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Background There is accumulating evidence about detrimental impacts of the pandemic on population mental health, but knowledge on risk of groups specifically affected by the pandemic and variations across time is still limited. Methods We surveyed approximately n=1,000 Austrian residents in 12 waves between April and December 2020 (n=12,029). Outcomes were suicidality (Beck Suicidal Ideation Scale), depressive symptoms (Patient Health Questionnaire-9), anxiety (Hospital Anxiety Depression Scale), and domestic violence. We also assessed the perceived burden from the pandemic. Demographic and Covid-19 specific occupational and morbidity-related variables were used to explain outcomes in multivariable regression analyses, controlling for well-established risk factors of mental ill-health, and variations over time were analyzed. Results Young age, working in healthcare or from home, and own Covid-19 illness were consistent risk factors controlling for a wide range of known mental health risk factors. Time patterns in the perceived burden from Covid-19-related measures were consistent with the time sequence of restrictions and relaxations of governmental measures. Depression and anxiety were relatively stable over time, with some increase of depression during the second phase of lockdowns. Domestic violence increased immediately after both hard lockdowns. Suicidal ideation decreased slightly over time, with a low during the second hard lockdown. Mental health indicators for women and young people showed some deterioration over time, whereas those reporting own Covid-19 illness improved. Limitations Data from before the pandemic were not available. Conclusions Among mental health outcomes, increases in domestic violence and, to some smaller extent, depressive symptoms, appeared most closely related to the timing of hard lockdowns. Healthcare staff, individuals working from home, those with Covid-19, as well as young people and women are non-traditional risk groups who warrant heightened attention in prevention during and in the aftermath of the pandemic. Keywords: Covid-19, pandemic, mental health, survey, Austria

Abstract. Background: The It Gets Better project aims to help prevent suicide among lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ+) adolescents. It features personal video narratives portraying how life gets better when struggling with adversities. Research on the contents of messages is scarce. Aims: We aimed to explore the content of videos in the Austrian It Gets Better project regarding the representation of various LGBTIQ+ groups and selected content characteristics. Method: A content analysis of all German-language videos was conducted ( N = 192). Messages related to coming out, stressors experienced, suicidal ideation/behavior, and on how things get better were coded. Results: Representation was strong for gay men ( n = 45; 41.7%). Coming out to others was mainly positively framed ( n = 31; 46.3%) and seen as a tool to make things better ( n = 27; 37.5%). Social support ( n = 42; 62.7%) and self-acceptance ( n = 37; 55.2%) were prevalent topics. Common stressors included a conservative setting ( n = 18, 26.9%), and fear of outing ( n = 17; 25.4%). Suicidality ( n = 9; 4.7%) and options to get professional help ( n = 7; 8.2%) were rarely addressed. Limitations: Only aspects explicitly brought up in the videos were codeable. Conclusion: Videos do not fully represent gender identities and sexual orientations. Messaging on suicidality and professional help require strengthening to tailor them better for suicide prevention.

Media stories featuring stories of personal experiences of coping with suicidal ideation have been shown to decrease suicide risk, but it is unclear whether more impersonal awareness materials have similar effects. This study aimed to test the impact of impersonal educative news articles featuring interviews with suicide prevention experts. Because the impact of news articles may be determined by the articles' pull quotes and headlines, we also aimed to compare the impact of two versions of the same suicide prevention news article. One version featured headlines and pull quotes highlighting the message that suicide is preventable, whereas the other version focused on the message that suicide is prevalent. In a web-based randomized controlled trial

Objective Media recommendations for the reporting of events where one person or a small group kills multiple others in public settings have been developed recently by suicide prevention experts. Evidence on the effects of reports that are compliant or noncompliant with these recommendations is lacking. Methods We conducted a randomized controlled trial with n = 148 participants who were randomly assigned to read newspaper articles (A) on acts of terrorism assumed to be conducted by Islamist terrorists and not consistent with media recommendations, (B) the same articles differing only in their compliance with recommendations, or (C) articles of similar style that were about homicide. Islamophobia as well as suicidal ideation, stress, and mood were measured before reading the article (T1), immediately afterwards (T2), and one week later (T3). The primary hypothesis was that there is an increase in islamophobia after exposure to media portrayals not consistent with media recommendations. Results Compared to the control group, only participants reading media reports that were not consistent with media recommendations showed a short-term increase in islamophobia. Conclusion These findings suggest that reporting on terrorism that is not consistent with media recommendations appears to increase islamophobia. In the context of reporting on Islamist terrorism, consistency with recommendations might help reduce negative attitudes toward Muslim minorities.

BackgroundAwareness materials featuring ways of coping with suicidal ideation can reduce suicidal ideation, the so-called Papageno effect. All of the previous experimental studies on this subject have been conducted with individuals not at risk of suicide.AimsTo assess effects of suicide awareness materials in a sample of individuals with recent suicidal ideation. Trial registration: German Clinical Trial Registry ID number DRKS00013613.MethodAdults (n = 266) with recent self-reported suicidal ideation or attempt were randomised to read an educative article featuring a lay individual with personal experience of suicidality (n = 86), a similar article featuring a mental health expert (n = 90), or an unrelated article (n = 90) in a double-blind online randomised controlled trial. Questionnaire data were collected before (T1) and immediately after exposure (T2) as well as 1 week later (study end-point, T3) and analysed with linear mixed models. The primary outcome was suicide risk as assessed using the Survival and Coping Beliefs subscale of the Reasons for Living Inventory (RFLI); secondary outcomes were suicide-prevention knowledge and mood.ResultsThere was an immediate beneficial effect on suicide risk in the intervention group exposed to the message delivered by the individual with personal experience (group 1) as compared with the control group that was maintained until the study end-point (study end-point: RFLI score mean difference from baseline within group 1 MD = −0.36 (95% CI −0.66 to −0.06), mean difference compared with control group MD = −0.71 (95% CI −1.27 to −0.14); d = −0.18). The effect was particularly pronounced for individuals with recent suicide attempt (RFLI score at T3, compared with control group: MD = −1.55 (95% CI −2.52 to −0.57); d = −0.23). Participants in this group also showed increased prevention-related knowledge compared with the control group.ConclusionsIndividuals with a recent suicide attempt appear to benefit from a printed narrative of positive coping with suicidal ideation. The intervention materials do not increase short-term suicide risk.

Social media may play a role in the “contagion” mechanism thought to underpin suicide clusters. Our pilot case-control study presented a novel methodological approach to examining whether Facebook activity following cluster and non-cluster suicides differed. We used a scan statistic to identify suicide cluster cases occurring in spatiotemporal clusters and matched each case to 10 non-cluster control suicides. We identified the Facebook accounts of 3/48 cluster cases and 20/480 non-cluster controls and their respective friends-lists and retrieved 48 posthumous posts and replies (text segments) referring to the deceased for the former and 606 for the latter. We examined text segments for “putatively harmful” and “putatively protective” content (e.g., discussion of the suicide method vs. messages discouraging suicidal acts). We also used concept mapping, word-emotion association, and sentiment analysis and gauged user reactions to posts using the reactions-to-posts ratio. We found no “putatively harmful” or “putatively protective” content following any suicides. However, “family” and “son” concepts were more common for cluster cases and “xx”, “sorry” and “loss” concepts were more common for non-cluster controls, and there were twice as many surprise- and disgust-associated words for cluster cases. Posts pertaining to non-cluster controls were four times as receptive as those about cluster cases. We hope that the approach we have presented may help to guide future research to explain suicide clusters and social-media contagion.

Suicide prevention videos featuring young people’s personal narratives of hope and recovery are increasingly used in suicide prevention, but research on their effects is scarce. A double-blind randomized controlled trial was conducted to test the effects of a suicide prevention video featuring an adolescent mastering his suicidal ideation by getting help on 14 to 19-year-olds. N = 299 adolescents were randomly allocated to watch the intervention video (n = 148) or a control video unrelated to mental health (n = 151). Questionnaire data were collected before (T1) and immediately after exposure (T2), and 4 weeks later (T3). Data were analyzed with a repeated-measures ANCOVA. The primary outcome was suicidal ideation, assessed with the Reasons for Living Inventory for Adolescents. Secondary outcomes were help-seeking intentions, attitudes towards suicide, stigmatization of suicidality, and mood. There was an immediate beneficial effect of the intervention on suicidal ideation (T2 mean change from baseline within intervention group MChange = − 0.16 [95% CI − 0.20 to − 0.12], mean difference compared to control group MDiff = − 0.09 [95% CI − 0.15 to − 0.03], ηp2 = 0.03), which was not maintained at T3. Participants reported significantly higher help-seeking intentions, which was maintained at 4-week follow-up. They also reported a sustained reduction of favorable attitudes to suicide. Effects on suicidal ideation were mediated by identification with the featured protagonist. Adolescents appear to benefit from suicide prevention narratives featuring personal stories from peers on coping with suicidal ideation and help-seeking.Trial registration DRKS00017405; 24/09/19; retrospectively registered.

Background Guidelines to encourage responsible reporting of suicide in news media are a key component of suicide prevention strategies. Recent guidelines have been developed on portrayal of suicide in entertainment media although the relationship between these portrayals and subsequent suicidal behaviour has received considerably less attention in research. Methods We conducted a systematic review and meta-analysis to examine the association between portrayals of suicide and suicide attempt in entertainment media and suicidal behaviour in the population. We searched PubMed, Scopus, Embase, PsycInfo, Web of Science and Google Scholar until April 20, 2021. We included studies adopting interrupted time series or single/multiple arm pre-post designs. Separate analyses were undertaken for studies of suicide and suicide attempts. We synthesized studies at moderate risk of bias and included studies at serious risk in a sensitivity analysis. Using a random-effects meta-analysis, we synthesized studies at moderate risk of bias and included studies at serious risk in a sensitivity analysis. Study registration: PROSPERO (CRD42020221333). Findings Twelve studies met our inclusion criteria. Six studies were about suicide. Two of these were at moderate risk of bias and both examined the effects of the Netflix series 13 Reasons Why. The pooled rate ratio (RR) for these studies was 1·18 (95% CI 1·09 to 1·27, p

Decades of research overwhelmingly supports the public health necessity of safe, balanced, and responsible news media reporting on suicide.1,2 When news media follow recommendations for safe reporting, the risk of copycat suicide decreases.3 The Recommendations for Media Reporting on Suicide were developed by leading experts in suicide prevention and in collaboration with several international suicide prevention and public health organizations, schools of journalism, media organizations, and key journalists, as well as Internet safety experts (www.reportingonsuicide.org). The recommendations are based on more than 100 international studies on suicide contagion. Furthermore, in recent years, Niederkrotenthaler and others have specifically examined suicide-related media portrayals focused on messages of hope, recovery, or mastery over a crisis. Research demonstrates that following such portrayals, those exposed experience a decrease in suicidal ideation, diminished distress, and an increased sense of hope.4,5 Importantly, in some cases, fewer suicides are observed across the exposed population.1 In other words, both suicide and resilience are contagious behaviors, and the content of suicide-related news media messaging can and does prevent tragic deaths.

Abstract. Background: Little is known about presenting problems of primary posters (i.e., posters opening the thread) and their responders in nonprofessional against-suicide and pro-suicide message boards. Aims: We aimed to compare problems described in suicide message boards between different types of users (primary posters and respondents) and between against-suicide, neutral, and pro-suicide message boards. Method: In all, 1,182 archival threads with 20,499 individual postings from seven nonprofessional suicide message boards supporting an against-suicide, neutral, or pro-suicide attitude were randomly selected. Problems mentioned by primary posters and their respondents were coded with content analysis. Differences between pro-suicide, neutral, and against suicide boards, as well as correlations between primary posters and respondents, were calculated. Results: Interpersonal problems were most frequently mentioned by primary posters in against-suicide threads (40.9%) and less frequently in pro-suicide threads (11.8%; p < .001). In pro-suicide boards, the most frequent stressors were suicide method-related (e.g., how to identify a safe method: 26.2% vs. 2.5% in against-suicide boards, p < .001). Primary posters resembled respondents in terms of presenting problems in pro-suicide boards, but not in against-suicide boards. Limitations: Only self-reported problems were assessed. Conclusion: The results confirm a stronger focus on death than on life among users in pro-suicide message boards, and posters with similar problems meet in pro-suicide boards. The posters appear to clearly emphasize social strains over psychiatric problems compared with some professional settings.

Abstract. Background: Little is known about linguistic differences between nonprofessional suicide message boards that differ in regard to their predominant attitude to suicide. Aims: To compare linguistic indicators potentially related to suicidality between anti-suicide, neutral, and pro-suicide message boards, and between the types of posters (primary posters, who initiate the thread, and the respective respondents). Method: In all, 1,200 threads from seven German-language nonprofessional suicide message boards were analyzed using the software Linguistic Inquiry and Word Count (LIWC) with regard to wording related to suicidal fantasies, aggression, and indicators of so-called suicidal constriction. Data were analyzed with ANOVA. Results: There were fewer words related to affective, social, cognitive, and communicative processes in pro-suicide message boards than in other boards. Death-related wording and aggression as well as tentative wording appeared more prevalent in pro-suicide boards. Limitations: Complex language structures cannot be analyzed with LIWC. Conclusion: The results suggest fewer emotion words and wording related to social circumstances among primary posters and respondents in pro-suicide boards as compared with other boards, and a higher use of death- and aggression-related words. These findings might signal a higher degree of suicidality or sheer differences in matters of interest or social desirability. The differences require attention in practice and research.

This paper presents a first quantitative analysis of language in media reports of neonaticide and a comparative examination of language use within the reports. One thousand twenty-seven Austrian print media reports from 2004 to 2014 were retrieved; after exclusion, 331 were analysed using the Linguistic Inquiry and Word Count (LIWC) software. After a preliminary analysis, a comparative analysis was carried out between reports on the Graz case and all other cases. The preliminary analysis revealed that a majority of media reports were related to one repeat neonaticide case (Graz) despite not being clinically different from other cases identified for the same period. The comparative linguistic analysis shows some statistically significant differences relating to the domains of emotional words (less words of anxiety, sadness) and family and in the category of insight and certainty (more words). The unexpected media attention on the Graz case and the ensuing verdict, which was in contradiction with the Austrian infanticide act, might have been influenced by the way language was used by journalists and the media. The authors suggest guidelines on sensitive media reporting are required.

Media allegations about malpractice in psychiatry are not uncommon, but little is known about their effects and how clinic management can effectively mitigate reputational damage. This study explored the impact of footage from a TV documentary raising allegations against a psychiatric clinic and assessed the effectiveness of different public response strategies from clinic management. N = 615 adults were randomized to one of four intervention groups watching allegations of malpractice in a psychiatric clinic or unrelated footage (control). Each intervention group further included one specific fictitious public response from clinic management: Denial, attack the accuser, apology, or decline to respond. The primary outcome was attitudes toward psychiatry, assessed before and after the intervention. Secondary outcomes (attitudes toward the staff of the clinic, intentions to recommend the clinic) were measured post-intervention. There was a decrease of favorable attitudes toward psychiatry across intervention groups (F = 14.46, p

ObjectiveTo examine the association between reporting on suicides, especially deaths of celebrities by suicide, and subsequent suicides in the general population.DesignSystematic review and meta-analysis.Data sourcesPubMed/Medline, PsychInfo, Scopus, Web of Science, Embase, and Google Scholar, searched up to September 2019.Review methodsStudies were included if they compared at least one time point before and one time point after media reports on suicide; follow-up was two months or less; the outcome was death by suicide; and the media reports were about non-fictional suicides. Data from studies adopting an interrupted time series design, or single or multiple arm before and after comparisons, were reviewed.Results31 studies were identified and analysed, and 20 studies at moderate risk of bias were included in the main analyses. The risk of suicide increased by 13% in the period after the media reported a death of a celebrity by suicide (rate ratio 1.13, 95% confidence interval 1.08 to 1.18; 14 studies; median follow-up 28 days, range 7-60 days). When the suicide method used by the celebrity was reported, there was an associated 30% increase in deaths by the same method (rate ratio 1.30, 95% confidence interval 1.18 to 1.44; 11 studies; median follow-up 28 days, range 14-60 days). For general reporting of suicide, the rate ratio was 1.002 (0.997 to 1.008; five studies; median follow-up 1 day, range 1-8 days) for a one article increase in the number of reports on suicide. Heterogeneity was large and partially explained by celebrity and methodological factors. Enhanced funnel plots suggested some publication bias in the literature.ConclusionsReporting of deaths of celebrities by suicide appears to have made a meaningful impact on total suicides in the general population. The effect was larger for increases by the same method as used by the celebrity. General reporting of suicide did not appear to be associated with suicide although associations for certain types of reporting cannot be excluded. The best available intervention at the population level to deal with the harmful effects of media reports is guidelines for responsible reporting. These guidelines should be more widely implemented and promoted, especially when reporting on deaths of celebrities by suicide.Systematic review registrationPROSPERO CRD42019086559.

Abstract. Background: Little is known about the impact of educative media reports on the intention to provide help to suicidal individuals and on suicide-related knowledge. Aims: To test whether material debunking widely shared myths influences knowledge and the intention to provide adequate help to others, and if such information reduces reading enjoyment. Method: A randomized controlled trial was utilized. Participants allocated to the intervention group were exposed to awareness material explicitly addressing suicide myths. Results: Analyses show that exposure to printed awareness material increased knowledge, which in turn positively influenced intentions to provide help. The inclusion of information regarding suicide myths did not reduce reading enjoyment. Limitations: The awareness material used in this study only addressed two suicide myths that were considered to be especially important. Conclusion: Information debunking suicide myths in suicide-related media reports is therefore both feasible and potentially helpful.

BackgroundSuicide prevention organisations frequently use websites to educate the public, but evaluations of these websites are lacking.AimsTo examine the effects of educative websites and the moderating effect of participant vulnerability.MethodA total of 161 adults were randomised to either view an educative website on suicide prevention or an unrelated website in a single-blinded randomised controlled trial (trial registration with the American Economic Association's registry: RCT-ID: 000924). The primary outcome was suicidal ideation; secondary outcomes were mood, suicide-prevention-related knowledge and attitudes towards suicide/seeking professional help. Data were collected using questionnaires before (T1), immediately after exposure (T2), and 1 week after exposure (T3) and analysed using linear mixed models.ResultsNo significant intervention effect was identified for the entire intervention group with regard to suicidal ideation, but a significant and sustained increase in suicide-prevention-related knowledge (T3v. T1P< 0.001, d = 1.12, 95% CI 0.96 to 1.28) and a non-sustained worsening of mood (P< 0.001, T2v. T1, d = −0.59, −0.75 to −0.43) were observed. Participants with increased vulnerability experienced a partially sustained reduction of suicidal ideation (T3v. T1, Pd = −0.34, −0.50 to −0.19).ConclusionsEducative professional suicide prevention websites appeared to increase suicide-prevention-related knowledge, and among vulnerable individuals website exposure may be associated with a reduction of suicidal ideation.

Abstract. Background: Studies have shown that suicidal individuals who use the Internet for suicide-related purposes are more suicidal than nonsuicide-related users, but evidence from European countries is lacking. Aims: We assessed differences between suicidal individuals who go online for suicide-related purposes and other suicidal individuals in Austria. Method: Participants were 53 individuals aged between 18 and 24 years who felt suicidal in the past year and completed an anonymous online survey. Results: Individuals who went online for suicide-related purposes were more suicidal, and more depressed, compared with individuals who did not use the Internet for suicide-related purposes. There were no large differences with regard to social anxiety and perceived barriers for help-seeking between the two groups. Conclusion: This study finds that suicidal online users are more depressed and suicidal than nonusers in a sample from Central Europe. Online interventions to combat depression and suicidality need to be strengthened to reach out to this important target population.

Abstract. Background: Previous studies suggest that troubled romantic relationships are associated with higher risk factors for mental health. However, studies examining the role of relationship satisfaction in suicide risk factors are scarce. Aims: We investigated differences in risk factors for suicide between individuals with high relationship satisfaction, individuals with low relationship satisfaction, and singles. Furthermore, we explored patterns of experiencing, and dealing with, conflicts in the relationship and examined associations with suicide risk factors. Method: In this cross-sectional study, we assessed relationship status, relationship satisfaction, specific types of relationship conflicts, and suicide risk factors (i.e., suicidal ideation, hopelessness, depression) with questionnaires among 382 individuals in Austria. Results: Risk factors for suicide were higher among singles than among individuals in happy relationships, but lower among those with low relationship satisfaction. Participants reporting a high number of unsolved conflicts in their relationship had higher levels of suicidal ideation, hopelessness, and depression than individuals who tend to solve issues with their partner amicably or report no conflicts. Conclusion: Relationship satisfaction and relationship conflicts reflect risk factors for suicide, with higher levels of suicidal ideation, hopelessness, and depression reported by individuals who mentioned unsolved conflicts with their partner and experienced low satisfaction with their relationship.

OBJECTIVE: Media stories on how to cope with suicidal crises have been shown to reduce suicidal ideation, but studies investigating if effects differ depending on delivery by individuals with or without personal experience of suicidality are lacking. The present study aimed to examine effects of news articles featuring interviews with experts with vs without personal experience of suicidal ideation. METHODS: In a web-based, double-blinded, randomized controlled trial conducted in April and May 2017, a total of 545 adults recruited from the general population were randomly assigned to read a news article featuring an interview with a suicide expert disclosing personal experience of suicidal ideation, the same article without disclosure of personal experience, or an article unrelated to suicide. The primary outcome was change from baseline suicidal ideation score (assessed by a subscale of the Reasons for Living Inventory); the secondary outcome was change from baseline in a measure of suicide-prevention-related knowledge (assessed by items from various questionnaires). Data from the 527 participants analyzed were collected using online questionnaires before and after exposure. RESULTS: Participants in the 2 intervention groups reported a decrease in suicidal ideation (Group 1 [article without personal experience of ideation]: P < .001, d = -0.16; 95% CI, -0.25 to -0.07; Group 2 [with personal experience]: P < .001, d = -0.25; 95% CI, -0.33 to -0.16) and an increase in suicide-prevention-related knowledge (Group 1: P < .001, d = 0.72; 95% CI, 0.64 to 0.81; Group 2: P < .001, d = 0.70; 95% CI, 0.62 to 0.79) after article exposure. There were no differences between the 2 intervention groups. CONCLUSIONS: Educative news articles featuring interviews with suicide prevention experts who disclose or do not disclose their personal experience of suicidality seem to be effective for suicide preventive education in the general public in accordance with the Papageno effect. TRIAL REGISTRATION: German Clinical Trials Register, identifier: DRKS00015781​​​. ispartof: JOURNAL OF CLINICAL PSYCHIATRY vol:80 issue:1 pages:1-8 ispartof: location:United States status: Published online

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.

Background and objective Suicide prevention plans support individuals with personal experience of mental disorders and suicidality to provide their narratives of coping in the media. The evidence how such portrayals impact on individuals with similar symptoms is limited and there are concerns about unwanted side effects. Methods This was a double-blinded randomized controlled online trial conducted from August to November 2018. N = 158 young adults aged 18–24 with current depressive symptoms and suicidal thoughts were randomized to watch a short film featuring a young individual with personal experience of depression and suicidality (n = 81), or a thematically unrelated control film (n = 77) with similar stylistic elements. Questionnaire data were collected before and immediately after exposure and analysed with ANOVA. The primary outcome was suicidal ideation; secondary outcomes were depressed mood and help-seeking intentions. We also tested the moderating effects of the degree of depressive symptoms on the effects. Results Depressed mood was significantly lower, with small-to medium effect size, in the intervention group compared to the control group (F(1,111) = 4.13, P Limitations Self-reported variables in an online setting. Conclusions Videos featuring personal experience of coping with depression appear safe for young individuals with similar or higher symptoms of depression and suicidal ideation on the short run, and might have some benefits. Trial registration German Clinical Trial Registry, DRKS00015095 (registration date: 2018-07-16).

Recent research suggests that search volumes of the most popular search engine worldwide, Google, provided via Google Trends, could be associated with national suicide rates in the USA, UK, and some Asian countries. However, search volumes have mostly been studied in an ad hoc fashion, without controls for spurious associations. This study evaluated the validity and utility of Google Trends search volumes for behavioral forecasting of suicide rates in the USA, Germany, Austria, and Switzerland. Suicide-related search terms were systematically collected and respective Google Trends search volumes evaluated for availability. Time spans covered 2004 to 2010 (USA, Switzerland) and 2004 to 2012 (Germany, Austria). Temporal associations of search volumes and suicide rates were investigated with time-series analyses that rigorously controlled for spurious associations. The number and reliability of analyzable search volume data increased with country size. Search volumes showed various temporal associations with suicide rates. However, associations differed both across and within countries and mostly followed no discernable patterns. The total number of significant associations roughly matched the number of expected Type I errors. These results suggest that the validity of Google Trends search volumes for behavioral forecasting of national suicide rates is low. The utility and validity of search volumes for the forecasting of suicide rates depend on two key assumptions ("the population that conducts searches consists mostly of individuals with suicidal ideation", "suicide-related search behavior is strongly linked with suicidal behavior"). We discuss strands of evidence that these two assumptions are likely not met. Implications for future research with Google Trends in the context of suicide research are also discussed.

Increasing help-seeking and referrals for at-risk individuals by decreasing stigma has been defined as Aspirational Goal 10 in the National Action Alliance for Suicide Prevention's Research Prioritization Task Force's 2014 prioritized research agenda. This article reviews the research evidence on the impact of mass media awareness campaigns on reducing stigma and increasing help-seeking. The review will focus on both beneficial and iatrogenic effects of suicide preventive interventions using media campaigns to target the broad public. A further focus is on collaboration between public health professionals and news media in order to reduce the risk of copycat behavior and enhance help-seeking behavior. Examples of multilevel approaches that include both mass media interventions and individual-level approaches to reduce stigma and increase referrals are provided as well. Multilevel suicide prevention programs that combine various approaches seem to provide the most promising results, but much more needs to be learned about the best possible composition of these programs. Major research and practice challenges include the identification of optimal ways to reach vulnerable populations who likely do not benefit from current awareness strategies. Caution is needed in all efforts that aim to reduce the stigma of suicidal ideation, mental illness, and mental health treatment in order to avoid iatrogenic effects. The article concludes with specific suggestions for research questions to help move this line of suicide research and practice forward.

This paper analyzed gender-specific reporting differences in Austrian newspapers on suicidal behavior related to portrayals of and language about suicidal motives in order to shed light on cultural scripts that may both reflect and shape gender stereotypes in a country where conservative gender-role models dominate. A total of 126 Austrian print-media reports on female suicidal behavior were compared to 381 reports on male suicidal behavior. The linguistic text analysis program LIWC was used to compare the use of language indicative of emotions, assess text complexity and detect indicators of social processes in the stories. Mental illness as a motive for suicide was more prevalent in reports on women’s suicidal behavior and was often portrayed in a stigmatizing manner. Consistent with Austria’s prevalent conceptions of gender-role functions, stories about female suicidal behavior contained more words indicating sociability and more references to other persons, and motives for female suicide were often linked to family situations. Words indicating anger were more prevalent in articles on male behavior, and male suicidal behavior was contextualized as stemming from breakups and spousal rejection. Articles on female suicide contained more tentative wording, and the language used to portray women’s suicidal behavior was more complex. These findings are consistent with a script that conforms to sociable, mentally disturbed women and angry, rejected men. This script reflects sexist cultural attitudes relevant to public education efforts.

Importance On March 31, 2017, Netflix released the show13 Reasons Why, sparking immediate criticism from suicide prevention organizations for not following media recommendations for responsible suicide portrayal and for possible suicide contagion by media. To date, little research has been conducted into the associations between the show and suicide counts among its young target audience. Objective To analyze the changes in suicide counts after the release of13 Reasons Why. Design, Setting, and Participants For this time series analysis, monthly suicide data for the age groups 10 to 19 years, 20 to 29 years, and 30 years or older for both US males and females from January 1, 1999, to December 31, 2017, were extracted from the Centers for Disease Control and Prevention’s WONDER (Wide-ranging Online Data for Epidemiologic Research) database. Twitter and Instagram posts were used as a proxy to estimate the amount of attention the show received through social media from April 1, 2017, to June 30, 2017. Autoregressive integrated moving average time series models were fitted to the pre–April 2017 period to estimate suicides among the age groups and to identify changes in specific suicide methods used. The models were fitted to the full time series with dummy variables for (1) April 2017 and (2) April 1, 2017, to June 30, 2017. Data were analyzed in December 2018 and January 2019. Main Outcomes and Measures Suicide data before and after the release of the show in 2017. Results Based on social media data, public interest in the show was highest in April 2017 and was negligible after June 2017. For 10- to 19-year-old males and females, increases in the observed values from April to June 2017 were outside the 95% confidence bands of forecasts. Models testing 3-month associated suicide mortality indicated 66 (95% CI, 16.3-115.7) excess suicides among males (12.4% increase; 95% CI, 3.1%-21.8%) and 37 (95% CI, 12.4-61.5) among females (21.7% increase; 95% CI, 7.3%-36.2%). No excess suicide mortality was seen in other age groups. The increase in the hanging suicide method was particularly high (26.9% increase; 95% CI, 15.3%-38.4%). Conclusions and Relevance Caution must be taken in interpreting these findings; however, the suicide increase in youth only and the signal of a potentially larger increase in young females all appear to be consistent with a contagion by media and seem to reinforce the need for collaboration toward improving fictional portrayals of suicide.

Summary Background Previous epidemiological analyses indicated a decreasing trend of suicide rates for 10–19-year-olds in Austria for the period 1970–2001. However, data from the new millennium are missing. This epidemiological update reports on youth suicide in Austria, covering the period 2001–2014 in order to inform suicide preventive interventions targeting adolescents. Methods The data on registered suicides among Austrian minors (10–19 years) and the population size were obtained from Statistics Austria. Chi-squared tests were used to analyze the associations between the suicide methods used and sex, as well as between suicide methods and Austrian federal states. Spearman correlations were calculated to assess time trends in the suicide rates. One-way ANOVA was used to investigate annual suicide rates of age groups 10–14, 15–19, and 10–19 years across the nine Austrian federal states. Results The total average suicide rate for Austrian minors was 4.57 per 100,000. The male–female ratio was 3.5:1. The total youth suicide rate and male suicide rate significantly declined from 2001 to 2014, whereas there were no significant changes in female rates. More than one third of suicides among Austrian youth occurred through hanging, whereas jumping in front of a moving object was the second-most common suicide method. A spring peak was found, with most suicides occurring in April and May. Conclusion Suicide rates among minors in Austria continue to decrease. The present findings help to inform the ongoing implementation of the National Austrian Suicide Prevention Plan (SUPRA).

Fragestellung: Es soll die Qualität der Berichterstattung über Suizide und Suizidversuche in deutschsprachigen Jugendmagazinen näher untersucht werden und Veränderungen der Suizidzahlen unter Jugendlichen in Österreich nach dem Erscheinen von Berichten erfasst werden. Methodik: Suizidberichte aus fünf großen deutschsprachigen Jugendmagazinen wurden mithilfe qualitativer Inhaltsanalyse im Hinblick auf Geschlecht, dargestellte Motive, Suizid(versuchs)methoden, positive und negative Darstellungsweisen, Schuldzuweisungen und Abweichungen von Medienempfehlungen zur Berichterstattung über Suizid analysiert. Die Suizidzahlen 2 Wochen vor und nach dem Erscheinen von Suizidberichten wurden verglichen. Ergebnisse: 59 Berichte wurden identifiziert. Die häufigste Berichterstattung zum Thema Suizid fand sich in der Zeitschrift Bravo, wobei es zu einer leichten Überrepräsentation weiblicher Suizide und insgesamt zu einer Unterrepräsentation von Suizidversuchen kam. Entsprechend der Epidemiologie suizidalen Verhaltens wurde Sturz in die Tiefe am häufigsten bei Mädchen und Erhängen bei den Jungen beschrieben. Bei den dargestellten Motiven zeigte sich, dass wichtige Faktoren wie psychiatrische Erkrankungen kaum Erwähnung fanden. Während Suizidentinnen häufig positiv dargestellt wurden, wurden Suizidenten häufiger negativ dargestellt. Implizite Schuldzuweisungen wurden vorwiegend den Eltern zugeschrieben. Es zeigte sich kein Hinweis auf einen Werther-Effekt nach Berichterstattung. Schlussfolgerungen: Die weitgehende Divergenz zwischen der Epidemiologie von Suizidalität Jugendlicher und im deutschsprachigen Raum derzeit vorherrschenden Mediendarstellungen verdeutlicht wichtige Ansatzpunkte für Präventions- und Aufklärungsarbeit in der Bevölkerung.

BackgroundMedia 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.AimsTo 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.MethodContent 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.ResultsRepetitive 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.ConclusionsThe 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.

This study aimed to investigate whether the risk of increased suicide occurrence after reports on suicide is associated with the social characteristics of the reported suicides and whether this varies with similarity between the reported suicides and suicides in the population. We collected reports on all 179 individual suicides named in the 13 largest Austrian nationwide newspapers from 1996 to 2006. Information on social status and sociodemographic characteristics of the reported suicides, on certainty of labelling the death as a suicide, and on the suicide methods applied were extracted from the articles. We conducted logistic regression analyses, with the increase of post-report suicides within 28 days after the reports as dependent variable. In model 1, the increase of suicides that matched the reported individual suicide with regard to age group, sex and suicide method was used as outcome variable. In model 2, the increase of suicides that were different from the reported suicide with regard to these characteristics was the outcome. In model 3, the post-report increase of total suicides was the dependent variable. Celebrity status of the reported suicide, age of the reported suicide between 30 and 64 years, and definitive labelling as a suicide were associated with an increased risk of a post-report increase of similar suicides; criminality (i.e. the individual was reported as suspected or convicted of crime) of the reported suicide was associated with a lower risk of a post-report increase. In dissimilar suicides, none of the variables was associated with a post-report increase of suicides. Celebrity status of the reported suicide was the only predictor of a post-report increase of total suicides. The findings support the hypothesis that social variables of reported suicides impact the risk of post-report copycat behaviour. Evidence of copycat effects seemed to be strongest in suicides that were similar to the respective model with regard to age group, sex, and suicide method.

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.

BackgroundMedia stories on suicide can increase suicidal ideation, but little is known about variations in media effects with regard to audience vulnerability and story contents.AimsWe 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.MethodWithin 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.ResultsThe 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.ConclusionsThe 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.

The authors investigated the impact of suicidality on identity work during film exposure. Adults with low suicidality (n = 150) watched either It's My Party or The Fire Within, censored versions of these films not depicting the suicide, or the control film that concluded with a non-suicidal death. Baseline suicidality was measured with questionnaires before the movie. Identity work and identification with the protagonist were measured after the movie. Suicidality was directly associated with identity work during film dramas depicting suicide methods. The reception of suicide-related media content seems to partially depend on personal suicidality. Potential implications for suicide prevention are discussed.

Several studies indicate that exposure to suicide in movies is linked to subsequent imitative suicidal behavior, so-called copycat suicides, but little is currently known about whether the link between exposure to suicidal movies and suicidality is reflected in individual film preferences. 943 individuals participated in an online survey. We assessed associations between preferred film genres as well as individual exposure to and rating of 50 pre-selected films (including 25 featuring a suicide) with suicidal ideation, hopelessness, depression, life satisfaction, and psychoticism. Multiple regression analyses showed that preferences for film noir movies and milieu dramas were associated with higher scores on suicidal ideation, depression and psychoticism, and low scores on life satisfaction. Furthermore, preferences for thrillers and horror movies as well as preferences for tragicomedies, tragedies and melodramas were associated with higher scores of some of the suicide risk factors. There was also a dose-response relationship between positive rating of suicide films and higher life satisfaction. Due to the cross-sectional design of the study causality cannot be assessed. Individual film genre preferences seem to reflect risk factors of suicide, with film genres focusing on sad contents being preferred by individuals with higher scores on suicide risk factors. However, suicide movies are more enjoyed by viewers with higher life satisfaction, which may reflect a better ability to cope with such content. peerReviewed

Background: A suicide awareness campaign was initiated in the Austrian federal state of Styria to increase help-seeking behavior in the population. Billboards were shown throughout Styria depicting joyful everyday-life situations with a focus on social and family connectedness, and promoting the Telephone Emergency Service, a crisis hotline. Aims: The present study investigated the impact of this campaign on the utilization of the crisis hotline and on suicide rates. Method: Phone calls and suicide rates in the study region 3 months before the campaign were compared with rates 3 months after the campaign. The changes were contrasted with the characteristics of phone calls and the suicide rate in a comparable control region. Results: There were significantly more phone calls in the study region after the awareness campaign compared to the control region, which was similar to seasonal trends in nonintervention years, and there was no increase of suicide-related phone calls. The proportion of suicide-related phone calls referring to family problems decreased after the initiation of the campaign. Suicide rates did not change. Conclusion: The campaign may have had some minor immediate impact on the utilization of the Telephone Emergency Service, but it did not seem to motivate suicidal individuals, especially those with family problems, to call.

To assess the impact of the Austrian firearm legislation (1997) on adolescent suicides, we investigated time trends in youth suicide prevalence (1986-2006) with Poisson regression. A temporary increase in firearm suicides after the reform was observed, followed by a continuous decrease. The hypothesis that media reporting triggered the short-term backlash effect is discussed.

Sensationalist media reports, as in Hong Kong’s print media,1 can trigger further suicides—the Werther effect.2 However, we recently found that the effects of suicide related news stories was broad and sometimes protective, depending on the contents of the story.3 …