The Role of the Narrative in Educative Suicide Awareness Materials: A Randomized Controlled Trial.

There has been a debate about the suitability of different narratives in educative suicide prevention materials. Whereas some suicide prevention experts recommend raising awareness of suicide by highlighting its prevalence, others argue that this approach may normalize suicide and advocate focusing on help resources instead. Unfortunately, empirical evidence regarding this question is lacking. This randomized controlled trial aimed to test the impact of educative news articles that conveyed different narratives of suicide prevention. One article focused on the prevalence of suicide, one article highlighted professional help resources, and one article emphasized on how everyone can help to prevent suicide. We randomized n = 334 participants to read either one of these three articles or an article unrelated to suicide. Data on suicidal ideation, stigmatizing attitudes toward suicidal individuals, attitudes toward suicide prevention, and help-seeking intentions were collected with questionnaires, and implicit measures were used to assess participants' mental accessibility of concepts related to suicide and suicide prevention. Participants exposed to the article highlighting the high prevalence of suicide tended to show a higher accessibility of potentially detrimental cognitive concepts related to suicide. In contrast, the accessibility of the concept of "helping" and that "suicide is preventable" was higher in participants' memory when exposed to materials focusing on help. It seems that the impact of educative suicide awareness materials on readers' access to suicide- and suicide-prevention-related concepts in memory varied depending on the narrative featured in the article.

Little Strokes Fell Big Oaks: How Repeated Recommendations for Suicide Reporting Drive the Quality of Suicide News in South Korea.

This study investigates how far repeated releases of recommendations for responsible reporting on suicide (RRS) are associated with changes in the quality of suicide reporting. A content analysis was conducted on suicide news articles (N = 606) by the Korean newspapers Hankyoreh Sinmun and Chosun Ilbo in four six-month periods from 2004 to 2019, which covered the periods before and after the releases of three versions of suicide reporting guidelines. Elements for RRS served as a proxy for the reporting quality, which includes both avoiding negative elements and providing positive ones. Not only the number of suicide news stories reduced by half in the last two observation periods, overall RRS scores and most individual RRS elements increased in the third period, compared to the first or second period. The avoidance RRS for headline, however, was not significantly improved. Korean news media also tended to be sensationalistic in using photos.

Celebrity Suicide and Forced Responsible Reporting in the Nineteenth Century: Crown Prince Rudolf and the Absence of a Werther Effect.

Crown Prince Rudolf, heir to the Imperial throne of the Austro-Hungarian Empire, died by suicide in 1889. His death is a prime example of a historical celebrity suicide. Although news coverage about celebrity suicide has been shown to be linked to increases in suicides - a phenomenon known as the Werther effect -, censorship and/or journalists' anticipatory obedience back then may have led to a form of "forced responsible reporting" that may have prevented a Werther effect. A content analysis was conducted, and civil death registers were used to identify suicides before and after Rudolf's suicide. We compared Rudolf's case with another historical celebrity suicide case (Colonel Redl) for which there is already empirical evidence consistent with a Werther effect. As expected, the press heavily reported on Rudolf's death, but did not give undue prominence to suicide and rarely gave details on the method. Importantly, there was no evidence of an increase in suicides. This is in stark contrast to the Redl case in which the press reported irresponsibly. The Rudolf case emphasizes the importance of current media guidelines on responsible reporting. Thus, a high amount of news coverage does not necessarily translate into a Werther effect.

News Framing and Preference-Based Reinforcement: Evidence from a Real Framing Environment During the COVID-19 Pandemic.

COVID-19 is a news issue that can be covered from many different angles. When reporting, journalists have to select, accentuate, or exclude particular aspects, which, in turn, may evoke a specific, and possibly constricted, perspective in viewers, a phenomenon termed the news-framing effect. Guided by the reinforcing spiral framework, we conducted a multi-study project that investigated the news-framing effect's underlying mechanism by studying the dynamic of self-reinforcing effects. Grounded in a real-life framing environment observed during the pandemic and systematically assessed via a content analysis (study 1) and survey (study 2), we offer supporting evidence for a preference-based reinforcement model by utilizing a combination of the selective exposure (i.e., self-selected exposure) and causal effects (i.e., forced exposure) paradigms within one randomized controlled study (study 3). Self-selection of news content by viewers was a necessary precondition for frame-consistent (reinforcement) effects. Forced exposure did not elicit causal effects in a frame-consistent direction.

Coronavirus Disease (COVID-19) Pandemic and Stock Price Crashes: A Cross-National Correlational Approach.

The coronavirus disease (COVID-19) pandemic is a serious threat to public health and the economy. Importantly, there was a stock price crash on Monday, March 9, 2020, followed by a similar crash one week later. Leading global indices substantially dropped. Based on previous research indicating that the news media may elicit effects on stock prices, we hypothesized that the amount of news coverage about COVID-19 within a given country would predict the size of the stock price drop in that country. Using data for N = 58 nations from five continents, we observed average stock price drops of 6.57% (week 1) and 6.43% (week 2). Using a cross-national correlational approach, we found a positive relationship between the amount of news coverage about COVID-19 and the extent of the stock price drop. Actual severity within a given country (indicated by the number of confirmed cases and deaths, based on data provided by the World Health Organization) and public attention (indicated by COVID-19-related Internet search engine volume) did not predict the extent of the stock price drop in multivariate analyses. Correlational evidence is consistent with the idea that intensive media reporting on a threatening pandemic with uncertain negative consequences on health, social life, and the economy may provoke substantial reactions in the market, with as yet unknown indirect effects on public health. However, the causal order of media attention and stock price drops should be assessed with caution.

The Opioid-Overdose Crisis and Fentanyl: The Role of Online Information Seeking via Internet Search Engines.

Opioid abuse is a severe public health threat. Recent evidence points to a disturbing increase in the illicit use of fentanyl, a potent synthetic opioid, with abuse often involving illicitly produced opioids mixed with heroin. Public health experts have emphasized that there is an urgent need for new, effective harm-reduction strategies and technologies. We asked whether Internet search engines could contribute toward this goal. Using state-level data from the USA, we provide evidence for a cross-sectional and longitudinal statistical relationship between opioid-related overdose deaths and the number of Google searches using the term "fentanyl." This finding points to the relevance of Internet search engines: Users - who may be non-addicted vulnerable individuals, addicts, addicts' friends and family members, or physicians - do in fact search for fentanyl online. We argue that during such searches, an info box including a warning (i.e., awareness material to educate users about the risks) and a help message (i.e., references to professional help) can be presented to target users and possibly prevent both unintentional and suicidal overdoses. Even if this info box only helps some users, the high number of daily Google searches renders this a promising public health intervention to supplement other opioid harm-reduction strategies.

Assessing responsible reporting on suicide in the nineteenth century: Evidence for a high quantity of low-quality news.

The press may have contributed to suicide as a mass phenomenon during the nineteenth century. There is limited knowledge on how the press reported on suicide. We utilized a content analysis of suicide news during the time period of suicide rate's strong increase in Austria (1855, 1865, 1875, 1885), assessing variables related to the responsible reporting on suicide (RRS). Analyses indicate that the press showed low levels of RRS and the quantity of low-quality reporting increased during the observation period. Although causal claims should be made with caution, the findings are consistent with the idea of a long-term Werther effect.

Problems posed by the Werther effect as a 'net effect': a comment on recent scholarly work on the effects of 13 Reasons Why.

Recent research estimated that an additional 195 suicides among 10- to 17-year-old youths occurred following the release of the television series 13 Reasons Why. There is an underrecognised aspect in this line of research that this effect represents a net effect based on different possible underlying patterns (e.g. +195/-0 or +395/-200).

The Press and Suicides in the 19th Century: Investigating Possible Imitative Effects in Five Territories of the Austro-Hungarian Empire.

During the 19th century, suicide rates increased in many countries. The press may have contributed to this increase, even though empirical evidence is lacking in this regard. We assessed suicide statistics within five territories of the Austro-Hungarian Empire between 1871 and 1910 and combined these data with a content analysis of suicide reporting in five newspapers, each appearing in one of the five territories. The analysis revealed a covariation between the quantity of reporting and the number of suicides within all five regions. Furthermore, the quantity of reporting significantly predicted the following year's suicides. Although the causal order of suicides and the quantity of reporting should be assessed with caution, evidence is consistent with the idea that the press may have contributed to the establishment of suicide as a mass phenomenon. The findings also support contemporary guidelines for journalists, especially the notion of avoiding undue repetition of suicide stories.

Investigating an Issue-Attention-Action Cycle: A Case Study on the Chronology of Media Attention, Public Attention, and Actual Vaccination Behavior during the 2019 Measles Outbreak in Austria.

The present study investigated the chronology of media attention, public attention, and actual vaccinations during a recent measles outbreak in Austria. The analysis indicated that initial news coverage about the measles outbreak (the first wave of media attention) sparked public attention and led to additional heavy news coverage about measles (the second wave of media attention). The observed patterns of public and media attention reflect typical issue-attention cycles, as revealed by previous research. As a supplement to previous studies, the present study links media and public attention with a consecutive increase in the number of vaccinations, thereby supporting the notion of an issue-attention-action cycle. Additional curve-fitting analyses showed that the day-by-day variations in media and public attention resembled sharp, short-term "spotlight effects," whereas consequences on vaccination behavior represented a broader, long-term "echo effect." Above and beyond the theoretical contributions, we discuss practical implications: Surveilling the development of media and public attention in the immediate aftermath of a measles outbreak may be a cost-effective strategy to predict future patient load, thereby helping to effectively allocate resources for vaccination programs. A thorough understanding of the issue-attention-action cycle contributes to this aim.

Ethnic Concordance in Patient-Physician Communication: Experimental Evidence from Germany.

Minority group members tend to have more negative health outcomes compared to majority group members. As reducing health inequalities is a global imperative, research testing strategies to improve minority patient health outcomes are important. Evidence exists that ethnic concordance in patient-physician communication is statistically associated with positive outcomes for minority patients. Previous research has exclusively relied on non-experimental observational methods. The present study adds to this literature by presenting supplementary experimental evidence, thus increasing confidence in the causal interpretation of the relationships observed in previous studies. Individuals with Turkish migration backgrounds living in Germany (N = 256) were randomly assigned to a hypothetical medical consultation in which a physician, Dr. Thomas Kirsch ("German majority physician"; ethnic-discordance condition) or Dr. Çagdas Kiliç ("Turkish minority physician"; ethnic-concordance condition) talked about lifestyle factors associated with chronic non-communicable diseases (tobacco smoking, an unhealthy diet, and physical inactivity). The analysis indicates that ethnic concordance improved belief in the physician, reduced reactance-related outcomes, and improved prevention-related knowledge transfer. Notably, the effect of ethnic concordance on knowledge was especially pronounced in low health-literacy participants. We discuss the implications related to the ongoing calls for a more diverse physician workforce.

Anti-Stigma HIV-Related Social Advertising: No Evidence for Side Effects on Condom Use.

Recent campaigns try to reduce social stigma associated with persons living with HIV. For example, a German campaign raised awareness that infection is unlikely in low-risk day-to-day interactions. Research has yet to show that there are no harmful side effects. This is essential because such messages promote a less threatening picture of HIV and thus may unintentionally increase complacency. We tested the possible side effects on the willingness to have sex without condoms. An experiment was conducted in which participants were exposed to anti-stigma messages or not. Anti-stigma messages did not elicit an increase in the willingness to have sex without condoms.

Effects of Gain- and Loss-Framed Quit Messages on Smokers: Test of the Ability to Process the Health Message as a Moderator.

Health messages can emphasize the benefits of engaging in healthy behavior (gain-framed) or the costs of failing to engage in it (loss-framed). Previous research revealed that gain-framed messages tend to be more effective in motivating smokers to quit. As a supplement to previous studies, we questioned whether the ability to process health messages moderates the size of the gain-frame advantage. There were two competing theoretical ideas. First, some scholars have noted that a high ability to process a health message is a necessary precondition to observe the advantage of gain-framing. Second, risk aversion-a central concept used in previous theorizing to explain the gain-frame advantage-is associated with automatic processing and automatic processing has a stronger influence on decision making under a low ability to process. We utilized a 2 (exposure to gain- or loss-framed quit messages) × 2 (low or high ability to process) randomized controlled trial with a pre-post exposure change in quit intentions as the target outcome (N = 182 smokers). Although the analysis revealed the hypothesized gain-frame advantage, the ability to process did not moderate the effect. We discuss the theoretical implications.

Suicide rates and information seeking via search engines: A cross-national correlational approach.

The volume of Google searches for suicide-related terms is positively associated with suicide rates, but previous studies used data from specific, restricted geographical contexts, thus, limiting the generalizability of this finding. We investigated the correlation between suicide-related search volume and suicide rates of 50 nations from five continents. We found a positive correlation between suicide rates and search volume, even after controlling for the level of industrialization. Results give credence to the global existence of a correlation. However, the reason why suicide-related search volume is higher in countries with higher suicide rates is still unclear and up to future research.

Optimizing Online Suicide Prevention: A Search Engine-Based Tailored Approach.

Search engines are increasingly used to seek suicide-related information online, which can serve both harmful and helpful purposes. Google acknowledges this fact and presents a suicide-prevention result for particular search terms. Unfortunately, the result is only presented to a limited number of visitors. Hence, Google is missing the opportunity to provide help to vulnerable people. We propose a two-step approach to a tailored optimization: First, research will identify the risk factors. Second, search engines will reweight algorithms according to the risk factors. In this study, we show that the query share of the search term "poisoning" on Google shows substantial peaks corresponding to peaks in actual suicidal behavior. Accordingly, thresholds for showing the suicide-prevention result should be set to the lowest levels during the spring, on Sundays and Mondays, on New Year's Day, and on Saturdays following Thanksgiving. Search engines can help to save lives globally by utilizing a more tailored approach to suicide prevention.

Abyss or Shelter? On the Relevance of Web Search Engines' Search Results When People Google for Suicide.

Despite evidence that suicide rates can increase after suicides are widely reported in the media, appropriate depictions of suicide in the media can help people to overcome suicidal crises and can thus elicit preventive effects. We argue on the level of individual media users that a similar ambivalence can be postulated for search results on online suicide-related search queries. Importantly, the filter bubble hypothesis (Pariser, 2011) states that search results are biased by algorithms based on a person's previous search behavior. In this study, we investigated whether suicide-related search queries, including either potentially suicide-preventive or -facilitative terms, influence subsequent search results. This might thus protect or harm suicidal Internet users. We utilized a 3 (search history: suicide-related harmful, suicide-related helpful, and suicide-unrelated) × 2 (reactive: clicking the top-most result link and no clicking) experimental design applying agent-based testing. While findings show no influences either of search histories or of reactivity on search results in a subsequent situation, the presentation of a helpline offer raises concerns about possible detrimental algorithmic decision-making: Algorithms "decided" whether or not to present a helpline, and this automated decision, then, followed the agent throughout the rest of the observation period. Implications for policy-making and search providers are discussed.

Effects of Suicide Awareness Material on Implicit Suicide Cognition: A Laboratory Experiment.

In spite of the increasing adoption of suicide awareness campaigns to prevent suicide, little is known about the effective construction of awareness messages used and on their impact on suicidal cognition. We hypothesized that media reporting on an individual overcoming a suicidal crisis increases the automatic association between "life" and self. University students (N = 112) were randomly allocated to one of three groups in a laboratory experiment. Participants allocated to treatment group 1 or group 2 read awareness material about a person coping with suicidal ideation by getting professional help. The only difference between the two groups was the amount of social similarity (low vs. high) between the protagonist and the participants. The control group read an article unrelated to suicide. Awareness material increased implicit cognition in terms of a strengthening of self-life associations. This effect was restricted to participants scoring low on wishful identification with the suicidal protagonist. This finding suggests that only individuals who do not wishfully identify with a protagonist going through difficult life circumstances benefit from the awareness material in terms of suicidal cognition. These findings provide a rich basis for further research and have potentially high relevance to the construction of suicide-awareness messages.

Suicide of a Tenor Amidst the Stage Setting of the Werther Opera's Death Scene.

Background: Reporting on suicide can elicit an increase in suicides, a phenomenon termed the "Werther effect." The name can be traced back to an alleged spike in suicides after the publication of Goethe's novel The Sorrows of Young Werther in 1774, in which the protagonist Werther dies by suicide. Aims: Acknowledging the importance and primacy of systematic ecological and individual-level studies, we provide a historical single-case report of the suicide of a "late arrival of the Werther epidemic," as the death was headlined in a news report in 1927. Method: Archival research on tenor Paul Vidal's suicide was conducted. Results: Vidal reconstructed the scene of the final act of the opera Werther in his apartment and died by a gunshot, as did Werther. Limitations: Causal interpretations must be made with caution. Conclusion: Striking similarities between Werther's and Vidal's deaths support the idea of strong identification with the fictional narrative and suggest causal effects. Considering the repeated high level of immersiveness and the intense emotions of opera performances, it is likely that performing the role of Werther increases identification processes, contributing to detrimental effects. The lack of knowledge regarding the role of fictional suicide stories on artists' suicides is discussed.

Suicide among soldiers and social contagion effects: An interrupted time-series analysis.

BACKGROUND: Suicide has become an increasingly concerning problem among soldiers in recent years. Previous research has hypothesized that media-related social contagion effects, termed "Werther effects," may contribute to military suicide numbers. Unfortunately, there is limited empirical knowledge on such social contagion effects in soldiers. We contribute to the literature by investigating this phenomenon in the context of a specific historical suicide case, allowing us to provide a longitudinal assessment: Crown Prince Rudolf, heir to the Imperial throne of the Austro-Hungarian Empire, who died by suicide in January 1889. His death was a well-known news story that shook the monarchy to its foundations. Notably, soldiers of the late nineteenth century were an especially vulnerable portion of the population, proven by the fact that the Austro-Hungarian military had one of the highest suicide rates at the time compared to other European countries. METHODS AND RESULTS: An interrupted time-series analysis, relying on annual military suicide rates between 1873 and 1910, indicated a significant increase in the suicide rate the year of Rudolf's death, a pattern consistent with a social contagion effect. In fact, time series analysis estimated that there were about 30 excess suicides per 100,000 population within the year of Rudolf's death. Additionally, we identified a substantial change in the trend after Rudolf's death, pointing to a long-term decrease in military suicide rates. The latter was not observed in the general population but appeared to be unique to soldiers. DISCUSSION: Although we are very careful when interpreting causal effects with our historical data, we discuss the latter finding by questioning whether a change in military culture, that is, the establishment of better conditions for soldiers in the aftermath of Rudolf's suicide, contributed to decreasing suicide numbers. Although tentative, these findings are also highly relevant for the study of military suicide today.

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.