indoctrination and political factors are decisive in analyzing this problem. Cultural, nationalistic, and religious factors are important. The conclusion is that in suicidal bombing, suicide is instrumental in the context of war, not in the context of psychopathology. Suicide bombing is instrumental in realizing fatalities, and it is only one of many weapons. The act of killing in warfare is more important to understanding suicidal terrorism than the act of suicide. This explains why psychological profiling of suicidal terrorists has to date not been successful.     

Understanding self-harm and suicide websites: a qualitative interview study of young adult website users

Self-harm and suicide websites have been heavily criticized both in the literature and the wider media, despite the fact that very little is known about them. To date, no study has interviewed users of these sites about them. This qualitative study aims to explore the accounts of young adults who engage in self-harming and suicidal behaviors and use websites dedicated to these issues, in order to develop a broader understanding of these websites and to identify potential implications for future research. In-depth interviews were conducted via e-mail with 10 participants, who were recruited directly from self-harm and suicide websites. Using discourse analysis, we identified three main ways in which participants wrote about the sites. They constructed them as sources of empathy and understanding, as communities, and as a way of coping with social and psychological distress. These discourses gave users access to important, socially valued identities, such as being understood, belonging to a community and coping with their problems. If health professionals and researchers hope to understand people who use self-harm and suicide websites, and engage them in their services, they must take a more balanced view and not focus solely on the possible risks associated with using such sites.     

Suicide prevention: a pragmatic review of recent studies

Because of the almost complete absence of randomized controlled trials demonstrating the effectiveness of specific treatments, there is sometimes a degree of pessimism about our ability to prevent suicidal behaviors. However, the methodological challenges to produce such research are formidable and may never be overcome. Therefore, a pragmatic review of evidence-based methods of suicide prevention is required. This review of recent studies using a variety of research strategies, both nonpharmacological and pharmacological, particularly at the community level, provides persuasive data that suicide prevention is possible. This is achievable by the application of broad community and professional education programs, as well as by the optimum management of mental disorders.     

Suicide to harass others: clues from mythology to understanding suicide bombing attacks

Suicide by revenge, the Samsonic suicide, and the suicide by devotio, all described in classical mythology and also reported in the ethnographic literature, belong to the same class of suicidal behaviors as kamikaze suicide and the suicide bombing attack: suicide to harass and burden others or suicide with a hostile intent. The lack of a social dimension to share in a positive manner may lead an individual to integrate him/herself in another social structure, e.g., a military organization, which allows the individual to express his/her desires and personal identity only by destroying others and themselves. The dynamics of these forms of suicide are also likely to work in other displays of life-threatening behavior, such as family annihilation, mass murder, and spree killing. A more thorough investigation of the dynamics operating in suicide bombing attacks could, therefore, contribute to preventative strategies against violence at large.     

Suicidal behavior in patients diagnosed with cancer of the cervix

There is a paucity of literature on suicide and cancer, especially cancer of the cervix. This study reports on suicidal behavior in these patients. The sample consisted of adult, black, Zulu-speaking women from palliative and radical oncology treatment groups who volunteered for the study. There were more patients in the palliative group who were younger, and had a more significant delay between cancer symptom presentation and seeking oncology treatment. Patients experienced: significant depression, anxiety, stress, hopelessness/helplessness, anxious preoccupation about their disease, poor current or delayed social support, feelings of being a burden to their significant others, beliefs that they would be better off dead, perceptions that they were stigmatized by society or that their communities suspected them of being HIV-AIDS positive, and suppressed anger. More patients in the palliative, compared to the radical treatment, group were inclined toward suicidal ideation with serious intent. Overall, most patients coped inadequately with their disease and its management. These patients are a high risk group for suicidal behavior and should be identified in time for appropriate psychological intervention.     

Familial study of suicidal behavior among adolescents in Slovenia

The number of adolescents who attempt or complete suicide is increasing. Risk factors range from mental disorders, to problems at school, family problems, or difficulties in establishing relationships. A further important, and too often underestimated, risk factor for adolescent suicide is the presence of suicidal behavior in the adolescent's family. We investigated 184 high school adolescents in a region in Slovenia with a high suicide rate (30/100,000/year). They were questioned by means of an anonymous questionnaire about the presence of suicidal behavior in their relatives and about the presence of suicidal thoughts, plans, and acts in themselves. The results revealed that 13% of the adolescents studied had a relative who had attempted suicide and a further 9% of the adolescents had lost a relative due to suicide. About half of all females and almost a third of males had had suicidal thoughts (differences between sexes were statistically significant: chi2 = 6.13; p < .01). Attempted suicide among relatives was positively correlated with the presence of suicidal plans among adolescents (phi = 0.15; p < .05). This correlation proved to be even stronger and statistically more significant in men when we split the sample by gender. All variables (suicidal thoughts, suicidal plans, and suicide attempts) in the adolescent males positively correlated with attempted suicide among their relatives ((phi = 0.28, p < .01; phi) = 0.26, p < .05; phi = 0.34, p < .01; respectively). Our results speak in favor of a higher risk of suicidal behavior among adolescents with suicidal behavior in their families.     

A pilot study of the suicide victim's last contact with a health professional

Suicide victims frequently have contact with health care professionals in the months before death. The primary aims of this pilot psychological autopsy study were to determine the feasibility of undertaking a full study and to describe the characteristics of the last health care professional contacts with suicide victims aged > 34 years. We interviewed the informants of 52 suicides. Interviews were obtained from 37 health care professionals who had contact with 28 of the suicides during the 3 months before death. The primary reasons for the last contact with the health care professional were mental health (62%), physical health (22%), and social (14%). 87% of health care professional contacts occurred within 1 month of death. Symptoms of depression were noted in 49% of health care professional contacts. Consensus psychological autopsy diagnoses of depression were made in 64% of suicide victims. Overall suicide risk was assessed by 38% of health care professionals during their last contact. This was more likely to occur when the deceased presented as depressed, was aged < 60 years or seen by a psychiatrist. None was assessed to be suicidal. The family informants regarded nine of the suicide victims to have been suicidal before death but informed a health care professional in only one third of the cases. Critical information that might have altered the management is not often accessed from family members.     

Remarks by Mary McAleese, President of Ireland made at the International Association of Suicide Prevention XXIV Biennial Conference, August 31, 2007, Irish National Events Centre, Killarney, Co. Kerry, Ireland

Reducing suicide rates requires a collective, concerted effort from all groups in society: health, social services, other professionals, communities and community leaders, voluntary and statutory agencies and organizations, parents, friends, neighbors, and individuals. It also requires the careful nurturing of a culture in which people in psychological distress don't hesitate to seek help from family, friends, health professionals and community leaders, a culture that recognizes the signs and signals of distress and is willing to help, and that focuses early in life on developing good coping skills and avoiding harmful practices; in short, a sensitive culture that cherishes human courtesy and takes responsibility for our own mental health and the mental health of others. Suicide occurs in many diverse contexts but there are recurring patterns and elements that research is revealing to us. The more we are learning, the better we are able to devise strategies and take action. We already know, for example, that alcohol abuse plays a very significant role in suicide and features prominently in youth suicide. Research has also established that cannabis increases the risk of depression and psychosis and that it reduces normal inhibitions against suicide. Since marijuana is the illegal drug most used by those under25 years of age, a critical factor in suicide prevention must be to inform young people as to its danger and counter the erroneous impression that it is a benign substance. We know that bullying sometimes features in the story of suicide. Our young people need to know just how damaging, just how unacceptable, bullying is. Education and access to support structures - whether at work, school, or home - are an essential part of protecting the victim of bullying not just from the bully but from their own downward spiral into suicidal thoughts. A less discussed but nonetheless important issue worth raising is the issue of dealing with sexual identity. Although Ireland is making considerable progress in developing a culture of genuine equality, recognition, and acceptance of gay men and women, there is still an undercurrent of both bias and hostility which young gay people must find deeply hurtful and inhibiting. For them, homosexuality is a discovery, not a decision, and for many it is a discovery which is made against a backdrop where, within their immediate circle of family and friends as well as the wider society, they have long encountered antigay attitudes which will do little to help them deal openly and healthily with their own sexuality.