U of T experts explain difficulties of reporting on suicide – and why it's important to focus on resilience

J.K. Rowling, Oprah Winfrey and Lady Gaga all figure among people who have contemplated suicide but found help and stepped back from the brink. 

But stories of resilience like these aren't always given the same weight in the press as those about celebrities who have tragically taken their own lives. Reports on suicide may give audiences the wrong impression and negatively influence vulnerable people – when instead experts emphasize that there's hope and help available to people experiencing mental health struggles.

Dr. Mark Sinyor and Dr. Ayal Schaffer, both in U of T's department of psychiatry in the Faculty of Medicine and associate scientists at the Sunnybrook Research Institute, have helped develop guidelines for Canadian journalists for reporting on suicide. The recommendations, which included input from journalists, were released by the Canadian Psychiatric Association and identify harmful aspects of coverage that should be avoided, appropriate language and mental health resources. Media guidelines on reporting on suicide are estimated to prevent more than 40 suicide deaths per year in Canada.

The guidelines aren't intended to censor talk of suicide, Sinyor explained in an interview with U of T News, but to equip journalists with up-to-date scientific evidence so they can report on the issue responsibly. More than 150 scientific papers have established that more suicide deaths occur after repetitive reporting on suicide – a phenomenon known as the Werther Effect. Meanwhile, a growing body of evidence also supports the idea of a Papageno Effect – the notion that stories of resilience are associated with subsequent lower suicide rates.

“The key point is that everything is contagious,” Sinyor said. “We all do something called social learning – we learn from each other. If the media – unintentionally but erroneously – suggests that suicide is the only option or a common outcome, then people take that on and it becomes a self-fulfilling prophecy.

“However, if we disseminate stories of resilience, which are by far the most common outcome in mental health, then people will copy that.”

Sinyor and Schaffer both spoke to U of T News. 

What are the origins of these guidelines? 

Sinyor: Countries around the world have been developing these kinds of guidelines about how to talk about suicide publicly really since the late 1980s. 

The world's first guidelines came from Austria. There had been a substantial number of suicide deaths in Vienna and across the country that had been widely publicized in the news media. The experts there were familiar with this thing called the Werther Effect. 

It comes from a book by Goethe, the famous German author, who wrote a novella about a young man who tragically at the end of the book dies by suicide. After it was published, there were case reports of men, who were rejected in love, dressing as Werther and ending their lives. 

The Austrians were interested in that and made suggestions to their journalists who took it very seriously and quite dramatically altered the way they reported about suicide. Studies of that experience showed that after those changes were made in Austria, there was a significant reduction in suicide deaths across the country. Since then many other countries have put out recommendations. The Canadian Psychiatric Association put out the first comprehensive recommendations in Canada in 2009.

How do experts know that the Werther Effect exists?

Sinyor: There have been a number of different kinds of studies. The most common format would be a sudden natural experiment. For example, a celebrity who died by suicide and it's widely publicized and then researchers will look afterward to see whether there has been an increase in suicides across the population. There’s a Canadian example, a journalist named Gaétan Girouard, who died in Quebec. After his death, there were approximately 200 more deaths in Quebec than expected in that province – a nearly 20 per cent increase.

The most famous recent example is Robin Williams. After his death, statistical modelling suggested that there were more than 1,800 suicides beyond what was expected in the United States in the following five months. That’s an extraordinary figure. That's a 10 per cent increase in the United States. I often ask epidemiologists and other experts: Can you think of any single event that can cause a 10 per cent increase in a top 10 cause of death, and they can't think of one. 

If you've ever had the unfortunate experience of being involved in a single suicide death, you know how tragic that is.

How long does the Werther Effect typically last? 

Sinyor: Most of the studies look at spans of weeks to months, very unusually more than a year. That actually is for reasons of convenience, because when you start looking at longer time periods, from a scientific methodology standpoint it's more difficult.

I think most of us in the field all probably believe there are acute effects that happen within days or weeks, but in fact exposures could potentially have effects for years.

Can you give me examples of suicide coverage that you found problematic?

Sinyor: I don't know if I have a specific example, but I sometimes feel disappointed by different kinds of coverage of the various celebrities who have died by suicide over the last few years, where the coverage really focuses on things like how it happened and the methods. That's known to potentially cause a copycat effect.

Worse than that is when they talk about things like "demons." Unfortunately I think all of us could come to figure out that we have some kind of demons because it doesn't really mean anything. We wouldn't use this kind of language anywhere else in health. For example, if you were covering a story about someone who died of a heart attack, you wouldn't talk about the evil spirits that invaded their coronary arteries.

It's a problematic message because invariably suicide arises from treatable mental health problems. I encourage the media to treat it like a health story. Figure out what the mental health problem was and guide and educate readers, listeners and viewers about how they can get help.

Another thing I found troubling is drawing simple cause-and-effect relationships between a specific event and suicide. For example, there's the notion that bullying causes suicide. Bullying is a risk factor for suicide – that's factually accurate. But it’s almost certainly wrong to say it causes suicide. The most common event prior to a suicide in youth typically is a fight with your parents or a relationship break-up. 

Schaffer: What frustrates me most about some past media coverage is that the terrible sadness, anger, guilt and loss that is left behind after a suicide death is often underrepresented, whereas the search for the “why” often takes precedence. This may be attempting to satisfy the natural curiosity of readers, but ultimately does not, and cannot, provide a clear and precise understanding. 

At its worst, such reporting can perpetuate myths about suicide that we know can be associated with a negative impact on the health of readers. Greater focus on the devastating impact of suicide and the missed opportunities for coping and resilience would highlight the true nature of suicide deaths.

What’s the Papageno Effect? 

Sinyor: The name comes from Mozart's The Magic Flute. There’s a scene in the opera where there’s a young man, Papageno, who’s going to attempt suicide and then these three boys come and convince him to choose life. He doesn’t go on to die.

The way in which that ended up being coined as a competing effect to the Werther Effect was through research by one of my colleagues in Austria, Thomas Niederkrotenthaler. He did a study where he showed what we see everywhere else: When people disseminate doom-and-gloom stories of people dying by suicide, you end up with more suicides across the population. However, he isolated nine per cent of stories in the Austrian media that had a very different narrative. They were about people who had been struggling and contemplating suicide, who may have been on the brink of acting but instead chose something different. They phoned a crisis line or they sought help, and they’re doing much better now. 

After articles with that narrative arc were published in Austria, there was a small but statistically significant reduction in deaths across the country.

The key point is that everything is contagious. We all do something called social learning – we learn from each other. If the media – unintentionally but erroneously – suggests to people that suicide is the only option or a common outcome, then people take that on and it becomes a self-fulfilling prophecy.

However, if we disseminate stories of resilience, which are by far the most common outcome in mental health, then people will copy that.

Can you tell me what goes into updating these guidelines and how often they're updated? 

Sinyor: There has been a rapid expansion of research literature on the potential positive and negative impact of certain aspects of media reporting on suicide deaths.  What is clear is that media reporting is neither inherently good or bad, but rather that certain specific aspects have clear impacts, and the updated guidelines reflect this more nuanced approach.

It is also clear that for media guidelines to be effective, they should be created and disseminated through a collaboration between researchers and media representatives. The recently published Canadian guidelines did just that, and have placed Canada in a leadership position with regards to this important topic.

What feedback have you received from Canadian journalists? 

Sinyor: I want to take my hat off to the journalism community in Canada. I take a lot of comfort in the fact that our journalists really want to do a great job,  and don't want to do anything in the context of their work that can cause harm to anybody. My interactions with journalists have been uniformly positive.

Last year after the deaths of Kate Spade and Anthony Bourdain, several news organizations purposefully put out very thoughtful articles highlighting important points, such as that we can celebrate the lives of these people but we shouldn't celebrate their deaths, that their deaths were tragic and we should encourage other ways of managing.

I'm sure you’ve heard the criticism that by not reporting on suicide,  journalists are sweeping the issue under the rug. How do you respond to that? 

Sinyor: That’s the elephant in the room. It’s a question we get all the time. It’s a very delicate balance. Nobody is telling anybody that they can’t talk about suicide. The issue is that we do know that fixating repeatedly on deaths, which are outliers, skews public knowledge. We have to find a happy medium where, on the one hand, the public is made aware of what’s happened in a newsworthy story, while at the same time trying to mitigate any potential harm. Simply reporting on every person who dies or all of the details is well known to cause harm, and nobody wants that to happen.

Schaffer: The guidelines are not suggesting any type of ban or censorship. The media has played an extremely positive role in raising awareness about mental health issues and highlighting the health-care needs of people struggling with a mental illness. Our hope for publishing the guidelines on media reporting of suicide is that there can continue to be a positive impact by safe media reporting being one of the pillars of a public-health approach to suicide prevention across Canada. 

Earlier I asked you for examples of coverage that frustrated you. You mentioned the importance of providing positive examples. Are there stories of resilience in the press that you found inspiring or encouraging? 

Sinyor:  I actually think there are many stories of resilience if you look in the popular press. The few that come to me off the top of my head are J.K. Rowling, Lady Gaga, Oprah Winfrey – celebrities who have publicly said they were suicidal and sought help and were able to overcome that and become some of the most revered people in our society. Finding ways to tell those stories of resilience is important. We can’t only dwell on unusual, negative outcomes. 

I think every article on this subject, if possible, has to highlight the fact that the conditions that give rise to suicide – whether it’s depression, anxiety, substance problems or PTSD – are treatable. There’s a growing army of us who want to treat them and are competent to do so.

If people need help, they should reach out because there is hope.

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