Using decision tree to predict non-suicidal self-injury among young adults: the role of depression, childhood maltreatment and recent bullying victimization.

Importance: Non-suicidal self-injury (NSSI) is a significant mental health issue requiring a deeper understanding of its underlying causes, such as childhood maltreatment, adult bullying victimization, and depression. Previous studies have not adequately addressed the cumulative risks of these factors on NSSI among college students. This population-based study investigates these cumulative risk factors.Design, setting, and participants: The cross-sectional study included 63 university's college students with a mean age of 19.6 years (N = 95,833).Main outcomes and measures: Two Chi-Square Automatic Interaction Detection (CHAID) decision tree models were used to classify subgroups based on childhood maltreatment and adult bullying victimization experiences and to investigate their cumulative risks of NSSI. Recursive partitioning algorithms determined each predictor variable's relative importance.Results: The CHAID model accurately predicted NSSI behaviours with an overall accuracy rate of 77.8% for individuals with clinically relevant depressive symptoms and 97.2% for those without. Among depressed individuals, childhood emotional abuse was the strongest NSSI predictor (Chi-Square, 650.747; adjusted P < .001), followed by sexual and physical abuse. For non-depressed individuals, emotional abuse in childhood was the strongest NSSI predictor (Chi-Square, 2084.171; adjusted P < .001), with sexual and verbal bullying in the past year representing the most significant proximal risks.Conclusions and relevance: Emotional abuse during childhood profoundly impacts individuals, increasing the risk of NSSI in both depressed and non-depressed individuals. Clinically relevant depressive symptoms have a moderating effect on the relationship between childhood maltreatment, adult bullying victimization, and NSSI. Identifying these factors can inform targeted interventions to prevent NSSI development among young adults.

Emotional abuse during childhood has a profound impact on individuals, increasing their risk of non-suicidal self-injury (NSSI), regardless of whether they are depressed or non-depressed.Among depressed individuals, childhood emotional abuse emerges as the strongest predictor of NSSI, followed by sexual and physical abuse.In non-depressed individuals, emotional abuse in childhood assumes a similar role as the strongest NSSI predictor, with sexual abuse and verbal bullying in the past year representing the most significant proximal risks.

Inequitable Changes in School Connectedness During the Ongoing COVID-19 Pandemic in a Cohort of Canadian Adolescents.

BACKGROUND: We examined whether subgroups of adolescents experienced disparate changes in school connectedness-a robust predictor of multiple health outcomes-from before the COVID-19 pandemic to the first full school year following pandemic onset. METHODS: We used 2 waves of prospective survey data from 7178 students attending 41 Canadian secondary schools that participated during the 2019-2020 (T1; pre-COVID-19 onset) and 2020-2021 (T2; ongoing pandemic) school years. Fixed effects analyses tested differences in school connectedness changes by gender, race, bullying victimization, socioeconomic position, and school learning mode. RESULTS: Relatively greater declines in school connectedness were reported by students that identified as females, were bullied, perceived their family to be less financially comfortable than their classmates, and attended schools in lower income areas. Marginally greater school connectedness declines resulted among students attending schools that were fully online at T2 than those at schools using a blended model. CONCLUSION: Results point to disparate school connectedness declines during the pandemic, which may exacerbate pre-existing health inequities by gender and socioeconomic position, and among bullied youth. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Effective strategies to improve school climates for equity denied groups are critical for pandemic recovery and preparedness for future related events.

Social poverty indicators with school bullying victimization: evidence from the global school-based student health survey (GSHS).

BACKGROUND: School bullying is prevalent in children and adolescents. Bullying victims are seen higher risk of negative psychological outcomes. Previously published studies suggested that social indicators may pose significant influence on bullying victimization. However, the association between social poverty and bullying victimization has not been exclusively discussed. METHODS: In this cross-sectional study, we analyzed the association between 6 commonly used social poverty indicators (Poverty Headcount Ratio, PHR; Poverty Gap, PG; Squared Poverty Gap, SPG; monthly household per capita income, PCI; Watts' Poverty Index, WPI; the Gini Index, Gini) and the prevalence of school bullying at country level by using the Global school-based Student Health Survey (GSHS) database. RESULTS: Altogether 16 countries were included into the final analysis, with school bullying victimization prevalence ranged from 12.9 to 47.5%. Bubble plots revealed statistically significant associations between the three indicators measuring absolute poverty level (PHR, PCI, WPI) and bullying victimization. Subsequently performed principal component regression indicated that, for all types of bullying victimization, the increase of absolute poverty level was related to elevated prevalence rates, and the association was particularly strong for verbal bullying victimization. CONCLUSIONS: Our study results may suggest that absolute social poverty is an important parameter for constructing and implementing school bullying victimization intervention strategies and measures.

Role of workplace bullying and workplace incivility for employee performance: Mediated-moderated mechanism.

Workplace events play a significant role in shaping the performance of employees and organizations. Negative events, in particular, require careful attention due to their severe impact on employee wellbeing and performance. Workplace bullying and incivility are two negative events that can cause significant harm to employees and contribute to poor performance. This study examines the effects of workplace bullying and incivility on employee performance in the presence of perceived psychological wellbeing (PWB), with the moderating role of perceived organizational support (POS) considered for both independent variables and employee performance (EP). The study focuses on female nurses working in the healthcare sector of Azad Jammu and Kashmir. The results of the study indicate that workplace bullying and incivility have adverse effects on employee performance and that PWB mediates these relationships. Moreover, perceived organizational support moderates the relationship between both predictors and the employee performance criterion. In conclusion, the findings of this study highlight the importance of creating a positive and supportive work environment to mitigate the negative effects of workplace bullying and incivility on employee performance.

Traditional and Race-based Bullying in Racial-Minority Majority and Racially Diverse Schools.

Few studies in the U.S. have simultaneously examined general and race-based bullying with consideration of school-level racial composition. The current study examined victimization as a function of school racial composition, in minority-majority and diverse schools (N = 1911, Mage = 13.7 years) enrolled in 7th grade in 24 public schools (42.3% Hispanics, 9.0% non-Hispanic White, 28.9% non-Hispanic Black, and 19.7% non-Hispanic Asian). Multilevel regression analyses suggest student-level protective factors related to both forms of victimization, but, school racial composition was only significant in explaining race-based bullying. Specifically, minority-majority schools had lower levels of race-based victimization compared to racially diverse schools. Findings suggest that consideration of school contextual factors offers a more nuanced understanding of the relation between race and victimization.

Emotional Distress Disparities Across Multiple Intersecting Social Positions: The Role of Bias-Based Bullying.

OBJECTIVES: To apply an intersectional lens to disparities in emotional distress among youth, including multiple social positions and experiences with bias-based bullying. METHODS: Data are from the 2019 Minnesota Student Survey (n = 80 456). Social positions (race and ethnicity, sexual orientation, gender) and 2 forms of bias-based bullying (racist, homophobic or transphobic) were entered into decision tree models for depression, anxiety, self-injury, suicidal ideation, and suicide attempts. Groups with the highest prevalence are described. Rates of emotional distress among youth with matching social positions but no bias-based bullying are described for comparison. RESULTS: LGBQ identities (90%) and transgender, gender diverse, and questioning identities (54%) were common among the highest-prevalence groups for emotional distress, often concurrently; racial and ethnic identities rarely emerged. Bias-based bullying characterized 82% of the highest-prevalence groups. In comparable groups without bias-based bullying, emotional distress rates were 20% to 60% lower (average 38.8%). CONCLUSIONS: Findings highlight bias-based bullying as an important point for the intervention and mitigation of mental health disparities, particularly among lesbian, gay, bisexual, transgender, gender-diverse, queer, and questioning adolescents. Results point to the importance of addressing bias-based bullying in schools and supporting lesbian, gay, bisexual, transgender, gender-diverse, queer, and questioning students at the systemic level as a way of preventing emotional distress.

Risk, race, and predictive policing: A critical race theory analysis of the strategic subject list.

Predictive policing is a tool used increasingly by police departments that may exacerbate entrenched racial/ethnic disparities in the Prison Industrial Complex (PIC). Using a Critical Race Theory framework, we analyzed arrest data from a predictive policing program, the Strategic Subject List (SSL), and questioned how the SSL risk score (i.e., calculated risk for gun violence perpetration or victimization) predicts the arrested individual's race/ethnicity while accounting for local spatial conditions, including poverty and racial composition. Using multinomial logistic regression with community area fixed effects, results indicate that the risk score predicts the race/ethnicity of the arrested person while accounting for spatial context. As such, despite claims of scientific objectivity, we provide empirical evidence that the algorithmically-derived risk variable is racially biased. We discuss our study in the context of how the SSL reinforces a pseudoscientific justification of the PIC and call for the abolition of these tools broadly.

Bias-based bullying, self-esteem, queer identity pride, and disordered eating behaviors among sexually and gender diverse adolescents.

OBJECTIVE: Limited research incorporates an intersectional approach when evaluating disordered eating behaviors among those holding minoritized social positions, such as lesbian, gay, bisexual, queer, questioning, and/or transgender/gender diverse (LGBTQ) adolescents. The current study assessed stigma experiences from peers at school, self-esteem, LGBTQ pride, and overlapping social positions as they relate to disordered eating behaviors among LGBTQ adolescents. METHOD: Participants included 11,083 adolescents (Mage = 15.6, SD = 1.3; 34.8% transgender/gender diverse) from a large national survey study of LGBTQ adolescents from 2017. Exhaustive Chi-square Automatic Interaction Detection analysis was used to identify bias-based bullying experiences (i.e., weight-based, identity-based), self-esteem, LGBTQ pride, and overlapping social positions (i.e., gender identity, sexual identity, race/ethnicity, body mass index (BMI) percentile) associated with the highest prevalence of unhealthy weight control behaviors, extreme unhealthy weight control behaviors, and past year binge eating. RESULTS: Adolescents in the 28 identified groups with a high prevalence of disordered eating behavior held at least one structurally marginalized social position (e.g., high BMI), bias-based bullying experience, low self-esteem, or low LGBTQ pride in addition to being LGBTQ. Weight-based bullying was a salient risk-factor for disordered eating across social positions. Among adolescents with the same social positions, levels of self-esteem, LGBTQ pride, but no bias-based bullying experience, prevalence estimates of disordered eating were, on average, 23% lower. DISCUSSION: LGBTQ adolescents with multiple marginalized social positions and related factors engage in disproportionately high prevalence disordered eating. Findings underscore the importance of addressing intersecting experiences of stigma to reduce disordered eating and promote health equity among adolescents. PUBLIC SIGNIFICANCE: Multiply marginalized LGBTQ adolescents, most of whom also reported experiencing bias-based bullying from peers at school, reported disproportionately high prevalence disordered eating. In comparison groups of adolescents with no bias-based bullying experience, prevalence of disordered eating was, on average, 24% lower. Findings underscore the importance of addressing intersecting experiences of stigma to reduce disordered eating and promote health equity among adolescents.

The development of anti-bullying, discrimination and harassment guidance: a survey among the Association of Surgeons in Training (ASiT) council members.

INTRODUCTION: Surgical trainees have a reasonable expectation to feel safe and valued in their workplace. Previous reports proved that poor behaviour and misconduct existed in national health systems. This study aimed to conduct a survey among the Association of Surgeons in Training (ASiT) council members to identify the need for guidance to report bullying, discrimination and harassment for trainees who experienced any type of poor behaviour in the workplace. METHODS: Data among executive and council members were collected. Questions were related to trainee demographics, level of training, specialties, and experience of, witnessed or reported poor behaviours including bullying, discrimination and harassment. We asked if participants lacked direction when experiencing poor behaviours, and if support strategies were needed such as a standardised guidance for reports. RESULTS: A total of 58 survey responses were received: 55.17% of participants experienced bullying, 77.58% witnessed it and 67.25% did not report the incidents. Furthermore, 37.93% experienced discrimination, 62.07% witnessed it and 68.97% did not report. A total of 24.14% experienced sexual harassment, 29.69% witnessed it, while 72.41% did not report. Over 80% mentioned they need more guidance to support trainees. Almost all participants (98%) agreed that surgical trainees should be made aware of routes for reporting, and 88% agreed that ASiT should develop the guidance to support trainees against poor behaviours. CONCLUSION: Most of the trainees who experienced or witnessed poor behaviours did not report the incidents. A new standardised anti-bullying, anti-discrimination and anti-harassment guidance was developed based on our study results. We envisage that its use may play a role in eliminating misconduct in surgical training.

A focus on adolescent peer violence and bullying in Europe, central Asia and Canada. Health Behaviour in School-aged Children international report from the 2021/2022 survey

The Health Behaviour in School-aged Children (HBSC) study is a large school-based survey carried out every four years in collaboration with the WHO Regional Office for Europe. HBSC data are used at national/regional and international levels to gain new insights into adolescent health and well-being, understand the social determinants of health and inform policy and practice to improve young people’s lives. The 2021/2022 HBSC survey data are accompanied by a series of volumes that summarize the key findings around specific health topics. This report, Volume 2 in the series, focuses on adolescent peer violence and bullying, using the unique HBSC evidence on adolescents aged 11, 13 and 15 years across 44 countries and regions in Europe, central Asia and Canada. It describes the status of adolescent peer violence (bullying, cyberbullying and fighting), the role of gender, age and social inequality, and how adolescent bullying and fighting behaviour has changed over time. Findings from the 2021/2022 HBSC survey provide an important evidence benchmark for current research, intervention and policy-planning.

Exposure to Islamophobia: The impacts of an increased risk of bullying victimization on human capital.

We use the shock caused by terrorist attacks on the US on September 11, 2001, to study the short- and long-term consequences of exposure to Islamophobia in high-school-aged youths. Our estimates show an immediate sharp increase in rates of identity-based bullying against Arab/Muslim youths relative to youths of other ethnic groups during the years 2001-2003. We also find exposure to Islamophobia increased school dropout rates by 4.11% among US-born male youths of Arab-Muslim origin, which is a large effect from a baseline of 4.6% of school dropout rate in the affected population. In the long term, however, we find no significant effect on educational attainment among the affected population. The data suggest Arab-Muslim male youths born in 1989 were 8.34% more likely to resort to GED tests as a means of obtaining high school credentials after the attacks. We find full-time male workers born in 1984 earn 12.8% less than similar workers who were unexposed to Islamophobia. Moreover, full-time male Arab-Muslim workers born between 1983 and 1985 are between 9% and 12.5% more likely to be in the first quintile of the state-of-residence-year-wage distribution than similar workers who were not exposed to Islamophobia.

A focus on adolescent substance use in Europe, central Asia and Canada. Health Behaviour in School-aged Children international report from the 2021/2022 survey. Volume 3

The Health Behaviour in School-aged Children (HBSC) study is a large school-based survey carried out every four years in collaboration with the WHO Regional Office for Europe. HBSC data are used at national/regional and international levels to gain new insights into adolescent health and well-being, understand the social determinants of health and inform policy and practice to improve young people’s lives. The 2021/2022 HBSC survey data are accompanied by a series of volumes that summarize the key findings around specific health topics. This report, Volume 3 in the series, focuses on adolescent substance use, using the unique HBSC evidence on adolescents aged 11, 13 and 15 years across 44 countries and regions in Europe, central Asia and Canada. It describes the status of adolescent substance use (cigarette smoking, electronic cigarette use, alcohol consumption, drunkenness and cannabis use), the role of gender, age and social inequality, and how adolescent substance use has changed over time. Findings from the 2021/2022 HBSC survey provide an important evidence benchmark for current research, intervention and policy-planning.

Assessment of psychological terror and its impact on mental health and quality of life in medical residents at a reference medical center in Mexico: A cross-sectional study.

BACKGROUND: Mobbing, particularly in medical residencies, can lead to psychological terror with lasting mental and physical health consequences. Its impact on Mexican residents, however, remains underexplored. AIM: This study aimed to investigate the prevalence and associated factors of psychological terror among medical residents at a medical center in Mexico City. METHODS: In a cross-sectional study, medical residents from various specialties were assessed for mobbing domains, quality of life, and anxiety/depression using the Leymann Inventory of Psychological Terror (LIPT), 36-Item Short Form Health Survey, Beck Depression Inventory-II, and Beck Anxiety Inventory, respectively. Psychological terror was defined as a LIPT score ≥ p80. Linear and binomial logistic regression models were used to explore independent predictors of mobbing and psychological terror. RESULTS: Of the 349 participants included (median age: 28; IQR: 27-30 years), 19.5% (95% CI: 15.5%-24.0%) were identified with psychological terror. Furthermore, 39% reported higher-degree trainees as mobbing perpetrators. Women in surgical residencies in their second or fifth year were found to experience higher levels of mobbing. Manifested bullying, workplace stigma, and inappropriate tasks were the most impacted mobbing domains. Anxiety, diminished mental health quality of life, and higher degree of medical specialization were independent predictors of mobbing. Meanwhile, increased anxiety, affiliation to surgical specialties, and being in the second or fifth year of training were identified as predictors of psychological terror. CONCLUSIONS: Mobbing and psychological terror are prevalent conditions among medical residents in Mexico. Identification of occupational conditions and adverse psychological stressors can help to improve quality of life and training of medical residents.

Future Directions in the Mental Health of Transgender Youth: Towards a Social-Affective Developmental Model of Health Disparity.

Mental health disparities in transgender and gender diverse (TGD) youth are well-documented. These disparities are often studied in the context of minority stress theory, and most of this research focuses on experiences of trauma and discrimination TGD youth experience after coming out. However, TGD youth may be targets of violence and victimization due to perceived gender nonconformity before coming out. In this Future Directions, we integrate research on attachment, developmental trauma, and effects of racism and homophobia on mental health to propose a social-affective developmental framework for TGD youth. We provide a clinical vignette to highlight limitations in current approaches to mental health assessment in TGD youth and to illustrate how using a social-affective developmental framework can improve clinical assessment and treatment approaches and deepen our understanding of mental health disparities in TGD people.

Examining the impact of a universal social and emotional learning intervention (Passport) on internalising symptoms and other outcomes among children, compared to the usual school curriculum: study protocol for a school-based cluster randomised trial.

BACKGROUND: School-based universal social and emotional learning (SEL) interventions implemented during the transition to adolescence may be efficacious in preventing the development of mental health difficulties. This protocol describes a two-arm parallel cluster randomised controlled trial to investigate the impact of a universal SEL intervention (Passport, compared to usual provision) on internalising symptoms (primary outcome), emotion regulation, well-being, loneliness, social support, bullying, academic attainment, and health-related quality of life in English primary school pupils aged 9-11 years. A developer-led trial demonstrated the feasibility, acceptability, and utility of Passport; this will be the first independent trial. METHODS: Sixty primary schools will be recruited across the Greater Manchester city region and surrounding areas, involving 2400 pupils aged 8-9 at baseline. Schools will be allocated to the intervention arm to implement Passport over 18 weekly sessions or to the control arm to implement the usual school curriculum. Random allocation will be at school level following completion of baseline measures, with minimisation to ensure balance across trial arms in school size and free school meal eligibility. Measures will be collected at baseline, post-intervention (12 months post-baseline), and at 12 months follow-up (24 months post-baseline). The primary outcome analysis (intervention effects on internalising symptoms at post-intervention) will comprise a two-level (school, child) hierarchical linear model, following the intention-to-treat principle. Additional analyses will be undertaken to assess intervention effects on secondary outcomes, maintenance effects for all outcomes, intervention compliance moderator effects, subgroup moderator effects, and mechanisms underpinning intervention effects on the primary outcome. A mixed-methods implementation and process evaluation will examine factors that influence implementation, and a health economic evaluation will assess the cost-effectiveness of the intervention. DISCUSSION: Findings will provide educators with crucial knowledge of whether and how increasing emotion regulation through a universal intervention impacts internalising symptoms and a range of related outcomes. Findings will also inform policy related to the promotion of mental health among children and young people. If the intervention is found to be efficacious in reducing internalising symptoms and is also cost-effective, it may offer high potential as a preventative intervention for widespread implementation. TRIAL REGISTRATION: ISRCTN12875599; registered on 24 November 2022.

Family economic status and vulnerability to suicidal ideation among adolescents: A re-examination of recent findings.

BACKGROUND: According to the "differential vulnerability hypothesis," individuals in adverse socioeconomic circumstances as less mentally resilient to stressful events. However, several recent papers radically challenged this hypothesis based on the accumulated literature on stress inoculation and presented cases in which lower-SES adolescents appear to be less vulnerable to suicidal ideation in the face of interpersonal aggression. OBJECTIVE: We re-examine the link between psychological vulnerability to acute stressors and SES using yearly longitudinal public survey data from South Korea. PARTICIPANTS AND SETTING: This is a secondary data analysis of a multi-year public health panel dataset on South Korean adolescents. METHODS: Logistic regression is used to examine the association between suicidal ideation and a range of predictor variables, with a particular focus on the interaction between bullying victimhood and log family income. These variables and the sample were chosen for consistency with recent revisionist research. RESULTS: We reaffirm the well-established finding that bullying victimhood strongly and consistently increases the odds of suicidal ideation (OR = 1.859, p < 0.01). However, we find no evidence in favor of the traditional "differential vulnerability hypothesis" or the recently proposed counterhypothesis. A subsample analysis from the latest wave (W4-W5) did produce results that are consistent with recent revisionist findings, but we suggest this is likely a false positive. CONCLUSIONS: There appears to be no systematic association between SES and vulnerability to suicidal ideation in the face of peer aggression among South Korean adolescents. The claim that lower-SES adolescents may be more resilient to stressful events stands on limited empirical support.

The associations of parental attitudes and peer bullying with alexithymia in adolescents: A structural equality model.

AIM: The aim of this study is to investigate the relationship between parental attitude and peer bullying and alexithymia in adolescents. METHODS: This cross-sectional descriptive study was conducted with adolescents aged 13-18 years within high schools in eastern Turkey. Cluster sampling method was applied, and the study was completed within four high schools determined by random selection method. Sociodemographic characteristics questionnaire form, Peer Bullying Scale Adolescent Form, and Twenty-item Toronto Alexithymia Scale (TAS-20) were used to collect the data. RESULTS: Among the adolescents, 52% were female, 60% had a medium income level, 25.3% were in the 11th grade, 83% were living with their parents, 7.4% had chronic illnesses, 9.2% had psychiatric illnesses, 25.3% had suicidal thoughts, 10.1% engaged in suicidal behavior, and 25.3% used TV, smartphones, or tablets for 3-4 h a day. Rejecting and indifferent parental attitudes were found to be a possible risk factor for alexithymia, bullying and victimization. CONCLUSIONS: This study highlights the connections between parental attitudes, peer bullying, and alexithymia in adolescents. By targeting positive parental attitudes and addressing peer interactions, nurses can effectively contribute to reducing the risk of alexithymia. PRACTICE IMPLICATIONS: Through collaboration with parents, nurses can establish supportive environments that nurture emotional understanding. Remaining attentive to risk factors, such as chronic illnesses and mental health issues in adolescents, empowers nurses to offer timely support or referrals. Partnerships with educators further enhance emotional awareness and encourage positive peer relationships.

Effects of education and age on the experience of youth violence in a very low-resource setting: a fixed-effects analysis in rural Burkina Faso.

OBJECTIVE: The study aimed to investigate the effects of education and age on the experience of youth violence in low-income and middle-income country settings. DESIGN: Using a standardised questionnaire, our study collected two waves of longitudinal data on sociodemographics, health practices, health outcomes and risk factors. The panel fixed-effects ordinary least squares regression models were used for the analysis. SETTINGS: The study was conducted in 59 villages and the town of Nouna with a population of about 100 000 individuals, 1 hospital and 13 primary health centres in Burkina Faso. PARTICIPANTS: We interviewed 1644 adolescents in 2017 and 1291 respondents in 2018 who participated in both rounds. OUTCOME AND EXPOSURE MEASURES: We examined the experience of physical attacks in the past 12 months and bullying in the past 30 days. Our exposures were completed years of age and educational attainment. RESULTS: A substantial minority of respondents experienced violence in both waves (24.1% bullying and 12.2% physical attack), with males experiencing more violence. Bullying was positively associated with more education (ß=0.12; 95% CI 0.02 to 0.22) and non-significantly with older age. Both effects were stronger in males than females, although the gender differences were not significant. Physical attacks fell with increasing age (ß=-0.18; 95% CI -0.31 to -0.05) and this association was again stronger in males than females; education and physical attacks were not substantively associated. CONCLUSIONS: Bullying and physical attacks are common for rural adolescent Burkinabe. The age patterns found suggest that, particularly for males, there is a need to target violence prevention at younger ages and bullying prevention at slightly older ones, particularly for those remaining in school. Nevertheless, a fuller understanding of the mechanisms behind our findings is needed to design effective interventions to protect youth in low-income settings from violence.

The role of monocausal versus multicausal explanations of suicide in suicide reporting: A randomized controlled trial.

BACKGROUND: Media guidelines for reporting on suicide recommend that journalists should avoid monocausal explanations of suicide, but it is unclear if media items with monocausal explanations elicit different effects as compared to multicausal portrayals. METHOD: Using a web-based randomized controlled trial (n = 969), we tested five versions of a news article about the suicide of a teenage girl with varying portrayals of reasons for the suicide: (1) bullying as the sole (external) factor (i.e., monocausal), (2) several external social factors, (3) a combination of internal and external factors, (4) a combination of internal and external factors along with a focus on suicide prevention, or (5) no reason for the suicide (control group). We measured perceptions about the cause of suicide, attitudes toward suicide and suicide prevention, and identification with the suicidal protagonist with questionnaires. RESULTS: Readers of articles that portrayed suicide as being caused by one specific reason or exclusively social factors tended to adopt these misconceptions. Identification with the suicidal protagonist did not vary between interventions groups, but was lower in the control group. CONCLUSION: Highlighting the multifactorial etiology of suicide in news articles may help to avoid the misconception that suicide is a monocausal issue.