People see what papers show! Psychiatry's stint with print media: A pilot study from Mumbai, India.

Mass media including television, internet, and newspapers influences public views about various issues by means of how it covers an issue. Newspapers have a wider reach and may affect the impact that a news story has on the reader by factors such as placement of the story within the different pages. We did a pilot study to see how two English newspapers from Mumbai, India were covering psychiatry related news stories. The study was done over a period of 3 months. We found a total of 870 psychiatry related news stories in the two newspapers over 3 months with the majority of them being covered in the main body of the newspapers. Sex-related crime stories and/or sexual dysfunction stories received the highest coverage among all the news while treatment and/or recovery related stories received very little coverage. It is crucial that the print media takes more efforts in improving reporting of psychiatry-related stories and help in de-stigmatizing psychiatry as a discipline.

INTRODUCTION

Mass media owing to its wide reach influences public views about various issues including psychiatry and psychiatric illnesses. The common man has always been fascinated by mental illness and the mentally ill. The way in which mental illness is covered by various media sources hence, becomes crucial in determining how it is perceived. Mass media has mostly stigmatized mental illness by reinforcing negative stereotypes such as people with mental illness are childlike,[1] antisocial and dangerous to themselves, and the society.[23] Such stereotypes can lead people to believe that mentally ill are “evil” leading to their devaluation and stigmatization.[4]

In terms of news coverage on television, what is covered is as important as how it is covered. Various visuals can psychologically affect the viewer. Similarly in print media, what is covered is as important as how and where it is covered. The placement of the news piece within the newspaper is an important factor that affects how it is read and perceived by the readers.[5] In fact, the placement of certain news stories in the newspaper affects its probability of being read, for instance, stories on the left-hand side of a newspaper were seen significantly earlier than stories on the right hand side by the readers in a study by Hansen.[6] It is also likely that “front-page” placement of news stories may affect the reader more than “other-page” placement. There have been a large number of policies and reforms for educating public about mental illness and for de-stigmatizing psychiatry as a discipline. Recently through television advertisements, (http://www.youtube.com/watch?v=kOm9DwSq5C8 [last accessed 20 July, 2013]) the National Mental Health Program, India[7] has taken an initiative to educate public about mental illnesses so that they see it like any other illness and seek treatment for the same without feeling stigmatized. The relationship between public opinions and media is to some extent bi-directional, with evidence of causal pathway running from negative media coverage to the prejudicial pathway in the public minds.[8]

Most media coverage of mental illness, suicides (both completed and attempted), and sex-related crimes are third party accounts such as information from friends, family, or the reporters’ own version. Currently, there are guidelines for coverage of suicide-related news but not for other psychiatric illnesses. There is no data from the Indian subcontinent regarding how psychiatry-related news is covered in the print media. We conducted a preliminary study to understand this issue. This paper is a cross-sectional study of news coverage related to psychiatry and psychiatric illnesses in two of the most widely read dailies from the city of Mumbai over a period of 3 months.

METHODOLOGY

Two newspapers from the city of Mumbai - Times of India (TOI) and Hindustan Times (HT) were selected and scanned daily over a period of 3 months from April 1, 2013 to June 30, 2013. These two dailies were selected because they are the two most widely read newspapers with TOI ranking first (a readership of 16.2 lakhs) and HT second (a readership of 8 lakhs) in Mumbai; in India TOI has a readership of 76.5 lakhs while HT has a readership of 37.9 lakhs.[9]

The two papers were scanned separately by two authors on a daily basis (TOI-GK; HT-SS) and then each paper was again cross-scanned by the two authors (TOI-SS; HT-GK) to ensure that all related news stories were included in our analysis. The papers were scanned page-by-page to retrieve stories that included any of the following terms: Schizophrenia/psychosis, mood disorder, mental illness with substance use, anxiety, eating disorders, dementia and other geriatric psychiatric illness, childhood psychiatric disorder (including attention deficit hyperactivity disorder [ADHD], conduct disorder, autism, learning disability), suicide/self-injurious behavior (SIB), sex-related crimes (rape, molestation, child sexual abuse) and/or sexual dysfunction, treatment/recovery and rehabilitation, mental health/mental illness, psychiatrist/mental health expert.

We also looked for grouping/clustering of various news items within a single page of the newspaper. For the purpose of our study, we defined “clustering” as the presence of three or more news items on the same page (clustering-others). Clustering related to sexual crimes (clustering-sex) consisted of three or more sex-crime related news items on a single page.

RESULT

A total of 870 news stories were retrieved from the two newspapers over a period of 3 months [Table 1]. About 93.57% of these were in the body of the newspapers while only 6.43% were on the front page. Maximum numbers (68.73%) of items were in the city/region/nation section of the newspaper. Most (97.82%) were news stories, and 2.18% were editorials/correspondence.

Table 1

Coverage of psychiatry related news stories in various sections of newspapers

The highest number (n = 455; 52.29%) of stories in these two dailies were on sex-related crimes and/or sexual dysfunction. Overall for our study duration, front pages of both the newspapers covered most items (n = 30) on sex-related crimes and/or sexual dysfunction. It is also worthwhile to note here that although these two categories were clubbed together, there were just 2–3 stories that covered sexual dysfunction and the rest covered sex-related crimes.

Schizophrenia/psychosis comprised only 0.22% of the total stories (n = 2) while depression comprised a slightly higher 5.74% (n = 50) of the total stories. Mental illness associated with substance use was covered in just three stories during the duration of our study. Anxiety disorders comprised 2.06% (n = 18) of the total psychiatry-related stories and were mostly covered in the lifestyle section of the newspapers. Eating disorder was hardly covered with just one story in the global/international section.

Dementia and geriatric psychiatric illness formed 1.14% of the total stories (n = 10) with maximum coverage being in the international/global section (n = 7). Childhood psychiatric disorders were covered in 1.72% (n = 15) of the total stories with the most coverage being given to learning disability and ADHD.

There were 20.22% (n = 176) stories on SIB. Of these 18 stories were on the front page with the rest being covered in other sections of the newspapers.

Treatment, recovery, and rehabilitation was very rarely covered with only 1.03% (n = 9) of related news being on this issue. About 4.48% (n = 39) stories made a mention of the person in the story being mentally ill or having some mental health issues without specifying the diagnosis of the person. A mental health expert was quoted in 7.93% (n = 69) of the total stories.

Clustering was more commonly seen with sex-related crime stories (n = 17; 1.95%) and less commonly with other psychiatric illnesses (n = 6; 0.689%). With sex-related crime stories, clustering was seen almost exclusively in the city/region/nation sections of the newspapers. Mental illness was linked to crime in just one news story during the duration of our study.

DISCUSSION

Our study looks at the coverage of news stories related to psychiatry and psychiatric illnesses in two major dailies of Mumbai, India. With a total of 870 stories retrieved over a period of 3 months, it is impressive how the print media is paying attention to psychiatry and related news stories.

Around 24 million people worldwide are affected with schizophrenia.[10] Despite this, we found only 2 stories on schizophrenia and psychosis in the international section of the newspaper. With this minimal coverage, it is clear that schizophrenia is not forming a major part of story material for the media. Media including films have often falsely portrayed schizophrenia in a negative light giving an impression that the patient is mostly violent and absurd.[11] There is thus a probability that media selectively looks out for schizophrenia-related stories that have an element of violence and absurdity in it, without which the stories are not covered and hence the lesser number of stories in our study. A similar picture was seen in the coverage of depression and mood disorders with very few stories being covered, despite the fact that there is a rise in cases of depression and mood disorders worldwide.[12] Moreover, most stories of depression in our study were linked to suicide stories, which reflect the fact that depression is the most common psychiatric illness in suicide cases.[13]

In recent times, there is a growing interest in the co-occurrence of mental illness and alcohol or other drug use. Alcohol and other drug use has been associated with mental illness, but a complete understanding of this co-morbid condition in not yet completely clear. A meta-analysis by Reddy and Chandrashekar,[14] revealed an overall substance use prevalence of 6.9/1000 for India with urban and rural rates of 5.8 and 7.3/1000 population, respectively. Though anecdotal experience shows that this is a common co-morbidity in clinical populations within India, in our study, we found that there were only three stories that covered this issue, thus making coverage on this issue minimal. Anxiety disorders can consist of brief episodic anxiety due to a stressful event like public speaking to a chronic disorder lasting over 6 months. In our study, most coverage of anxiety was in the lifestyle section of the newspapers. This section, read by a large number of readers, covers a wide range of issues including but not limited to exercise, diet, personal care and hygiene, physical and mental fitness, dating and relationships, and personality. Anxiety being mostly covered in this section can be viewed as media's efforts in normalizing the experience of anxiety, thus increasing awareness in the readers. Media coverage of slim models and their effect on the general public, who then try to have slimmer bodies, has always been a topic of discussion. During the 3 months of our study, we came across a single story of a celebrity dying of anorexia nervosa covered in the international section. This reflects the fact that eating disorders are rarely seen in developing countries but are more common in the developed nations.[15]

Dementia was the most common elderly psychiatric disorder covered in the stories on geriatric psychiatric disorders. Most of these stories were related to research and newer developments in dementia. There was not enough coverage for childhood psychiatric problem in the newspapers in our study. Among those covered, autism and the rights of these children in various schools found wider coverage. Recently, there has been an increased awareness of learning disability and autism in children in India and their rights in mainstream education, which is reflected within the news stories.

Over 170 stories were on suicide and self-injurious behaviors with 18 stories being on the front page. Such placement of suicide stories on the front page is likely to influence readers since it increases the prominence of the story,[16] and is also against the international guidelines for suicide reporting in media.[17]

With over 450 stories on sex-related crime and/or sexual dysfunction, it is obvious that the print media is paying more attention to such news stories. In the covered stories, we could hardly find any mention of related laws and punishment for such crimes. Moreover, there was more grouping of such stories together (clustering) with some pages covering up to 6 different sex-related crime stories. Such high coverage including a higher clustering of sex-related crime stories is not appropriate, as it may negatively affect the readers and is likely to lead to the over-inflated perception of such crimes. Overall, it was observed that the newspapers were sensationalizing stories related to suicide and sex crime. The print media should instead pay more attention to make a mention of helpline numbers in suicide stories and laws and punishment in sex-related crimes.

There was very little coverage of stories related to treatment and recovery in psychiatry. These stories frequently occurred in the international section. Psychiatric illnesses are mostly treatable,[18] and the media can play an important role in educating public about psychiatric illnesses and their treatment. This could be achieved through mental-health expert opinions and covering short stories of treatments and recoveries in psychiatric patients. Though mental health expert opinions and quotes were found in 70 stories in our study, it is still a very small number. Nevertheless, it is encouraging enough to see that the media is turning to more expert opinions in their stories thus increasing their credibility. Experts can help by providing explanations, evaluations, and recommendations on various issues related to the news stories.[19] Advocacy efforts could be aimed at encouraging journalists in spreading public awareness by providing specific information about the illness, available treatment and how to seek services.

The majority of previous research has suggested that themes related to crime and violence are common in the coverage of mental illness by news media.[20] However in our study, we found only one news item where a serial killer was described as mentally ill. This is encouraging as it shows a shift from the stereotyped killer-psycho mentality that is usually portrayed in the media.

Limitations

Out study was limited by the fact that we used a set of keywords and search terms to identify news stories to be included. Although these terms were broad based and covered most psychiatry-related issues, some stories might still have been missed. A separate study to compare the output with different search terms may be helpful. We selected two most widely read newspapers in Mumbai both being in English. It is highly likely these are read by only a section of the population. A different study including more newspapers from the entire country may give a complete picture. Newspapers are a part of the larger mass media that also includes television, radio, and the internet. We, however, did not include these sources and focused only on newspapers and that took over a period of 3 months. Future research efforts need to include these sources as well and need to be done over a longer period of time to understand the trends of media reporting of psychiatry-related news stories. Finally, we did not look at whether these news items covered the stories in a positive or a negative light and how they affected the readers. It is important to see how readers interpret print media messages and how these interpretations inform their attitudes and beliefs.

CONCLUSION

Psychiatry and psychiatric illnesses have always found a place within media including news stories in television or newspapers and films. Viewers and readers pay closer attention to such stories since they are often sensationalized by the media. The current study is a preliminary study that looks at coverage of psychiatry-related news stories in two of the most widely read English newspapers from Mumbai, India. It was seen that psychiatry-related stories did form an important part of the entire news though there was much more attention paid to sex-related crime stories that added an element of sensationalism to the newspapers. There were some instances where mental health experts were quoted in the stories, although the number was relatively small but encouraging. In the future, one needs to look into deeper aspects of such news coverage including positive or negative coverage and their effects on the attitudes of the readers.