December 16, 2019

Responsible Reporting of Suicide

Joshua A. Gordon, M.D., Ph.D.

By Joshua A. Gordon, M.D., Ph.D.
Director, NIH’s National Institute of Mental Health (NIMH)

Experts estimate that about 800,000 people die by suicide every year. More than 47,000 of these deaths occur in the United States. For many of us, these staggering statistics are underscored by the immediate, personal impact of the tragic loss of a friend, family member, or co-worker. For others, we learn of this impact through media—news articles, television shows, movies, or books that relate the story of a death by suicide.

Media portrayals of deaths by suicide can have profound impacts—both good and bad. When properly portrayed, stories about suicide and mental illnesses raise awareness of these issues, get people talking with each other, and inspire those thinking about harming themselves to get help. But media portrayals can sometimes have negative effects. Often, these portrayals can do both. For example, in the weeks and months after Robin Williams’ tragic death by suicide, calls to suicide hotlines increased—arguably a good thing, since thousands of people used these hotlines to get the help they needed. More concerning was the increase, over the same time period, in suicide attempts that used the same method as did Mr. Williams. So-called “copycat” suicide attempts illustrate the phenomenon of social contagion, which can be exacerbated by media portrayals, particularly ones that provide graphic descriptions of the attempt.

The increases in suicide rates in the U.S. and elsewhere demand that we address the problem. How then can suicide be treated constructively by the media? The good news is that there are guidelines available. The National Action Alliance for Suicide Prevention (NAASP), a public-private partnership involving multiple Federal agencies, non-profits, and corporations, has published the National Recommendations for Depicting Suicide, aimed at helping those in the entertainment industry responsibly “tell more balanced and authentic stories.” ReportingOnSuicide.org, a collaboration between the NAASP and additional partners, has recommendations for journalists reporting on suicide deaths.  Globally, the World Health Organization has published “Preventing suicide: a resource for media professionals” and “Preventing Suicide:  a resource for filmmakers and others working on stage and screen.”

There are several core principles identified in each of these sets of recommendations. Best practices include:

• Avoiding explicit descriptions or pictures of the location or method of death;
• Not using sensationalistic headlines or language that normalizes suicide (see the Do’s and Don’ts section from reportingonsuicide.org);
• Contextualizing the death rather than describing suicide as inexplicable or without warning (most studies show this is rarely if ever the case);
• Reporting on suicide as a public health problem, including providing accurate information about suicide facts and suicide prevention efforts; and
• Highlighting stories of successful coping and describing how and where people can get help.

The importance of these recommendations must not be underestimated. To underscore this point, I offer an additional example—the effects of the Netflix series, “13 Reasons Why.” Independent scientific studies revealed an increase in rates of death by suicide amongst teenagers in the months after the release of the original series. While these findings demonstrate a correlation in time, not a definitive causal relationship, they were concerning enough that Netflix, in consultation with the producers of the series, decided to edit out the explicit suicide scenes shown in the original version. This change is consistent with the recommendations of the media guidelines mentioned above.

I hope that future efforts by journalists and artists will use these recommendations proactively, creating media that helps responsibly raise awareness about suicide risk and suicide prevention, helping mental health professionals save lives.

References

Increase in suicides the months after the death of Robin Williams in the US. Fink DS, Santaella-Tenorio J, Keyes KM. PLoS One. 2018 Feb 7;13(2):e0191405. doi: 10.1371/journal.pone.0191405. eCollection 2018. PMID: 29415016.

Increases in Demand for Crisis and Other Suicide Prevention Services After a Celebrity Suicide. Ramchand R, Cohen E, Draper J, Schoenbaum M, Reidenberg D, Colpe L, Reed J, Pearson J. Psychiatr Serv. 2019 Aug 1;70(8):728-731. doi: 10.1176/appi.ps.201900007. Epub 2019 Apr 30. PMID: 31035892.

Association Between the Release of Netflix's 13 Reasons Why and Suicide Rates in the United States: An Interrupted Time Series Analysis. Bridge JA, Greenhouse JB, Ruch D, Stevens J, Ackerman J, Sheftall AH, Horowitz LM, Kelleher KJ, Campo JV. J Am Acad Child Adolesc Psychiatry. 2019 Apr 28. pii: S0890-8567(19)30288-6. doi: 10.1016/j.jaac.2019.04.020. [Epub ahead of print] PMID: 31042568.

Association of Increased Youth Suicides in the United States With the Release of 13 Reasons Why. Niederkrotenthaler T, Stack S, Till B, Sinyor M, Pirkis J, Garcia D, Rockett IRH, Tran US. JAMA Psychiatry. 2019 May 29. doi: 10.1001/jamapsychiatry.2019.0922. [Epub ahead of print]. PMID: 31141094.