News Media Can Help Prevent Suicide

Batya Swift Yasgur, MA, LSW

November 30, 2018

Educational articles featuring interviews with suicide prevention experts are effective in preventing suicide, regardless of whether or not the expert discloses personal experience of suicidality, new research shows.

Investigators randomly assigned 545 adults to three groups: one group read a news article consisting of an interview with a suicide prevention expert who disclosed personal experience of suicidal ideation; the second group read an article by a suicide prevention expert who did not disclose personal experience of suicidality; the third group, which served as a control, read an article unrelated to suicide.

Regardless of the self-disclosure of the expert, participants in both intervention groups reported a decrease in suicidal ideation as well as an increase in knowledge related to suicide prevention — a phenomenon known as the Papageno effect. By contrast, there was no change in suicidal ideation in the control group.

"The Papageno effect describes suicide-protective media effects of stories of personal mastery of crisis and of educative information that addresses how to cope with suicidal ideation," coauthors Benedikt Till, DSc, assistant professor, and Thomas Niederkrotenthaler, MD, PhD, associate professor, the Department of Social and Preventive Medicine Center for Public Health, Medical University of Vienna, Austria, told Medscape Medical News in an email.

"The term 'Papageno effect' goes back to the protagonist Papageno in Mozart's opera The Magic Flute, who successfully overcomes his suicidal crisis with the help of three boys reminding him of his alternatives to suicide," they explained.

Summarizing the study findings, they said, "Suicide prevention experts speaking about prevention make an important contribution to suicide prevention by increasing suicide-prevention-related knowledge and reducing suicidal ideation, supporting a suicide-protective Papageno effect."

The study was published online November 22 in the Journal of Clinical Psychiatry.

Controversial Discussion

Media reports that sensationalize suicide can "trigger so-called imitational suicides," whereas media content that highlights how to cope with suicidal behavior can have a protective impact (Papageno effect), the authors write.

Previous studies have demonstrated a reduction of suicidal ideation after exposure to news articles, fictional movies, or educational websites that feature individual accounts of how to cope with suicidality and that present general information about suicide prevention.

"With regard to expert interviews, we found in an earlier study that these were often put in a sensationalist context, particularly when experts were speaking about the problem of suicide but not about how to effectively prevent it," Till and Niederkrotenthaler said.

They were therefore interested in investigating "whether an expert speaking about suicide prevention might actually have a preventive effect" and whether "disclosing personal experience with suicidal ideation in the media interview might reduce or increase a Papageno effect.

"There is a controversial discussion if experts can discuss their own personal experience with suicidal ideation and what effects that disclosure might have," they noted.

To investigate the question, the researchers conducted a Web-based randomized controlled trial of adults aged 18 years and older (n = 545; 56.8% women; mean age, 41.3 years; SD, 13.9 years) who had responded to an email inviting them to participate in a noncommercial online panel regarding the effects of material relating to health awareness.

Participants were divided into three groups: Group 1 consisted of people who read an article about suicide prevention that did not include the expert's personal experience (n = 173); group 2 consisted of people who read an article about suicide prevention that included the expert's personal experience (n = 174); the control group consisted of people who read a news article that featured an expert who was interviewed about influenza prevention.

The investigators hypothesized that the news articles that discussed prevention would be superior to the control article with regard to preventing suicide and that the group that read an article with the expert's self-disclosure would experience a reduction in suicidal ideation.

After the participants had read the articles, their suicidal ideation and suicide-prevention-related knowledge were measured, and sociodemographic factors were assessed.

Participants were also assessed with regard to current suicidal thoughts.

Suicidal ideation was assessed using the 23-item Survival Coping Beliefs subscale of the Reasons for Living Inventory.

To determine participants' suicide-prevention-related knowledge, the researchers administered the Questionnaire on Suicide-Prevention-Related Knowledge, which they had adapted and compiled from previous questionnaires.

The researchers compared the impact of article exposure on participants with lower vs higher baseline suicidal ideation by applying a median split of the sample, using the score for suicidal ideation (median = 2.30) observed prior to article exposure.

The participants were then stratified into two groups: group 1 included those with a lower degree of baseline suicidal ideation, and group 2 included participants with a higher degree of suicidal ideation.

Reduced Suicidality

For the primary outcome (suicidal ideation), the news articles group revealed a significant group × time interaction such that participants who had been exposed to any of the two news articles on suicide prevention experienced a small reduction in suicidal ideation after the exposure (group 1: contrast test after vs before exposure: Bonferroni-corrected P < .001; d = −0.16; 95% confidence interval [CI], −0.25 to −0.07; and group 2: contrast test after vs before exposure: Bonferroni-corrected P < .001; d = −0.25; 95% CI, −0.033 to −0.16).

By contrast, degree of suicidal ideation did not change in the control group (contrast test after vs before exposure: Bonferroni-corrected P = .62; d = 0.03; 95% CI, −0.07 to 0.14).

When the researchers omitted baseline suicidal ideation from the statistical model, the same effects emerged.

The researchers likewise found a significant group × time interaction for the suicide-prevention-related knowledge (the secondary outcome).

No difference was observed between the two intervention groups.

Only 11 of the 503 participants (2.2%) who completed the assessment of current suicidal thoughts indicated that they were currently experiencing suicidal thoughts (n = 3, n = 5, and n = 3 in group 1, group 2, and the control group, respectively).

However, the researchers were unable to include this variable their analyses because of the small number of individuals who were currently suicidal.

"Educative articles featuring interviews with suicide experts reduce suicidal ideation and increase suicide-prevention-related knowledge among readers," Till and Niederkrotenthaler note.

"There were no differences with regards to this positive impact between a media article featuring an expert with vs without personal experience of suicidal ideation, as compared to the control group," they add.

"While previous studies have found a media-induced reduction in suicide risk predominantly among individuals with comparatively higher vulnerability, baseline suicidal ideation did not moderate the article effects in the current study," the authors write.

Power of the Media

Commenting on the study for Medscape Medical News, John Draper, PhD, executive director, National Suicide Prevention Lifeline, and executive vice president of national networks, Vibrant Emotional Health, who was not involved with the study, called the work "absolutely groundbreaking, some of the more essential research on suicide prevention that's been done in years."

The findings "remind us of the power of media and messaging information to affect people's behavior positively," he said.

It is known that when "people are feeling suicidal and are exposed to media or stories, information about suicide, relentless reports, let's say, of a celebrity suicide, it is associated with increased suicide risks, called in some circles the 'contagion' effect," he said.

By contrast, "the Papageno effect uses experts, storytelling, and providing information promoting hope about how people have found hope and help through suicidal moments, and how they healed," he said.

He noted that self-disclosure can be helpful in preventing suicide.

"I personally love the idea of sharing personal stories, because we know that for every one person who dies [of suicide], there are about 280 people who think seriously about it but don't do it, so these untold stories are potentially models to remind people they're not alone and hope and help are possible, even probable.

"I think it's vital for medical and mental health professionals to play a role in moving this forward, and what Niederkrotenthaler and colleagues are doing is giving a road map for the kind of message that they and we can be saying to save lives," he emphasized.

The authors state, "The present study highlights the relevance of recent national and international media recommendations for suicide reporting."

They "recommend that experts should always ask journalists and editors to consider current media recommendations for suicide reporting."

Resources regarding optimum ways to report on suicide are available online.

The study received no funding. The authors of the study and Dr Draper have disclosed no relevant financial relationships.

J Clin Psychiatry. Published online November 22, 2018. Abstract

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