Media Matters in suicide - Indian guidelines on suicide reporting.

The Press Council of India chaired by Justice C.K. Prasad, in a release dated September 13, 2019, has adopted guidelines on reporting on suicides, based on the WHO guidelines. It states that newspaper and news agencies while reporting the cases of suicide must NOT:

Place stories about suicide prominently and unduly repeat such stories

Use language which sensationalizes or normalizes suicide or presents it as a constructive solution to problems

Explicitly describe the method used

Provide details about the site/location

Use sensational headlines

Use photographs, video footage, or social media links.

The WHO report on suicide (2014)[1] states that the sensitive portrayal of suicide in media is an important suicide prevention strategy.

The impact of sensational reporting of suicide and the subsequent increase in suicide rates was first studied by Philips.[2] He found suicide rates to be higher in the months where the U.S press had front-page articles on suicide, compared to months where there were no such articles. He coined the term “Werther effect.”

The term has its origins in Goethe's 1774 novel “The Sorrows of Young Werther,” which was loosely based on a love affair in his own life. The novel depicts a young man called Werther who falls in love with a woman whom he cannot marry because she hails from higher strata and was already engaged. As a consequence, Werther takes his own life. When the book was released in Europe, a series of suicides followed, and there was strong evidence that the book had influenced a number of individuals in their final act. Some were dressed in a similar fashion to Werther, some used a pistol to take their own lives just as Werther had done, and some were found with a copy of the book at the scene of their death. Hence, the book was banned.

Since Phillip's study,[2] there have been numerous studies which have confirmed the association between reporting of individual suicides in the news media and an increase in suicide rates.

Pirkis and Blood[3] conducted a systematic review of relevant studies and identified 77 that related to traditional news and information media and suicide rates. Sisask and Värnik[4] undertook a similar review in 2012, and using stricter criteria for the selection of studies, identified 56. Both the reviews concluded that there is strong evidence for the Werther effect operating through traditional news media. The impact is usually at a maximum shortly after the report and levels off after 2 weeks,[5] although sometimes it lasts longer.[6] It is facilitated by prominent coverage and repetition of stories.[7] It is accentuated when the person described in the story is a celebrity[8] and/or when he or she and the reader or viewer are similar in some way.[910] Particular subgroups in the population, especially those with depression and youth, may be especially vulnerable to engaging in imitative suicidal behaviors.[1112] Finally, and perhaps most importantly, an overt description of suicide by a particular method may lead to increases in suicidal behavior employing that method.[13]

Sinyor et al.[14] studied 6367 articles with suicide as a major focus and found that elements most strongly associated with increased suicides were suicide method, a headline which included suicide, inevitability of suicide, and suicide pacts.

There are very few studies about newspaper reporting of suicide in India. Chandra et al.[15] reported that the method of suicide was reported in 89% and 32% of reports where in prominent pages of the newspaper. Armstrong et al.[16] undertook a content analysis of nine major newspapers in Tamil Nadu. They showed that harmful reporting practices of suicide were common (43.3%), while helpful practices were rare (2.5%).

Considering the mounting evidence, many countries around the world have developed media guidelines on reporting of suicide. The WHO and International Association for Suicide Prevention developed a set of international guidelines.[17]

SUICIDE AND NEWER MEDIA

There has been a proliferation of pro-suicide websites. These websites typically describe suicide methods (e.g., provide details of doses of medication that would be fatal in overdose) and provide social media forums for suicidal individuals. Some implicitly or explicitly encourage suicide pacts.[18] A systematic review[19] found that the Internet and social media use were associated with self-harm by adolescents. A recent study in Australia that found that suicidal individuals who used the Internet for suicide-related purposes were more severely suicidal (i.e., more likely to indicate that they would carry out a suicidal act in the future) than suicidal individuals who did not use the Internet in this way.[20]

The recent Netflix series, 13 Reasons Why - is a fictional story of a teenage girl who leaves behind 13 media recordings on tapes after taking her life. The end of her life is portrayed in great detail. Niederkrotenthaler et al.[21] showed that there was a significant increase in adolescent suicides in the U.S, particularly in young girls after the series.

There have been few impact and outcome studies on media guidelines. Michel et al.[22] demonstrated that the implementation of media guidelines in Switzerland led to less sensational and higher-quality reporting. Etzersdorfer et al.[23] demonstrated that the introduction of media guidelines regarding reporting suicides on the Viennese subway not only resulted in a decrease in the rate of subway suicides but also 20% decrease in the overall suicide rate.

Recently, there has been an attempt to determine whether certain features of stories about suicide in traditional media might be associated with a decrease in suicidal acts. Niederkrotenthaler et al.[24] conducted a content analysis of nearly 500 Austrian newspaper stories and identified four classes of stories: (a) the suicide case class which tended to report on cases where individuals had taken their own lives; (b) the mastery of crisis class which tended to report cases where individual had overcome a suicidal crisis; (c) the epidemiological fact class which provides information about research into suicide or statistics; and (d) the expert opinion class, providing information about suicide, supporting services, etc. They found that reports that fell into the mastery of crisis class were negatively associated with suicide rates (there was a marked decrease in the suicide rate following these stories). They took this as evidence that such stories have a positive impact, presumably because they model an adaptive response to adverse circumstances rather than implying that suicide may be a solution.

They coined the term “Papageno effect” to describe this positive phenomenon. Papageno is a character in Mozart's opera “The Magic Flute” who becomes suicidal because he fears losing his true love, Papagena. He is about take to own life when three boys come to his rescue, offering him alternatives and he changes his decision.

The press council release is likely to prompt news reporters to seek psychiatrists for their expert opinion. Hence, it is may be useful for them to have a template ready with the local suicide rates, multicausality of suicide, the role of mental disorders in suicide, and local sources of help.

Overcoming challenges in implementing the Press Council's guidelines requires active collaboration between media personnel and mental health professionals. Further, a monitoring mechanism has to be initiated to ensure that the guidelines are followed.

The guidelines on media reporting of suicide are likely to have a greater impact if they are embedded in a broader national strategy to prevent suicides.