Media-Influenced Suicide Contagion
Research has shown that media representations of suicide can influence suicidal behavior on a massive scale, a phenomenon known as media-influenced suicide contagion. Suicide rates tend to increase following media reports of a celebrity death by suicide or other widely covered suicide event, suggesting media coverage can be a contributing factor to suicidal behavior. However, these events also serve as a valuable opportunity for the media to educate the public about reasons and risk factors for suicide and how to get help for those who may be struggling.
Leading experts in the fields of mental health, suicide prevention, and journalism developed the Recommendations for Reporting on Suicide, guidelines based on more than 50 international studies of suicide contagion. Research has found that media professionals can significantly reduce the risk of imitative suicide (also known as ‘copycat deaths’) by providing factual, non-speculative information, avoiding the use of sensational language and graphic detail, and disseminating mental health and suicide prevention resources. TEMPOS was developed to help encourage and monitor adherence to the Recommendations and to assist journalists in quickly applying the Recommendations to specific articles, scripts, and social media posts in real time.
For feedback or questions on TEMPOS contact us here.
How Journalists Use the Guidelines
We encourage media leaders to incorporate the Recommendations for Reporting on Suicide and the TEMPOS tool in their organizations’ stylebooks or alternative best-practices manuals. (The Recommendations are included and linked in The Associated Press Stylebook.) To embed safer suicide reporting in the organizational culture, we further suggest that newsroom leaders, such as standards editors or senior copy editors, be tasked to implement systematic compliance with the guidelines through real-time editing, directive memos, and group discussions.
Instructions
Below are the ten criteria for the TEMPOS web interactive for scoring your article. Please click on each criteria’s question numbered 1-10 to expand the selection. It will provide 3 definitions constructed for each rating level, as well as their corresponding examples and a rationale section. For the scoring tool on the right hand side, you will find the 10 TEMPOS criteria listed with the option to score from 0-2 as follows:
- 2 (Helpful): Helpful messaging / Full adherence to the guideline
- 1 (Mixed): Mixed messaging / Partial adherence to the guideline
- 0 (Harmful): Harmful messaging / Non-adherence to the guideline
You can use these selections to score your report as you read along. Once you are finished, click the button to add your scores and see to what extent your report's messaging is helpful or harmful.
TEMPOS Criteria
| Scores | Definitions | Examples |
|---|---|---|
| 2 (Helpful) | Frames suicide as a preventable mental health outcome; reports that coping skills, support and treatment work for most people (recovery is possible). | "If you or someone you know is struggling with suicidal thoughts, help is available. With proper treatment and support, it is possible to get help for suicidal thoughts and other mental health challenges." |
| 1 (Mixed) | Doesn't portray suicide as an escape or inevitable response to hardship, but fails to include that suicide is preventable and that resources are available to those who are struggling; may include a mix of these two portrayals. | |
| 0 (Harmful) | Explicitly presents or strongly implies that suicide is a common, acceptable, or inevitable response to hardship; frames suicide as a way out or a way of taking control of one's circumstances. | "The young girl was being bullied at school and she felt like she had no other escape but to take her own life."
|
Why is this important?
Media reports that suggest simple explanations or single motivations for suicide, such as family issues and job loss, can normalize suicide and disinhibit those who are vulnerable1. Studies have found that media stories that frame suicide as an inevitable result of one’s circumstances was associated with increased rates of subsequent suicides2,3,4,5. Inversely, research shows that media stories that focus their coverage on positive coping strategies in the aftermath of adverse events have protective impacts for the community that may help mitigate suicide contagion6. One quantitative review revealed that findings based on stories marked by strong negative definitions of suicide were 99% less likely to uncover copycat effects than findings based on other stories1.
References
1. Stack S. (2005). Suicide in the media: a quantitative review of studies based on non-fictional stories. Suicide & life-threatening behavior, 35(2), 121–133. doi.org/10.1521/suli.35.2.121.62877
2. Sinyor, M., Schaffer, A., Nishikawa, Y., Redelmeier, D. A., Niederkrotenthaler, T., Sareen, J., Levitt, A. J., Kiss, A., & Pirkis, J. (2018). The association between suicide deaths and putatively harmful and protective factors in media reports. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 190(30), E900–E907. doi.org/10.1503/cmaj.170698
3. Chen, Y.-Y., Tsai, P.-C., Chen, P.-H., Fan, C.-C., Hung, G. C.-L., & Cheng, A. T. A. (2010). Effect of media reporting of the suicide of a singer in Taiwan: The case of Ivy Li. Social Psychiatry and Psychiatric Epidemiology: The International Journal for Research in Social and Genetic Epidemiology and Mental Health Services, 45(3), 363–369.
4. Etzersdorfer, E., & Sonneck, G. (1998). Preventing suicide by influencing mass-media reporting The Viennese experience 1980-1996. Archives of Suicide Research, 4(1), 67–74. doi.org/10.1080/13811119808258290
5. Ortiz, P., & Khin Khin, E. (2018). Traditional and new media’s influence on suicidal behavior and contagion. Behavioral Sciences & the Law, 36(2), 245–256. doi.org/10.1002/bsl.2338
6. Niederkrotenthaler T, Voracek M, Herberth A, Till B, Strauss M, Etzersdorfer E, Eisenwort B, Sonneck G. Role of media reports in completed and prevented suicide: Werther v. Papageno effects. Br J Psychiatry. 2010 Sep;197(3):234-43. doi: 10.1192/bjp.bp.109.074633. PMID: 20807970.
| Scores | Definitions | Examples |
|---|---|---|
| 2 (Helpful) | Includes information that is clearly factual in nature, not speculative. May include quotes or objective information from informed sources (e.g. people or organizations with mental health or suicide prevention expertise, and/or people with lived experience). | "Anne Shuchat M.D. is principal director at CDC. She told reporters, we did see increases in younger and older people. Essentially every age group other than those over 45." |
| 1 (Mixed) | Does not include speculation/non-factual information, but also fails to provide factual information about suicide/mental health; may include a mix of these two portrayals. | |
| 0 (Harmful) | Includes information that is clearly speculative (e.g., non-factual) about the causes of / reasons for suicide. Sources of information (e.g. friends / family / professionals) are not factually informed or are inaccurate / inappropriate. | "According to a friend, [Avicii was] an artist who seemed to be having a slow-motion nervous breakdown brought on by the relentless pressures of success and a brutal torturing schedule."
|
Why is this important?
Suicide is a massive national and global public health challenge with 800,000 suicides reported globally each year1. Therefore, mass media messaging on suicide should be shaped in consultation with suicide prevention experts. With specialized suicide prevention knowledge and input, media can ensure that stories do not replace important facts with speculation and approach suicide with a public safety framework in order to lower the risks for vulnerable individuals. It is important to recognize that not all mental health professionals are suicide prevention experts. In fact, most mental health professionals do not receive training on the complexities of suicide contagion. This is an important distinction to make when considering sources.
References
1. Niederkrotenthaler T, Voracek M, Herberth A, Till B, Strauss M, Etzersdorfer E, Eisenwort B, Sonneck G. Role of media reports in completed and prevented suicide: Werther v. Papageno effects. Br J Psychiatry. 2010 Sep;197(3):234-43. doi: 10.1192/bjp.bp.109.074633. PMID: 20807970.
| Scores | Definitions | Examples |
|---|---|---|
| 2 (Helpful) | Uses appropriate/non-stigmatizing language that is more neutral and treats suicide similarly to other causes of death (e.g. died by suicide) | "Anthony Bourdain died by suicide." |
| 1 (Mixed) | Uses a mix of inappropriate and appropriate language. | |
| 0 (Harmful) | Uses inappropriate / stigmatizing language that implies criminality (e.g. committed), judgment, or positive connotations (e.g. successful attempt). | "Anthony Bourdain committed suicide." |
Why is this important?
The language we use to talk about suicide may either promote or limit the prejudice and discrimination surrounding mental illness/suicide. “Commit” is still often used to describe a death by suicide. Because the term “commit” is often associated with a criminal or sinful activity, suicide prevention professionals advocate for alternate phrases to characterize suicide in ways that break down prejudice and discrimination. These include “died by suicide” and “killed themselves.”
Moving away from stigmatized language helps reduce the barriers for those experiencing suicidal thoughts in being able to seek help. With approximately 5% of adults and nearly one in eight young people in the United States experiencing thoughts of suicide each year, being intentional with how we communicate about suicide can be a matter of life and death1.
References
1. National Alliance on Mental Illness (2022). Mental Health by the Numbers. [online] Available at: https://www.nami.org/mhstat [Accessed 14 April 2022].
| Scores | Definitions | Examples |
|---|---|---|
| 2 (Helpful) | Reports the death as a suicide but keeps information general and does not mention method. | "Famed fashion designer Kate Spade was found dead in an apparent suicide this past week." |
| 1 (Mixed) | Briefly mentions suicide method (e.g. asphyxiation, overdose) but does not include explicit details about the method used or the scene of the death. | |
| 0 (Harmful) | Describes or depicts, in a detailed manner, the method and/or location of the suicide; ‘sets the scene’ by including information about what was found at the scene of the death, how the person was found, or the type of object used. | "Kate Spade, a fashion designer known for her sleek handbags, was found hanged in the bedroom of her Park Avenue apartment Tuesday in an apparent suicide, law enforcement officials said. The 55-year-old was found by housekeeping at about 10:20 a.m. Her husband and business partner Andy Spade was in the house at the time. The couple’s 13-year-old daughter was at school at the time and officials said a note was found at the scene telling her it was not her fault."
|
| N/A | Article is not about a specific person’s suicide. |
Why is this important?
Research has repeatedly shown that instances of media outlets reporting the method of a suicide are followed by an increase in suicides by the same method. In one example, multiple studies found that in the months following actor Robin Williams’ death by suicide in 2014, not only did suicides increase, but deaths using the same method increased by 32%1.
Individuals who are struggling with suicidal thoughts or impulses are vulnerable to public messaging around suicide. Learning about the method not only provides an option to explore, but it also offers an example of the method being effective. There also appears to be a propensity for stories about celebrities to trigger more copycat suicides than noncelebrities, possibly due to increased media coverage and the reverence that celebrities hold where some may regard them as particularly strong role models2,3.
References
1. Fink DS, Santaella-Tenorio J, Keyes KM (2018) Increase in suicides the months after the death of Robin Williams in the US. PLOS ONE 13(2): e0191405. doi.org/10.1371/journal.pone.0191405
2. Sinyor, M., Schaffer, A., Nishikawa, Y., Redelmeier, D. A., Niederkrotenthaler, T., Sareen, J., Levitt, A. J., Kiss, A., & Pirkis, J. (2018). The association between suicide deaths and putatively harmful and protective factors in media reports. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 190(30), E900–E907. doi.org/10.1503/cmaj.170698
3. Niederkrotenthaler, T., Fu, K. W., Yip, P. S., Fong, D. Y., Stack, S., Cheng, Q., & Pirkis, J. (2012). Changes in suicide rates following media reports on celebrity suicide: a meta-analysis. J epidemiol community health, 66(11), 1037-1042.
| Scores | Definitions | Examples |
|---|---|---|
| 2 (Helpful) | Does not mention a note or its contents; states that no note was found. | "No note was found." |
| 1 (Mixed) | Reports that a note was found but does not include any content from the note. | |
| 0 (Harmful) | Shares specific content drawn directly from a suicide note. | "Kate Spade left a heartbreaking note to her daughter in which she wrote, Bea – I have always loved you. This is not your fault. Ask Daddy!"
|
| N/A | Article is not about a specific person’s suicide. |
Why is this important?
Media professionals are advised to avoid publishing the contents of a suicide note1. The more details that are offered about the individual’s thoughts or actions, the more a vulnerable reader might identify with the person who died and may be at greater risk for eliciting copycat or imitative suicidal behavior. Adherence to such guidelines is associated with a reduction in suicide rates22, decreased use of more lethal suicide methods3, and increased utilization of support resources4.
References
1. Hawton, K., & Williams, K. (2002). Influences of the media on suicide. BMJ (Clinical research ed.), 325(7377), 1374–1375. doi.org/10.1136/bmj.325.7377.1374.
2. Niederkrotenthaler, T.; Sonneck, G. Assessing the Impact of Media Guidelines for Reporting on Suicides in Austria: Interrupted Time Series Analysis. Aust. N. Z. J. Psychiatry 2007, 41, 419–428, doi:10.1080/00048670701266680.
3. Barker, E.; Kolves, K.; De Leo, D. Rail-Suicide Prevention: Systematic Literature Review of Evidence-Based Activities. Asia-Pac. Psychiatry Off. J. Pac. Rim Coll. Psychiatr. 2017, 9, doi:10.1111/appy.12246.
4. Niederkrotenthaler T, Voracek M, Herberth A, Till B, Strauss M, Etzersdorfer E, Eisenwort B, Sonneck G. Role of media reports in completed and prevented suicide: Werther v. Papageno effects. Br J Psychiatry. 2010 Sep;197(3):234-43. doi: 10.1192/bjp.bp.109.074633. PMID: 20807970.
| Scores | Definitions | Examples |
|---|---|---|
| 2 (Helpful) | Uses visual content of the person who died from school/work/ family or photo unrelated to suicide. | "Visual content of decedent unrelated to suicide; stock image that is not related to suicide or death." |
| 1 (Mixed) | Includes visual content of grieving/sad individuals, memorials, or funerals. | |
| 0 (Harmful) | Includes any visual content (e.g. photos / videos) of the location or method of death. | "Visual content of the scene or method of death, e.g. train tracks, scene with police tape, bridge, gun, noose, pills." |
| N/A | Absence of visual content |
Why is this important?
Providing visual content may increase suicidality among vulnerable individuals, often youth, especially when the images are particularly graphic or in video format. Actual depictions of suicide in television or movies have been linked to suicide contagion. The linkage between visual imagery and increased suicide rates is established1,2. Research also shows that pictures associated with suicidal acts, such as the scene or method of death, can be reactivated by vulnerable readers later, such as during a personal crisis, and may then trigger suicidal behavior3.
References
1. Pirkis, J. E., Burgess, P. M., Francis, C., Blood, R. W., & Jolley, D. J. (2006). The relationship between media reporting of suicide and actual suicide in Australia. Social Science & Medicine, 62(11), 2874–2886. doi-org.paloaltou.idm.oclc.org/10.1016/j.socscimed.2005.11.033
2. Schaffer, E. R. (2018). A Review of the Werther Effect and Depictions of Suicide: 13 Reasons Why. UC Merced Undergraduate Research Journal, 10(2). dx.doi.org/10.5070/M4102038937
3. World Health Organization. Preventing Suicide: A Resource for Media Professionals, Update 2017. https://apps.who.int/iris/bitstream/handle/10665/258814/WHO-MSD-MER-17…
| Scores | Definitions | Examples |
|---|---|---|
| 2 (Helpful) | Acknowledges (in the body of the article or in a sidebar) the complexity of suicide and describes risk factors (e.g. mental illness, economic hardship, family issues) that give suicide context. | "Robin Williams struggled with depression for many years prior to his death. However, the causes of suicide are complex and often involve multiple factors, such as mental illness, relationship issues, economic hardship, substance use issues, bullying, or a recent loss. You can learn more about risk factors and warning signs at CDC.gov." |
| 1 (Mixed) | Does not speculate about reasons for death but does not include information about risk factors. | |
| 0 (Harmful) | Oversimplifies or speculates on the reason for suicide; simplifies the issue of suicide by directly or indirectly attributing the death to a single reason or saying that it happened ‘without warning’. | "Kate Spade kills herself after husband asks for divorce."
|
Why is this important?
As suicide remains the 10th leading cause of death for adults and the second leading cause of death for youth and young adults aged 10-34, it must be appreciated and communicated with great sensitivity and with a different approach as is required when reporting on sexual assault, for example. Educating the reading public about the complexities of suicide, avoiding the simplification of the death to a single factor or reason, and emphasizing its multi-factorial nature gives suicide greater context1,2.
References
1. Niederkrotenthaler T, Voracek M, Herberth A, Till B, Strauss M, Etzersdorfer E, Eisenwort B, Sonneck G. Role of media reports in completed and prevented suicide: Werther v. Papageno effects. Br J Psychiatry. 2010 Sep;197(3):234-43. doi: 10.1192/bjp.bp.109.074633. PMID: 20807970.
2. Sinyor, M., Schaffer, A., Nishikawa, Y., Redelmeier, D. A., Niederkrotenthaler, T., Sareen, J., Levitt, A. J., Kiss, A., & Pirkis, J. (2018). The association between suicide deaths and putatively harmful and protective factors in media reports. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 190(30), E900–E907. doi.org/10.1503/cmaj.170698
| Scores | Definitions | Examples |
|---|---|---|
| 2 (Helpful) | Reports on the death using non-sensational facts and language that focuses on the person’s life rather than death (similar to reporting on non-suicide deaths); when referring to suicide rates, references best available data and uses words like ‘increase’ or ‘rise.’ | "Anthony Bourdain, celebrity chef, dead at 61"
|
| 1 (Mixed) | Includes some sensitive language that focuses on the person’s life rather than death, but also includes a few instances of sensational language/details about the death. | |
| 0 (Harmful) | Includes shocking or provocative language / details about suicide designed to elicit an emotional response; uses sensational language (e.g. ‘epidemic’, ‘skyrocketing’, ‘spike’) when describing suicide rates. | "Devastating suicide cluster strikes local high school."
|
Why is this important?
Sensational language that dramatically or graphically portrays a death by suicide in their headlines and stories have demonstrated negative impacts on vulnerable individuals, with youth and young adults at particularly heightened risk1,2. During the years of sensational news coverage of subway suicides in Vienna, there were up to nine subway suicides per six months. After Austria implemented guidelines for reporting on suicide and the sensational coverage ceased, in turn, there was an 84% reduction in suicides3.
References
1. Gould, M. S., Kleinman, M. H., Lake, A. M., Forman, J., & Midle, J. B. (2014). Newspaper coverage of suicide and initiation of suicide clusters in teenagers in the USA, 1988–96: a retrospective, population-based, case-control study. The Lancet Psychiatry, 1(1), 34-43.
2. Etzersdorfer, E., Voracek, M., & Sonneck, G. (2001). A dose–response relationship of imitational suicides with newspaper distribution. Australian and New Zealand Journal of Psychiatry, 35(2), 251. doi.org/10.1046/j.1440-1614.2001.0884d.x
3. Etzersdorfer, E.; Sonneck, G. Preventing Suicide by Influencing Mass-Media Reporting. The Viennese Experience 1980–1996. Arch. Suicide Res. 1998, 4, 67–74, doi:10.1023/A:1009691903261.
| Scores | Definitions | Examples |
|---|---|---|
| 2 (Helpful) | Does not portray suicide in a positive or glamorous manner; focuses on the life they lived rather than their death, acknowledges positive aspects of their life, as well as their struggles. | "Through the simple act of sharing meals, Bourdain showcased both the extraordinary diversity of cultures and cuisines, yet how much we all have in common – he was open about his mental health challenges and struggles with addiction throughout his life, and often discussed his struggles in writing and on his show, Anthony Bourdain: Parts Unknown. Tragically, Bourdain took his own life on Friday." |
| 1 (Mixed) | Includes some content that glamorizes/portrays suicide in a positive light; portrays their life in an idealized or glamorized way without acknowledging struggles. | |
| 0 (Harmful) | Majority of article content glamorizes suicide; includes several tributes or portrays suicide in a positive manner (e.g. ties suicide to heroism, romance, honor). | "It’s telling that [Bourdain] killed himself in this picturesque, story tale village."
|
Why is this important?
Glamorizing or romanticizing someone’s death from suicide in a media story may send a dangerous message to vulnerable individuals who are already struggling with suicidal ideation and are at heightened risk of following the same path. A “contagion effect” can occur through identification with the one who died by suicide and through social norming of suicide death1,2. An at-risk individual may feel, “I am just like them,” or “I want to be like them,” because their suicide accomplished a relatable goal.
References
1. Reyes-Portillo, J.A., Lake, A.M., Kleinman, M. and Gould, M.S. (2019), The Relation between Descriptive Norms, Suicide Ideation, and Suicide Attempts among Adolescents. Suicide Life Threat Behav, 49: 535-546. doi-org.laneproxy.stanford.edu/10.1111/sltb.12446
2. Stack, S. (2002). Media coverage as a risk factor in suicide. Injury Prevention, 8(suppl 4), iv30-iv32.
| Scores | Definitions | Examples |
|---|---|---|
| 2 (Helpful) | Includes a suicide hotline/crisis number as well as additional resources for mental health care and suicide prevention, for example local mental health resources, suicide prevention organizations, websites. | You can call or text the 988 Suicide and Crisis Lifeline, chat 988lifeline.org or you can text HOME to the Crisis Text Line at 741741.
American Foundation of Suicide Prevention (afsp.org) American Association of Suicidology (suicidology.org) National Institute of Mental Health (nimh.nih.gov) Suicide Prevention Resource Center (sprc.org) |
| 1 (Mixed) | Includes a suicide hotline/crisis number as well as additional resources for mental health care and suicide prevention, for example local mental health resources, suicide prevention organizations, websites. | |
| 0 (Harmful) | Does not include any resources. |
Why is this important?
One of the key recommendations for responsible reporting on suicide is to include reliable crisis line numbers and mental health care resources in every article.
The 988 Suicide & Crisis Lifeline (You can call or text the 988 Suicide and Crisis Lifeline, chat 988lifeline.org or you can text HOME to the Crisis Text Line at 741741.) is free and confidential and is available 24 hours a day, 7 days a week, across the United States. Many other hotlines are available, via call or text, throughout the country. Local hotlines are excellent resources to include in addition to the national lines.
An analysis was performed on suicide prevention line call data in Kurt Cobain’s hometown following the aftermath of his death. The town’s local media focused their coverage on the promotion of mental health treatment and suicide prevention resources in the months to follow. The analysis revealed an increase in calls to the suicide hotline and a drop in suicide during the months after Cobain’s suicide. This is an extraordinary example of media-based suicide prevention1.
References
1. Jobes DA, Berman AL, O'Carroll PW, Eastgard S, Knickmeyer S. The Kurt Cobain suicide crisis: perspectives from research, public health, and the news media. Suicide Life Threat Behav. 1996 Fall;26(3):260-69; discussion 269-71. PMID: 8897665.
Copyright Disclaimer:
TEMPOS was developed through a collaboration with the County of Santa Clara Behavioral Health Services Department’s Suicide Prevention Program and the Stanford Department of Psychiatry and Behavioral Sciences’ Media and Mental Health Initiative.
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