Suicide Contagion Research Articles

16.1 The Tool for Evaluating Media Portrayals of Suicide (TEMPOS): A Novel Tool for Reducing the Risk of Media-Influenced Suicide Contagion

16.1 The Tool for Evaluating Media Portrayals of Suicide (TEMPOS): A Novel Tool for Reducing the Risk of Media-Influenced Suicide Contagion

77.4 Who Is Most Vulnerable?

The objectives are to: 1) identify possible risk factors seen in suicide clusters; 2) understand current data on who is most susceptible to this contagion effect via social media; and 3) propose possible risk factors based on clinical experience.

SOCIAL MEDIA CONTAGION: A PARALLEL PANDEMIC?

This session aims to facilitate the following learning objectives: 1) to review the literature about mental health contagion and compare and contrast the phenomena we are seeing currently with tics, ASD, and dissociative identity disorder (to name a few) with suicide and self-harm contagion; and 2) to share our clinical experiences with these phenomena, identify the gaps in our knowledge and training, and propose next steps for child and adolescent psychiatrists.

Impact of Celebrity Suicides on mental health of vulnerable population

Suicide is culminating into a grave public health concern. Approximately 800,000 people worldwide commit suicide annually, with 3/4th owing to low- middle-income countries.(1) In 2016, the suicide rate in India was 16.5, exceeding the global average of 10.5/1,00,000.(1) Suicide is the deliberate ending of one's own life(2) and primarily done due to persistent sense of despair, depression, drug misuse, and various personal and financial stress factors. One such trigger is suicide by an eminent figure, also known as werthering effect, modelling effect, or copycat suicide. This phenomenon commonly affects the adolescent and younger adults. In India, the 15-29 age group were found most vulnerable.(1) Nearly 5% of consecutive suicides occur after a celebrity death primarily among young, female, and unemployed without being prompted by adverse life circumstances.(3) Given the global gravity of suicide and India's contribution to it, it is critical to identify the psychopathology and risk factors behind it.

Racial Disparities in Spatial and Temporal Youth Suicide Clusters.

Deaths by suicide correlate both spatially and temporally, leading to suicide clusters. This study aimed to estimate racial patterns in suicide clusters since2000. Data from the US National Vital Statistics System included all International Classification of Diseases, Tenth Revision (ICD-10)-coded suicide cases from 2000-2019 among American Indian/Alaska Native (AI/AN), Asian/Pacific Islander (A/PI), Black, or White youth and young adults, aged 5-34 years. We estimated age, period, and cohort (APC) trends and identified spatiotemporal clusters using the SaTScan space-time statistic, which identified lower- and higher-than-expected suicide rates (cold and hot clusters) in a prespecified area (150 km) and time interval (15 months). We also calculated the average proportion of deaths by suicide contained in clusters, to quantify the relative importance of spatiotemporal patterning as a driver of overall suicide rates. From 2010-2019, suicide rates increased from between 37% among AI/AN (95% CI= 1.22, 1.55) to 81% among A/PI (95% CI= 1.65, 2.01) groups. Suicide clusters accounted for 0.8%-10.3% of all suicide deaths, across racial groups. Since 2000, the likelihood of detecting cluster increased over time, with considerable differences in the number of clusters in each racial group (4 among AI/AN to 72 among White youth). Among Black youth and young adults, 27 total clusters were identified. Hot clusters were concentrated in southeastern and mid-Atlantic counties. Suicide rates and clusters in youth and young adults have increased in the past 2 decades, requiring attention from policy makers, clinicians, and caretakers. Racially distinct patterns highlight opportunities to tailor individual- and population-level prevention efforts to prevent suicide deaths in emerging high-risk groups.

The development and validation of a dashboard prototype for real-time suicide mortality data.

Introduction/AimData visualisation is key to informing data-driven decision-making, yet this is an underexplored area of suicide surveillance. By way of enhancing a real-time suicide surveillance system model, an interactive dashboard prototype has been developed to facilitate emerging cluster detection, risk profiling and trend observation, as well as to establish a formal data sharing connection with key stakeholders via an intuitive interface.Materials and MethodsIndividual-level demographic and circumstantial data on cases of confirmed suicide and open verdicts meeting the criteria for suicide in County Cork 2008–2017 were analysed to validate the model. The retrospective and prospective space-time scan statistics based on a discrete Poisson model were employed via the R software environment using the “rsatscan” and “shiny” packages to conduct the space-time cluster analysis and deliver the mapping and graphic components encompassing the dashboard interface.ResultsUsing the best-fit parameters, the retrospective scan statistic returned several emerging non-significant clusters detected during the 10-year period, while the prospective approach demonstrated the predictive ability of the model. The outputs of the investigations are visually displayed using a geographical map of the identified clusters and a timeline of cluster occurrence.DiscussionThe challenges of designing and implementing visualizations for suspected suicide data are presented through a discussion of the development of the dashboard prototype and the potential it holds for supporting real-time decision-making.ConclusionsThe results demonstrate that integration of a cluster detection approach involving geo-visualisation techniques, space-time scan statistics and predictive modelling would facilitate prospective early detection of emerging clusters, at-risk populations, and locations of concern. The prototype demonstrates real-world applicability as a proactive monitoring tool for timely action in suicide prevention by facilitating informed planning and preparedness to respond to emerging suicide clusters and other concerning trends.

Exploring Place-Based Differences in Suicide and Suicide-Related Outcomes Among North Carolina Adolescents and Young Adults

PurposeSuicide is an ongoing public health crisis among youth and adolescents, and few studies have investigated the spatial patterning in the United States among this subpopulation. Potential precursors to suicide in this vulnerable group are also on the rise, including nonfatal self-injury. MethodsThis study uses emergency department data, death certificates, and violent death reporting system data for North Carolina from 2009 to 2018 to investigate spatial clusters of self-injury and suicide. ResultsFindings show that the demographic characteristics of individuals committing fatal and nonfatal self-injury are quite different. Self-injury and completed suicides exhibited different geographical patterns. Area-level measures like micropolitan status and measures of racial and income segregation predicted the presence of high-risk suicide clusters. Suicides among Native Americans and veteran status/military personnel also were associated with higher risk suicide clusters. DiscussionFuture interventions should target these specific high-risk locations for immediate reductions in adolescent and youth suicides.

Spatial and space-time clusters of suicides in the contiguous USA (2000–2019)

The present study investigates the spatiotemporal variations in suicide mortality and tests associations between several covariates and suicides for the years 20002019 in the contiguous USA. The epidemiological disease surveillance software was used to identify spatiotemporal variations in suicide mortality rates and to test for significant spatial and space-time clusters with elevated relative suicide risk. The analysis was done with age-adjusted suicide mortality counts data from the Centers for Disease Control (CDC) with International Classification of Diseases (ICD)-10 codes. Specifically, data with codes ICD-10 codes X60-X84.9 and Y87.0, plus ICD-10 113 codes from the CDC, was used. Fourteen significant spatial clusters and five significant space-time clusters of suicide in the contiguous USA were found, including nine significant bivariate spatial clusters of suicide deaths and opioid deaths. Based on these data, there exist significant and non-random suicide mortality clusters after adjusting for multiple covariates or risk factors. The covariates studied provide evidence to develop a better understanding of possible associations in geographical areas where the suicide mortality rates are higher than expected. In addition, there is a significant association between several of the studied risk factors and suicide mortality. While most suicide clusters are also opioid clusters, there exist some clusters with high opioid deaths that are not suicide clusters. These results have the potential to provide a scientific framework that is based on surveillance, allowing health agencies to intervene and reduce elevated rates of suicides in selected counties in the U.S. The study is limited due to the resolution of the data at the county level, and some covariate data was unavailable for the entire period of the study.

Suicide clusters in law enforcement: a descriptive analysis

PurposeThis study examined the national prevalence of cluster suicides among law enforcement personnel at the county level, the influence on future suicides and risk factors associated with clusters.Design/methodology/approachLaw enforcement suicide data were obtained from The National Violent Death Reporting System (NVDRS) and categorized into: (1) cluster and (2) non-cluster suicides. Chi-square was used to compare differences between the two groups. Logistic regression was used to predict the probability of suicide risk factors in the groups.Findings2,465 law enforcement suicides were listed in NVDRS between 2003–2018. 80 (9.4%) US counties had clusters, with 640 officers (25.7%) of officers as part of those clusters. Odds ratios for risk factors associated with the suicide cluster group were: mental health crisis (OR = 2.6, p = 0.026), age (OR = 1.01, p = 0.003), married (OR = 1.729, p=<0.001), military service (OR = 2.59, p=<0.001) and job problems (OR = 1.70, p = 0.05).Research limitations/implicationsThis study suggests that cluster suicides occur in law enforcement. The study is primarily descriptive and limited by the different numbers of contributing states in the NVDRS database through the years.Practical implicationsThis study suggests that clusters occur in law enforcement and that they can impact future suicides. It is important for law enforcement organizations to recognize the potential for suicide clusters.Originality/valueThis study is among the first to empirically examine suicide clusters in law enforcement.

Differences in Suicide-Related Twitter Content According to User Influence.

Background: The content of suicide-specific social media posts may impact suicide rates, and putatively harmful and/or protective content may vary by the author's influence. Aims: This study sought to characterize how suicide-related Twitter content differs according to user influence. Method: Suicide-related tweets from July 1, 2015, to June 1, 2016, geolocated to Toronto, Canada, were collected and randomly selected for coding (n = 2,250) across low, medium, or high user influence levels (based on the number of followers, tweets, retweets, and posting frequency). Logistic regression was used to identify differences by user influence for various content variables. Results: Low- and medium-influence users typically tweeted about personal experiences with suicide and associations with mental health and shared morbid humor/flippant tweets. High-influence users tended to tweet about suicide clusters, suicide in youth, older adults, indigenous people, suicide attempts, and specific methods. Tweets across influence levels predominantly focused on suicide deaths, and few described suicidal ideation or included helpful content. Limitations: Social media data were from a single location and epoch. Conclusion: This study demonstrated more problematic content vis-à-vis safe suicide messaging in tweets by high-influence users and a paucity of protective content across all users. These results highlight the need for further research and potential intervention.

Analysis of mortality from suicide in the Altai Republic, Russia, for the period of 1990-2019

IntroductionThe Altai Republic (AR) is a national republic of the Russian Federation (RF), where the indigenous people – Altaians live, and where a high death rate from suicide is recorded.ObjectivesTo analyze the dynamics of mortality from suicide in the AR for the period from 1990 to 2019.Methods Data on mortality of the population were obtained from the Russian databases of demographic indicators. The data were analyzed in terms of indicators standardized per 100,000 population.ResultsIn the AR, as well as in the RF as a whole, there has been an increase in the level of suicide since 1990, but in Altai it lasted for a longer period of time – for 13 years. Throughout the entire period, the suicide rates in the AR have consistently exceeded the all-Russian indicators by 1.5-3 times, and by 2019 the gap in indicators has doubled compared to 1990. The curve of mortality from suicide in the AR has a fluctuating character with spontaneous peaks, in contrast to the curve in the RF that has the form of a “plateau”.Conclusions In the AR, the mortality rate from suicide consistently exceeds the all-Russian indicators, by 2019 the gap in indicators has doubled. The mortality curve is fluctuating, which we associate with clustering of suicides. This phenomenon requires further study.DisclosureNo significant relationships.

Battle of the Books: Charles Moore’s Full Inquiry into the Subject of Suicide (1790) versus Subversive Narratives of Suicidal Distress

ABSTRACT Published in 1790 by the prestigious Rivington brothers, Charles Moore’s Inquiry forms a dynamic intervention in the eighteenth-century suicide debate. In this text, Moore attempts to disgrace not only the act of suicide itself but, more strikingly, the texts that so powerfully defend it, with a view to quelling the “bloody business” of modern self-murder. This article considers Moore’s censure of the works he deems most responsible for apparent rising suicide rates, namely David Hume’s “Of Suicide” and Johann Wolfgang von Goethe’s The Sorrows of Young Werther. Moore “reads” these works in order to dissect, deride, and ultimately discount their arguments. In an effort to guard against the dangers of associating with subversive material, he rewrites the central premise of “Of Suicide” and seeks to remove the central protagonist from Werther. The Inquiry thus becomes a space where fears surrounding suicide, sympathetic identification, and textual contagion are negotiated and contested. Yet Moore’s unparalleled, even erratic, engagement with these works ultimately signals his downfall. In warning readers against the perils of textual contagion, Moore’s text becomes an inadvertent instrument of contagion itself.

Quantitative Methods to Detect Suicide and Self-Harm Clusters: A Systematic Review

Suicide and self-harm clusters exist in various forms, including point, mass, and echo clusters. The early identification of clusters is important to mitigate contagion and allocate timely interventions. A systematic review was conducted to synthesize existing evidence of quantitative analyses of suicide and self-harm clusters. Electronic databases including Medline, Embase, Web of Science, and Scopus were searched from date of inception to December 2020 for studies that statistically analyzed the presence of suicide or self-harm clusters. Extracted data were narratively synthesized due to heterogeneity among the statistical methods applied. Of 7268 identified studies, 79 were eligible for narrative synthesis. Most studies quantitatively verified the presence of suicide and self-harm clusters based on the scale of the data and type of cluster. A Poisson-based scan statistical model was found to be effective in accurately detecting point and echo clusters. Mass clusters are typically detected by a time-series regression model, although limitations exist. Recently, the statistical analysis of suicide and self-harm clusters has progressed due to advances in quantitative methods and geospatial analytical techniques, most notably spatial scanning software. The application of such techniques to real-time surveillance data could effectively detect emerging clusters and provide timely intervention.

Responding to Suicide Clusters in the Community: What Do Existing Suicide Cluster Response Frameworks Recommend and How Are They Implemented?

Suicide clusters involve an excessive number of suicides, suicide attempts, or both, that occur close in space or time or involve social links between cluster members. Although suicide clusters are rare, evidence documenting the implementation of suicide cluster response activities in communities is required yet remains limited. In this study, we identified the core components of existing suicide cluster response frameworks through a search of the grey literature and conducted an international survey to assess the implementation of the core components by stakeholders with experience responding to a suicide cluster. The following six core components were identified from five cluster response frameworks and were incorporated into a survey assessing stakeholders’ experiences of responding to a suicide cluster: (1) Preparing for a suicide cluster; (2) Routine monitoring of suicide, suicide attempts, and cluster detection; (3) Coordination with the media and monitoring social media; (4) Identifying and supporting individuals at risk; (5) Promoting help-seeking and building community resilience; and (6) Long-term follow-up and evaluation. Twenty-six stakeholders completed the online survey. Many of the core components were implemented by stakeholders. However, gaps in practice were reported in terms of cluster surveillance, monitoring of referral uptake among bereaved individuals, and long-term evaluation. Barriers to implementation included the perceived availability and suitability of mental health services, and availability of long-term funding. Strategic policy and planning that addresses the practice-based experiences of communities has the potential to facilitate a more coordinated and timely response to suicide clusters.

Suicide Framing on Online Media in Indonesia

News about suicides in online media is increasingly worrying. This is due to the fact that the news stories often show specific display and details of suicide incidents. This study aims to analyse two online media in framing suicide news and the compatibility of the news of the rules from the press Council in 2019 by using a research method adapted from Matthes and Kohring in year 2008. The data used in this research are 85 articles, with the details of 38 articles from Tribunnews.com and 47 articles from suara.com. This research is important in that, if the news is repeated with high news frequency, the mentioned detailed mode is done explicitly, to hyperbolic reporting, it will be able to cause copycat suicide. It is hoped that the results of this research can provide meaningful input for the Indonesian Press Council to provide guidance to journalists in Indonesia regarding writing suicide reports. The methodology utilised for this research is content analysis of media frames guided by Robert M. Entman and then tabulated using the ward’s method by non-hierarchical clustering. The result of the research shows that online media in Indonesia mostly frame suicide as a crime issue and show in detail the ways in which victims commit suicide. This is opposite of the Press Council’s rules in 2019 who regulated suicide as a mental health issue because it is caused not only by a single factor. Keyword: Suicide, online media, contextual jurnalism, press council, Entman’s framing.

PUBLIC RESPONSE TO CELEBRITY SUICIDES NEWS DUE TO MENTAL HEALTH ISSUES

Around 800,000 people die by suicide in a year, or one per 40 seconds. Despite the fact that suicide is a complex phenomenon impacted by personal qualities as well as numerous socioenvironmental factors, it is considered as a avoidable public health problem, and public health methods to suicide prevention are fast gaining traction. Because of its vast impact, media might be considered to have a "dual-edged" polarity when it comes to mental health. It has the potential to increase mental health awareness, education, and development of treatment and service, but it also has the potential to undermine awareness, disseminate misinformation, and stigmatize mental health. This article is made by reviewing and evaluating several literatures that discusses media coverage amd public response through social media regarding the suicide of a number of celebrities and their relationship to people's mental health. The literature used is limited to articles published between 2017 – 2021. Prior research on the public's perceptions of celebrity suicide has primarily concentrated on the negative consequences, sometimes recognized as "copycat suicide" in other words "Werther effect" The positive consequences occurred when there was media coverage of a celebrity who committed suicide primarily due to mental health issue in the preceding month, the number of persons who consulted a psychiatrist increased. Increasing 'mental health awareness' on depression and suicide may help people cope with the impact of celebrity suicide news while also making it easier to get help. Inadequate mental health knowledge about depression therapy and suicide prevention may raise the likelihood of negative psychological consequences and lower the desire to seek help among those who are disturbed by such news. Keywords: celebrity, suicide, response.

The Tool for Evaluating Media Portrayals of Suicide (TEMPOS): Development and Application of a Novel Rating Scale to Reduce Suicide Contagion.

Research suggests that media adherence to suicide reporting recommendations in the aftermath of a highly publicized suicide event can help reduce the risk of imitative behavior, yet there exists no standardized tool for assessing adherence to these standards. The Tool for Evaluating Media Portrayals of Suicide (TEMPOS) allows media professionals, researchers, and suicide prevention experts to assess adherence to the recommendations with a user-friendly, standardized rating scale. An interdisciplinary team of raters constructed operational definitions for three levels of adherence to each of the reporting recommendations and piloted the scale on a sample of articles to assess reliability and clarify scale definitions. TEMPOS was then used to evaluate 220 news articles published during a high-risk period following the suicide deaths of two public figures. Post-hoc analyses of the results demonstrated how data produced by TEMPOS can be used to inform research and public health efforts, and inter-rater reliability analyses revealed substantial agreement across raters and criteria. A novel, wide-reaching, and practical approach to suicide prevention, TEMPOS allows researchers, suicide prevention professionals, and media professionals to study how adherence varies across contexts and can be used to guide future efforts to decrease the risk of media-induced suicide contagion.

Comparison of Work-Related Stress in Cluster of Workers' Suicides in Korea: Analysis of Industrial Accident Compensation Insurance, 2010-2017.

Background: There is limited research on the heterogeneity of worker suicides. We compared differences in workers’ suicides by clustering suicide deaths. Methods: From 2010 to 2017, 353 suicide deaths were claimed in the Industrial Accident Compensation Insurance; variables were coded using a standardized methodology. A two-step cluster analysis classified the clusters based on demographic and employment conditions. Details of the suicide, clinical variables, personal stresses, and work-related stresses were compared using the chi-square test and one-way analysis of variance. Results: We identified five clusters and they differed particularly in work-related stress. “Responsibility-burdened type” experienced excessive responsibility as managers; “role-changed type” experienced a sudden and unpredictable role change as clerks or sales workers; “risk-exposed type” experienced physical risk factors at work (working alone, outdoors, and in shifts) as machine operating and assembling workers, or craft and related trades workers; “job-insecurity type” experienced unstable employment (irregular, nonpermanent) as elementary or service workers; “workplace-violence type” was mainly unmarried women who lived alone, and experienced interpersonal conflict and violence as professionals and related workers. There were no differences between clusters in clinical variables (except problem drinking) and personal stresses. Conclusion: Interventions to alleviate work-related stress in worker clusters are needed to prevent suicide in workers.

Media Coverage of Senior and Celebrity Suicides and Its Effects on Copycat Suicides among Seniors

ABSTRACT This study examined whether suicide rates in the elderly population are associated with media coverage of senior or celebrity suicides. Analyzing data from 2012 to 2015, we found that seniors were likely to be more influenced by media coverage of senior suicides than by celebrity suicides. Furthermore, the effects of media coverage of senior suicides were more significant when the reported reason was either health (mental or physical problems) or financial issues, such as poverty than other reasons.

Effects of media stories of hope and recovery on suicidal ideation and help-seeking attitudes and intentions: systematic review and meta-analysis

There is strong evidence that suicides increase after media stories about suicides by celebrities, particularly those that highlight the suicide method (the Werther effect). Much less is known about the Papageno effect-the protective effects of media stories of hope and recovery from suicidal crises. A synthesis of the retrievable evidence is lacking. We aim to summarise findings from randomised controlled trials about the effects of stories of hope and recovery on individuals with some degree of vulnerability to suicide. For this systematic review and individual participant data meta-analysis, we searched PubMed (including MEDLINE), Scopus, Embase, PsycInfo, Web of Science, and Google Scholar published from inception to Sept 6, 2021, without language restrictions. We included trials that reported suicidal ideation (the primary outcome) or help-seeking attitudes or intentions (the secondary outcome) and tested a media narrative of hope and recovery. Studies were excluded if they did not feature a clearly positive story of hope and recovery, or had a control group exposed to suicide-related stimulus material. We contacted the lead or senior authors of all original studies to obtain participant-level data for this study. The primary analysis was restricted to individuals with some vulnerability to suicide. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomised trials. The study is registered with PROSPERO, number CRD42020221341. Our search yielded 7347 records. 3920 records were screened by title and abstract, and 25 full-text records assessed for eligibility. There were eight eligible studies with 2350 participants for which individual participant data were sought. For suicidal ideation, six studies met the inclusion criteria for the primary analysis. Follow-up responses were available for 569 (90%) of 633 participants who were randomised with high vulnerability (345 [55%] allocated to the intervention group and 288 [45%] to the control group). The pooled standardised mean difference (SMD) indicated a small reduction in suicidal ideation of -0·22 (95% CI -0·39 to -0·04, p=0·017; six studies) in the intervention group. For help-seeking attitudes and intentions, four studies met the inclusion criteria and follow-up data were available for 362 (86%) of 420 participants (247 [59%] allocated to the intervention group and 173 [41%] to the control group). The pooled SMD showed no evidence of a difference between the groups (SMD=0·14, 95% CI -0·15 to 0·43, p=0·35; four studies). Low levels of cross-study heterogeneity effects were observed for both analyses (I2=5% [suicidal ideation] and I2=36% [help-seeking attitudes and intentions]). We found no evidence of publication bias. Media narratives of hope and recovery from suicidal crises appear to have a beneficial effect on suicidal ideation in individuals with some vulnerability, but there is insufficient evidence regarding help-seeking attitudes and intentions. These findings provide new evidence about narratives for suicide prevention. None.