Determining the effects of films with suicidal content: a laboratory experiment.

BACKGROUND: Media stories on suicide can increase suicidal ideation, but little is known about variations in media effects with regard to audience vulnerability and story contents. AIMS: We investigated the impact of three drama films with suicidal content that varied with regard to the final outcome (suicide completion, mastery of crisis and death by natural causes) and tested the moderating effect of baseline suicidality of the participants on the effects. METHOD: Within a laboratory setting, we randomly assigned 95 adults to three film groups. We used questionnaires to analyse the effects of the films on mood, depression, life satisfaction, self-worth, assumed benevolence of the world and suicidality, as well as identification with the protagonist. We stratified the sample into participants with suicidal tendencies above and below the sample median. RESULTS: The film that ended with the protagonist's suicide led to a deterioration of mood particularly in individuals with baseline suicidality below the median, who also experienced an increase in self-worth. Participants with stronger suicidal tendencies experienced a rise in suicidality that depended on their level of identification with the protagonist. The film featuring the main character positively coping with his crisis increased life satisfaction particularly among participants with higher suicidal tendencies. CONCLUSIONS: The effects of suicide-related media material seem to vary with individual vulnerability and with type of media portrayal. Individuals with lower vulnerability experience more emotional reactions when exposed to a film culminating in suicide, but individuals with higher vulnerability experience a rise in suicidal tendencies particularly if they identify with the protagonist who died by suicide. In contrast, portrayals of individual mastery of crisis may have beneficial effects in more vulnerable individuals.

Who identifies with suicidal film characters? Determinants of identification with suicidal protagonists of drama films.

BACKGROUND: Identification with a media character is an influential factor for the effects of a media product on the recipient, but still very little is known about this cognitive process. This study investigated to what extent identification of a recipient with the suicidal protagonist of a film drama is influenced by the similarity between them in terms of sex, age, and education as well as by the viewer's empathy and suicidality. SUBJECTS AND METHODS: Sixty adults were assigned randomly to one of two film groups. Both groups watched a drama that concluded with the tragic suicide of the protagonist. Identification, empathy, suicidality, as well as socio-demographic data were measured by questionnaires that were applied before and after the movie screening. RESULTS: Results indicated that identification was not associated with socio-demographic similarity or the viewer's suicidality. However, the greater the subjects' empathy was, the more they identified with the protagonist in one of the two films. CONCLUSIONS: This investigation provides evidence that challenges the common assumption that identification with a film character is automatically generated when viewer and protagonist are similar in terms of sex, age, education or attitude.

Predictors of suicide and suicide attempt in subway stations: a population-based ecological study.

Suicidal behavior on the subway often involves young people and has a considerable impact on public life, but little is known about factors associated with suicides and suicide attempts in specific subway stations. Between 1979 and 2009, 185 suicides and 107 suicide attempts occurred on the subway in Vienna, Austria. Station-specific suicide and suicide attempt rates (defined as the frequency of suicidal incidents per time period) were modeled as the outcome variables in bivariate and multivariate Poisson regression models. Structural station characteristics (presence of a surveillance unit, train types used, and construction on street level versus other construction), contextual station characteristics (neighborhood to historical sites, size of the catchment area, and in operation during time period of extensive media reporting on subway suicides), and passenger-based characteristics (number of passengers getting on the trains per day, use as meeting point by drug users, and socioeconomic status of the population in the catchment area) were used as the explanatory variables. In the multivariate analyses, subway suicides increased when stations were served by the faster train type. Subway suicide attempts increased with the daily number of passengers getting on the trains and with the stations' use as meeting points by drug users. The findings indicate that there are some differences between subway suicides and suicide attempts. Completed suicides seem to vary most with train type used. Suicide attempts seem to depend mostly on passenger-based characteristics, specifically on the station's crowdedness and on its use as meeting point by drug users. Suicide-preventive interventions should concentrate on crowded stations and on stations frequented by risk groups.

Effects of sunshine on suicide rates.

OBJECTIVES: Seasonal spring peaks of suicide are well described in epidemiological studies, but their origin is poorly understood. More recent evidence suggests that this peak may be associated with the increase in the duration of sunshine in spring. We investigated the effect of number of sunshine hours per month on suicide rates in Austria between 1996 and 2006. METHODS: Suicide data, differentiated by month of suicide, sex, and method of suicide (violent vs nonviolent methods), were provided by Statistics Austria. Data on the average number of sunshine hours per month were calculated from 39 representative meteorological stations (provided by the Austrian Central Institute for Meteorology and Geodynamics). For statistical analysis, analysis of variance tests, Kruskal-Wallis tests, and Pearson correlation tests were used. RESULTS: A total of 16,673 suicides with a median of 126 ± 19.8 suicides per month occurred in the examined period. A clear seasonal pattern was observed, with suicide frequencies being highest between March and May and lowest between November and January (df = 11, F = 5.2, P < .0001) for men (df = 11, F = 4.9, P < .0001) and women (df = 11, F = 2.4, P = .008). The average number of sunshine hours per month was significantly correlated with the number of suicides among both sexes (r = .43, P < .0001), violent methods (r = .48, P < .0001) but not with nonviolent methods (r = .03, P = .707). CONCLUSIONS: This study shows that seasonal changes in sunshine account for variations in the number of suicides and especially violent suicides. We propose that sunshine, via interactions with serotonin neurotransmission, may trigger increased impulsivity and promote suicidal acts. However, because of the hypothesis-generating design of this study, more research is needed to further clarify the role of sunshine in triggering neurobiologic changes, which might contribute to suicidal behavior.

[Suicide Prevention Austria (SUPRA) : the implementation of a national suicide prevention program]. / Suizidprävention Austria (SUPRA) : Umsetzung eines nationalen Suizidpräventionsplanes.

Suicide Prevention Austria (SUPRA) is a package of measures which should help the Austrian ministry of health to realize an evidence based suicide prevention program. That such a program is indispensible can be seen on the fact that suicide is on the second position as cause of death in male Austrians up to the age of forty. The concept itself summarizes successful national programs which fit to the Austrian situation. In the meantime the Austrian ministry of health established an office for coordination of the SUPRA program and a commission of experts which is responsible for the first activities of the national Austrian suicide prevention program.

[Suicides in Austria: update on present state and recent trends]. / Suizide in Österreich: ein Update zur Entwicklung und aktueller Stand.

Suicide rates exceed fatal traffic accidents two-fold in Austria but have been decreasing since 1987. Against common perceptions, approximately 75 % of all suicides in Austria are commited by men each year and while suicide attempts are more common in adolescents, completed suicides increase with age. Studies show that suicide rates are more common in rural than in urban areas and are associated with socio-economic factors. Nationwide prevention efforts should keep these epidemiological aspects in mind.

[Suicide and suicide prevention in Vienna from 1938 to 1945]. / Suizid und Suizidprävention 1938-1945 in Wien.

Beginning with the inception of suicide prevention in interwar Vienna, the paper illustrates how the high number of counselling centres contrasted with a discourse of selection. Despite the fact that suicide rates proved extremely high, suicide prevention declined in importance between 1934 and 1945. Suicide was increasingly attributed to the weak and the inferior. The massive threat to Vienna's Jewish population and the high suicide rates among Viennese Jews are also outlined. The paper concludes with a synopsis of V. E. Frankl's activities in the field of suicide prevention at the Rothschild Hospital as well as the concentration camp in Theresienstadt.

Lithium in drinking water and suicide mortality.

BACKGROUND: There is some evidence that natural levels of lithium in drinking water may have a protective effect on suicide mortality. AIMS: To evaluate the association between local lithium levels in drinking water and suicide mortality at district level in Austria. METHOD: A nationwide sample of 6460 lithium measurements was examined for association with suicide rates per 100,000 population and suicide standardised mortality ratios across all 99 Austrian districts. Multivariate regression models were adjusted for well-known socioeconomic factors known to influence suicide mortality in Austria (population density, per capita income, proportion of Roman Catholics, as well as the availability of mental health service providers). Sensitivity analyses and weighted least squares regression were used to challenge the robustness of the results. RESULTS: The overall suicide rate (R(2) = 0.15, ß = -0.39, t = -4.14, P = 0.000073) as well as the suicide mortality ratio (R(2) = 0.17, ß = -0.41, t = -4.38, P = 0.000030) were inversely associated with lithium levels in drinking water and remained significant after sensitivity analyses and adjustment for socioeconomic factors. CONCLUSIONS: In replicating and extending previous results, this study provides strong evidence that geographic regions with higher natural lithium concentrations in drinking water are associated with lower suicide mortality rates.

[The history of the institutionalization of medical psychology in Austria]. / Zur Geschichte der Institutionalisierung der Medizinischen Psychologie in Österreich.

Beginning with Freudian psychoanalysis and the Zürich school of psychiatry, which in the early 20th century were the first to call for studies in medical psychology at universities, the article traces the path to the institutionalization of medical psychology in Austria especially in Vienna. Particular attention is devoted to the Academic Society for Medical Psychology (Akademischer Verein für Medizinische Psychologie) which held lectures and courses at the University of Vienna from 1926 to 1938. The Society can thus be viewed as a predecessor of the foundation of the institutes for medical psychology and psychotherapeutic clinics, starting in the late 1960s and continuing into the early 1980s.

Role of media reports in completed and prevented suicide: Werther v. Papageno effects.

BACKGROUND: Media reporting of suicide has repeatedly been shown to trigger suicidal behaviour. Few studies have investigated the associations between specific media content and suicide rates. Even less is known about the possible preventive effects of suicide-related media content. AIMS: To test the hypotheses that certain media content is associated with an increase in suicide, suggesting a so-called Werther effect, and that other content is associated with a decrease in suicide, conceptualised as a Papageno effect. Further, to identify classes of media articles with similar reporting profiles and to test for associations between these classes and suicide. METHOD: Content analysis and latent class analysis (LCA) of 497 suicide-related print media reports published in Austria between 1 January and 30 June 2005. Ecological study to identify associations between media item content and short-term changes in suicide rates. RESULTS: Repetitive reporting of the same suicide and the reporting of suicide myths were positively associated with suicide rates. Coverage of individual suicidal ideation not accompanied by suicidal behaviour was negatively associated with suicide rates. The LCA yielded four classes of media reports, of which the mastery of crisis class (articles on individuals who adopted coping strategies other than suicidal behaviour in adverse circumstances) was negatively associated with suicide, whereas the expert opinion class and the epidemiological facts class were positively associated with suicide. CONCLUSIONS: The impact of suicide reporting may not be restricted to harmful effects; rather, coverage of positive coping in adverse circumstances, as covered in media items about suicidal ideation, may have protective effects.

Suicidal ideation and its correlates among elderly in residential care homes.

OBJECTIVE: The highest suicide rates are found among the elderly, therefore suicidal ideation is prevalent in long-term care facilities. Despite these facts and multiplying losses, most residents show no signs of suicidal ideation. There is a lack of information on which factors protect against suicidal thoughts among the elderly. The aim of this pilot study was to assess the prevalence and correlates of suicidal ideation with risk and protective factors among older residential care home residents in Vienna. METHODS: This cross-sectional study was conducted in 15 Viennese residential care homes. Participants completed a self-report questionnaire containing sociodemographic factors, physical health, mental health, and protective factors like optimistic attributional style, self-efficacy, and internal locus of control as well as satisfaction with life and were finally asked about active and passive suicidal thoughts and behaviors. RESULTS: With the voluntary participation of 129 residents aged 60 years or more, active suicidal ideation during the last month was identified in 7% of the elderly, 11% reported active suicidal ideation during the past year. Primarily, we found that protective factors like internal locus of control, self-efficacy, and satisfaction with life were important single predictors of active suicidal ideation during the past month. Depressive symptoms and current psychotherapeutic treatment were additionally important predictors. CONCLUSIONS: Suicidal ideation is prevalent in Viennese residential care homes; consequently it is necessary to recognize and treat suicidal ideation in an adequate way. Our findings suggest that research and prevention strategies could not merely target risk, but also include protective factors.

Consistency of immigrant suicide rates in Austria with country-of-birth suicide rates: a role for genetic risk factors for suicide?

Multifaceted evidence (family, twin, adoption, molecular genetic, geographic, and surname studies of suicide) suggests genetic risk factors for suicide. The migrant study design is also informative in this context, but underused. In particular, immigrant studies of suicide with a continental European host country are unavailable. The correspondence of suicide prevalence among 22 immigrant groups in Austria (1970-2006) with those of the homelands during the same period was analyzed. Immigrant and homeland suicide rates were significantly positively associated. Controls for age of suicide victim, immigrant group size, national pride, and quality of life in the homelands left the finding essentially unchanged. This correspondence of immigrant and country-of-birth suicide rates is consistent with the assumption of population differences in the prevalence of genetic risk factors for suicide, for which there is emerging evidence.

The gap between suicide characteristics in the print media and in the population.

BACKGROUND: Programmes to educate media professionals about suicide are increasingly established, but information about which suicide cases are most likely to be reported in the mass media is sparse. METHODS: We applied binomial tests to compare frequencies of social characteristics of all domestic suicides in the 13 largest Austrian print media in 2005 with frequencies of suicide characteristics in the population. Additionally, each reported suicide case was linked to its respective entry in the suicide database. We performed a logistic regression analysis, with presence of an article as outcome, and sex of the suicide case, age, religious affiliation, family status, conduction of an autopsy and location of the suicide as explaining variables. Time of the year and federal state where the suicide happened was controlled for. RESULTS: Binomial tests showed that suicides involving murder or murder attempt were over-represented in the media. Reporting on mental disorders was under-represented. In the regression analysis, the likelihood of a report was negatively associated with the age of suicide cases. Foreign citizenship was a further predictor of a suicide report. The methods of drowning, jumping, shooting and rare methods were more likely to be reported than hanging, which is the most frequent suicide method in Austria. CONCLUSIONS: Suicide characteristics in the media are not representative of the population. The identified discrepancies provide a basis for tailor-made education of mass media professionals.

The beliefs in the inheritance of risk factors for suicide scale (BIRFSS): cross-cultural validation in Estonia, Malaysia, Romania, the United Kingdom, and the United States.

The genetics of suicide is increasingly recognized and relevant for mental health literacy, but actual beliefs may lag behind current knowledge. We examined such beliefs in student samples (total N = 686) from Estonia, Malaysia, Romania, the United Kingdom, and the United States with the Beliefs in the Inheritance of Risk Factors for Suicide Scale. Cultural effects were small, those of key demographics nil. Several facets of construct validity were demonstrated. Marked differences in perceived plausibility of evidence about the genetics of suicide according to research design, observed in all samples, may be of general interest for investigating lay theories of abnormal behavior and communicating behavioral and psychiatric genetic research findings.

Beliefs about the genetics of suicide in Canadian students: cross-language validation of the Beliefs in the Inheritance of Risk Factors for Suicide Scale (BIRFSS).

AIM: The genetics underlying suicidal behavior is becoming increasingly recognized and investigated. Convergent evidence towards this end has emerged from numerous research strategies (adoption, family, genome-scan, geographic, immigrant, molecular genetic, surname, and twin studies of suicide). The topic-related mental-health literacy (i.e. knowledge and beliefs) of professionals and laypersons, however, may lag behind this research progress, and data on this question are scant. The aim of the present study was therefore to further validate, in a cross-language setting, the novel 22-item Beliefs in the Inheritance of Risk Factors for Suicide Scale (BIRFSS), originally developed in German, which assesses beliefs about the genetics of suicide. METHODS: Data were collected from a mixed student sample from Canada (n = 288; 70.5% females, 58.0% studying psychology as a major or minor). RESULTS: Factor analysis of BIRFSS items yielded a dominant first factor. Internal scale consistency was, however, only middling (lower than previously observed in Austrian samples). Although the structure of beliefs about the genetics of suicide seems to be complex, the Canadian sample's item-performance indicators corresponded strongly to those obtained in Austrian samples, thus indicating cross-sample and cross-language robustness of item statistics. CONCLUSION: For the Canadian sample, BIRFSS scores were positively related to overall and specific knowledge about suicide and general beliefs about genetic determinism (convergent validity), whereas they were not (or only trivially) related to the Big Five personality dimensions, lay theories of suicide, locus of control, social desirability, religiosity, and political orientation (discriminant validity), and to several key demographic variables. Supplemental findings, study limitations, application possibilities, user recommendations, and avenues for further inquiry are discussed.

Not carried away by a moonlight shadow: no evidence for associations between suicide occurrence and lunar phase among more than 65,000 suicide cases in Austria, 1970-2006.

OBJECTIVES: Belief in lunar effects on abnormal or deviant human behavior ("moon madness") is old, common, perpetuated by the media and notably widespread among health professionals, and may thus have public health consequences. This study investigated lunar effects on one particular outcome (completed suicide) for which the literature appears unsettled, owing to some recent reports with positive findings. METHODS: The timing of all 65,206 suicides (46,451 men; 18,755 women) officially registered in Austria between 1970 and 2006 was analyzed with respect to the phases of the moon. This was the first such study based on national data conducted outside the USA, with the database comprising the second-longest study period and the second-largest sample ever investigated in this subject area. RESULTS: Observed proportions of both male and female suicide occurrence did not deviate from expected proportions during the new, crescent, full, and decrescent moon quarters or from those expected for 3-day windows centered around new and full moon, relative to the interphase. Subgroup analysis (by sex and year), additionally conducted for demonstration purposes, yielded results conspicuously resembling those of related studies with positive findings; namely, sporadically emerging significant findings that were entirely absent in the overall analysis and directionally erratic, thus suggesting they were spurious (false positive). CONCLUSIONS: This large-sample evidence strongly suggests no lunar effects on the timing of completed suicide. Scattered previous evidence in support of such effects in all likelihood was spurious; that is, was due to statistical type 1 errors or erroneously taking calendrical periodicities of suicide occurrence that are real as evidence for lunar effects.

The malleability of beliefs in the genetics of suicide: an intervention study with the beliefs in the inheritance of risk factors for suicide scale (BIRFSS).

BACKGROUND: Previous research has documented that disbelief in the genetics of suicide prevails. OBJECTIVES: This study examined for the first time the malleability of such beliefs and their internal structure, using the Beliefs in the Inheritance of Risk Factors for Suicide Scale (BIRFSS). METHODS: A sample of 38 Austrian first-year psychology students (27 women, 11 men), previously not exposed to the topic, studied a recent overview article on the genetics of suicide as a self-paced exercise. Exposure to the contents of the article was evaluated with a subjective self-report measure and with an objective quiz. RESULTS: Validity checks were suggestive for a successful implementation of the intervention. Compared with baseline data 4 months prior to the intervention, evaluation of the intervention showed that participants held significantly stronger beliefs (Cohen's d = 1.41) in the genetics of suicide which also were more coherent. CONCLUSIONS: Disbelief in the genetics of suicide is modifiable. Study limitations, directions for future research, and practical implications are discussed.

Surname study of suicide in Austria: differences in regional suicide rates correspond to the genetic structure of the population.

OBJECTIVES: There is convergent evidence from adoption, family, geographical, immigrant, molecular genetic, twin and, most recently, surname studies of suicide for genetic contributions to suicide risk. Surnames carry information about genetic relatedness or distance and, in patrilineal surname systems, are a close substitute for Y-chromosome markers and haplotypes, since surname transmission is similar to the transmission of the nonrecombining part of the Y chromosome. This study investigated whether differences in regional suicide rates correspond to the genetic structure of the Austrian population. METHODS: Differences in district-level standardized suicide rates 1988-94 between the five major surname regions identified for Austria were analyzed. The surname regions used in the analysis reflect the contemporary population structure and closely follow the natural borders found in the topography of Austria, less so its administrative division into nine states. RESULTS: Surname region accounted for a significant (P < 0.001) and substantial (38%) portion of the variance in district-level suicide rates. Adjusting the suicide rates for a set of five social and economic indicators that are established ecological correlates of suicide prevalence (income, and rates of the divorced, unemployed, elderly and Roman Catholics) left the results essentially unchanged. CONCLUSIONS: Regional differences in suicide rates within Austria correspond to the genetic structure of the population. The present evidence adds to related findings from geographical and surname studies of suicide that suggest a role for genetic risk factors for suicidal behavior. Genetic differences between subpopulations may partially account for the geography of suicide. Study limitations and directions for future research are discussed.

Facts and myths about seasonal variation in suicide.

The prevalence of suicide presents a universal seasonal pattern. In the Northern hemisphere, suicides peak during spring and early summer and the trough occurs during winter. This peculiar pattern might be counterintuitive for everyday reasoning. Data from 1,093 medical and psychology undergraduates from Austria (382 men and 711 women; M age 25.0 yr., SD=6.6) indicated an almost perfectly reversed pattern of beliefs about suicide seasonality compared with the actual seasonal distribution. The vast majority of respondents believed the peak to be located in late autumn and early winter and the trough occurring in late spring and the summer months. Implications for education and practice are discussed.