Dr. Madelyn Gould reviewed two issues, the role of the media in fostering suicide contagion in adolescents, and suicide clusters. She described characteristics of media portrayals of suicide, and characteristics of individual adolescents that increase susceptibility to suicide contagion. She discussed approaches to addressing contagion at the institutional level, including the description of specific guidelines for media coverage, as well as the barriers and challenges to successfully reducing contagion. She also gave a brief overview of the current state of information on suicide clusters.

The Media. Contagion of a behavioral disorder is generally defined as increased risk upon affliction of someone in the same social sphere. This definition, however, is limited according to Dr. Gould because it assumes that direct interpersonal experience with the incident and the suicide victim is necessary for contagion to occur. Yet Dr. Gould described studies showing that indirect influence occurs as well for both real and fictional characters portrayed in the media. Thus, suicide can have contagious effects far beyond the immediate social network of the victim.

According to Dr. Gould, the majority of studies on contagion in the United States and other countries indicate that media coverage of suicides significantly increases the rate of suicide. This poses an essential conflict for the media between producing compelling stories and avoiding contagion. (The code of ethics of the Society of Professional Journalists is “Seek truth in reporting and minimize harm”). One response of the media to contagion has been to cease reporting on suicide, but this is not the best option, according to Dr. Gould, since silence on the subject can foster shame and hinder help-seeking by those at risk. Instead, Dr. Gould calls for reporting that is informed by the data, and building alliances between the health and media communities to balance needs of the media and public health as discussed below. Dr. Gould pointed out that not all media presentations of suicides have a negative impact. Some are neutral, and some have a positive effect providing a powerful opportunity for reducing suicide.

Characteristics of the media presentation, the individual, and interactions between media and individual factors impact suicide contagion. According to Dr. Gould, content analysis studies revealed the following eight media factors that increase suicide contagion, especially for young people. (1) Repeated news coverage of the same story. (2) Front-page coverage. (3) Larger size headlines. (4) Celebrity suicides have greater impact. (5) Portrayal of “rewards” such as the grieving family and boy/girlfriend can foster revenge motivations for suicide, especially among angry and dejected youth. (6) Media reporting indicating suicide as something that is “unavoidable,” that “someone will be next.” (7) Presenting suicide as a political issue, e.g., as due to desegregation or job stress. (8) Victims shown as possessing desirable, high status qualities.

Dr. Gould indicated that teenagers are especially vulnerable to contagion of suicide from portrayals in the media, as well as through direct knowledge of the person (clusters). The stronger the similarities between the individual and the victim portrayed in a media story, the greater is the impact of the story. Dr. Gould described a study of media coverage of suicide in Japan that showed that if the story was about a Japanese individual the rate of completed suicide went up in Japan, but not if the story was about a non-Japanese person.

The media can have an impact on suicide, not only by avoiding deleterious effects, but also to increase public health and wellbeing. Dr. Hemenway cited such examples in the injury field. The media now include the status of any smoke detectors when a fire is reported. Likewise, helmet use is indicated when reporting a bicycle. Dr. Gould underscored the importance of reporting correct information about suicide. Anecdotal data reveal numerous instances of misleading and/or incomplete information about risk factors, implicating trivial triggers, with no or minimal coverage of antecedent mental disorders, and rare or absent listing of local services. Dr. Gould highlighted this opportunity for media to have a positive and proactive impact on suicide prevention.

Dr. Gould made recommendations for pro-social media reporting on suicide. The foremost overarching need is to establish and then to institutionalize working relationships, and possibly new organizations, linking public health, mental health, and the media. Such relationships and/or institutions would necessarily include media professionals and training program leaders, researchers, and advocacy groups. They would serve as a ready source of information for journalists and would develop national media guidelines. Courses in ethical and pro-social reporting should be mandatory in all journalism programs. Continued education about the newest data for journalists is indicated. A venue for continued dialog among all stakeholders should also be established. Dr. Kay Jamison expressed concern that attempts to encourage responsible reporting could discourage the media from addressing suicide in any way. She stated that the media should be given positive examples of stories done well as models to follow.

Dr. Gould listed the following specific guidelines for media coverage of suicide.

(1) Consider whether the suicide in question is newsworthy. (2) Do not misrepresent suicide as a mysterious act by an otherwise healthy or high-achieving person. (3) Do not present suicide as a reasonable or understandable way of problem solving. (4) Include information that suicide in an uncommon, but fatal complication of mental and/or substance abuse disorders, which are treatable. (5) Include information that suicide can be prevented with appropriate treatment. (6) Exercise care when using pictures of victims, since it remains unknown if pictures increase contagion. (7) Do not provide a detailed description of method. Evidence shows that when enough details are given, vulnerable youths will commit suicide in the same spot and/or with the same methods. (8) Limit the prominence, length, and number of stories. (9) Edit headlines to match and not sensationalize the story. (10) Provide local treatment resources with each story. Dr. Kalafat suggested that the media is just one part of the “competent community” and should be included in the community collaborative.

Internet. Dr. Gould briefly discussed the possible influence of internet content and chat rooms on fostering suicide contagion. She mentioned research on help-seeking behavior demonstrating that adolescents are likely to look to the internet for help with problem solving. This provides an opportunity for contagion to occur, as well as a point of intervention and prevention efforts.

Suicide Clusters. Dr. Gould provided a brief discussion of suicide clusters through the mechanism of contagion. The first generation of research on clusters consisted of descriptive studies looking at specific clusters in various groups, including religious sects, psychiatric inpatient wards, and high schools students. These anecdotal case reports were difficult to interpret or draw conclusions from. The next wave of studies used statistical approaches to test for clusters. As Dr. Gould described, these generally showed that clusters did occur, primarily among teenagers and young adults. Case-controlled psychological autopsy studies are one way to examine why clusters occur. Dr. Gould reports that very little research has been completed in this area, although some studies are currently underway to address these gaps.

Dr. Gould concluded by emphasizing that the development and implementation of media guidelines and strategies to prevent clusters are just one part of the overall model for suicide prevention, a necessary part of a competent community. Major risk factors for suicide, whether psychiatric disorders, biological factors, or the impact of stressful events, must be attended to as an essential part of any suicide prevention strategy. Underlying vulnerabilities are what allow contagion to facilitate the route to suicide in certain individuals.