Impact of Celebrity Suicide on Population Mental Health: Mediators, Media, and Mitigation of Contagion.

Sir,

Celebrity suicide has a negative impact on public health, chiefly by its potential to trigger suicide contagion (Werther effect) among vulnerable individuals. These effects are accentuated by detailed and imbalanced media portrayals of celebrity suicide, a prevalent and concerning practice in Asia.[1]

Questions remain on the potential drivers of this observed vulnerability to imitative suicidal behavior. Below, we offer some insights into mediators of suicide contagion following a celebrity suicide and propose suggestions from a preventive standpoint.

Pre-existing psychiatric morbidity or maladaptive cognitions: Pre-existing vulnerability could be due to a combination of biological and psychosocial factors. Evidence from both retrospective[2] and prospective[3] studies suggest that prior psychological distress, depression, or anxiety symptoms and history of negative life events, such as being abused or having interpersonal conflicts, may moderate the effects of celebrity suicide. Other factors that may mediate the vulnerability include severe mental illness, substance use disorders, and chronic pain disorders; the latter has been associated with both suggestibility and suicidality.[4]

Excessive identification and idealization: Celebrities enter the public psyche through many forms of media and networking. All these contribute to their larger than life image and may result in their idealization by certain subgroups. When such individuals die by suicide, it becomes a deeply triggering event, and explicit media portrayals of suicide can further increase the emotional impact and trigger suicide contagion.[5] This is particularly the case for individuals who excessively identify themselves with the deceased. However, idealization is neither necessary nor sufficient for suicidality. As an example, suicides in celebrities whom one might not necessarily like or admire can also trigger a contagion.

The role of peer integration: Following a celebrity suicide, increased discussion with peers and misinformation may ensue; this may amplify feelings of loss, particularly for those who closely identify themselves with the deceased. These assertions are indirectly supported by evidence from retrospective studies[2] and the Foxconn suicides,[6] in which temporal clustering of suicides occurred in a single organization. This suggests that contagion could occur even in highly cohesive environments.

Public image and influence of the celebrity: A study that examined the effects of news about the suicide of a politician celebrity and that of an entertainment celebrity on subsequent suicide rates found that suicide of the entertainment celebrity had a more acute impact in the short term and that its effects extended for a longer period.[7] The authors speculated that this was because of the greater emotional connectedness that the public may feel for an entertainer than a political figure and because the entertainer’s death received more widespread media coverage.

Social and community factors: Factors that may be operating here include social learning, modelling, and social facilitation, wherein a person’s internal constraints may be overcome by observing the actions of others. These phenomena also overlap with suicide theories of Durkheim, who emphasized the role of social integration and regulation in triggering imitative suicide. Finally, reactionary social media posts following a celebrity suicide have also been found to activate suicide contagion;[8] this association may also be explained by social learning and facilitation.

Increase public awareness about the negative impact of celebrity suicide (universal strategy): Here, the media can play an important role and raise awareness by including educational or preventive information, such as the possibility of suicide contagion, when covering a celebrity suicide.[5]

Responsible media reporting of celebrity suicide (selective strategy): Specific aspects that need to be avoided by the media while reporting celebrity suicides include a description of the suicide method, the inclusion of photographs of the deceased, and prominent placement of the report; all of which violate international suicide reporting recommendations[9] and have the potential to trigger a contagion.[5] Available Indian guidelines for media suicide reporting include those by the Press Council of India[10] and the position statement of the Indian Psychiatric Society[11]; these must be adhered to in letter and spirit.

Early identification and monitoring of vulnerable individuals (indicated strategy): One of the ways to achieve this is to periodically screen individuals identified as vulnerable by family or society. Harnessing the potential of artificial intelligence approaches, such as machine learning techniques, to screen, identify, and monitor vulnerable groups in this context, such as adolescents based on their social media posts, can be a viable and less resource-intensive method.

Positive thinking and promoting positive mental health approaches: Media stories focusing on the positive aspects of the deceased celebrity and developing positive definitions of him/her (such as “Mrs X was a strong and independent woman”) have been found to facilitate imitative suicidal behavior in the same gender.[7] Consequently, media must consciously avoid highlighting positive aspects of the deceased in reporting the celebrity suicide to reduce the likelihood of contagion.

Postvention activities: This should be directed at family and close relatives of the deceased celebrity. In addition, vulnerable individuals, such as adolescents and teenagers, could also be targeted through postvention activities in schools.