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Different words used for suicide (so-called suicide referents) have different moral connotations, and neutral referents are recommended in media reporting guidelines. Background: Different words used for suicide (so-called suicide referents) have different moral connotations, and neutral referents are recommended in media reporting guidelines. Aims: To assess how different referents in media reports are related to actual suicides. Method: = 276 months) were obtained from the Austrian Press Agency. Time series were modeled for media items referring to suicide as a crime [Selbstmord], an act of freedom [Freitod], or neutral connotation [Suizid]. Temporal associations with suicides in the month before, during, and after the reporting were examined. n Terminology referring to suicide as an act of free will [Freitod] was weakly associated with increases in total, male, and female suicides and with suicides in up to 64-year-olds in the same month. No other statistically significant associations were found. Results: Terminology referring to suicide as an act of free will [Freitod] was weakly associated with increases in total, male, and female suicides and with suicides in up to 64-year-olds in the same month. No other statistically significant associations were found. Limitations: During times of prevalent use of referents suggesting suicide to be an act of freedom, there are small-sized increases in suicides. The simultaneous occurrence of this referent and suicides might reflect effects of a societal framing present in both the media and the community rather than a sheer media effect.Conclusion: During times of prevalent use of referents suggesting suicide to be an act of freedom, there are small-sized increases in suicides. The simultaneous occurrence of this referent and suicides might reflect effects of a societal framing present in both the media and the community rather than a sheer media effect.

Objective: The aim of this study was to assess associations of various content areas of Twitter posts with help-seeking from the US National Suicide Prevention Lifeline (Lifeline) and with suicides., Methods: We retrieved 7,150,610 suicide-related tweets geolocated to the United States and posted between 1 January 2016 and 31 December 2018. Using a specially devised machine-learning approach, we categorized posts into content about prevention, suicide awareness, personal suicidal ideation without coping, personal coping and recovery, suicide cases and other. We then applied seasonal autoregressive integrated moving average analyses to assess associations of tweet categories with daily calls to the US National Suicide Prevention Lifeline (Lifeline) and suicides on the same day. We hypothesized that coping-related and prevention-related tweets are associated with greater help-seeking and potentially fewer suicides., Results: The percentage of posts per category was 15.4% (standard deviation: 7.6%) for awareness, 13.8% (standard deviation: 9.4%) for prevention, 12.3% (standard deviation: 9.1%) for suicide cases, 2.4% (standard deviation: 2.1%) for suicidal ideation without coping and 0.8% (standard deviation: 1.7%) for coping posts. Tweets about prevention were positively associated with Lifeline calls ( B  = 1.94, SE = 0.73, p  = 0.008) and negatively associated with suicides ( B  = -0.11, standard error = 0.05, p  = 0.038). Total number of tweets were negatively associated with calls ( B  = -0.01, standard error  = 0.0003, p  = 0.007) and positively associated with suicide, ( B  = 6.4 × 10 -5 , standard error  = 2.6 × 10 -5 , p  = 0.015)., Conclusion: This is the first large-scale study to suggest that daily volume of specific suicide-prevention-related social media content on Twitter corresponds to higher daily levels of help-seeking behaviour and lower daily number of suicide deaths., Preregistration: As Predicted, #66922, 26 May 2021.

Objective: The U.S. suicide rate has increased 35% since 1999. The role of the Internet has not been thoroughly investigated despite Internet use more than doubling from 1999 to present. The majority of U.S. suicide deaths are by firearm; however, there is no examination of the association between trends in firearm Internet searches and overall and firearm monthly suicide rates. We hypothesized that search strings related to firearm suicide would be significantly associated with monthly suicide rates (both all methods and firearm)., Methods: Google Trends provides data on request frequencies of searches. Twenty-four search strings were examined representing possible searches by individuals considering firearm suicide and compared to U.S. suicide rates with time-series modeling., Results: In the time series with higher search volumes, consistent associations were found of negative cross-correlation at lag +1., Conclusions: Several searches appeared at least sensitive enough to consistently show associations with overall and firearm suicide rates in the following month. This novel finding should be followed up as the potential exists to predict suicide trends., (© 2021 The American Association of Suicidology.)

Objective: The suicides of Kate Spade and Anthony Bourdain, two major American icons, in a span of days in June 2018 represent a unique and tragic natural experiment to characterize associations with actual suicides in the aftermath of celebrity suicides. The aim of this study was to identify changes in suicide counts after their deaths., Methods: Suicide data were obtained from the United States' Centers for Disease Control and Prevention's public-use mortality file. A time-series analysis was performed, examining monthly suicide data by age group (⩽19, 20-44, 45-64 and ⩾65 years), for both men and women, for all suicide methods and for hanging versus non-hanging methods, from January 1999 to December 2018. Seasonal autoregressive integrated moving-average models were fitted to the pre-June 2018 period, estimating suicides in subsequent months and identifying deviations from expected values. The volume of Twitter posts about Kate Spade and Anthony Bourdain was used as a proxy of societal attention., Results: Tweets about the celebrities were mainly concentrated in June 2018 and faded quickly in July. Total suicides exceeded the 95% confidence interval for June and approximated the upper limit of the 95% confidence interval in July. Over this 2-month span, there were 418 (95% confidence interval = [184, 652]) more suicides than expected, including 275 (95% confidence interval = [79, 471]) excess suicides in men and 182 (95% confidence interval = [93, 271]) in women. These equate to 4.8%, 4.1% and 9.1% increases above expected counts. There were 392 (95% confidence interval = [271, 514]) excess suicides by hanging, a 14.5% increase, with no significant increase in all other methods combined., Conclusion and Relevance: These findings demonstrate that mortality following celebrity suicides can occur at a similar magnitude to that observed for other public health emergencies. They underscore the urgency for interventions to mitigate imitation effects after celebrity suicide reporting.

Objective: "13 Reasons Why," a Netflix series, included a controversial depiction of suicide that has raised fears about possible contagion. Studies of youth suicide in the United States found an increase on the order of 10% following release of the show, but this has not been replicated in other countries. This study aims to begin to address that gap by examining the relationship between the show's release and youth suicide in Canada's most populous province., Methods: Suicides in young people (under the age of 30) in the province of Ontario following the show's release on March 31, 2017, were the outcome of interest. Time-series analyses were performed using data from January 2013 to March 2017 to predict expected deaths from April to December 2017 with a simple seasonal model (stationary R 2 = 0.732, Ljung-Box Q = 15.1, df = 16, P = 0.52, Bayesian information criterion = 3.09) providing the best fit/used for the primary analysis., Results: Modeling predicted 224 suicides; however, 264 were observed corresponding to 40 more deaths or an 18% increase. In the primary analysis, monthly suicides exceeded the 95% confidence limit for 3 of the 9 months (May, July, and October)., Conclusion: The statistical strength of the findings here is limited by small numbers; however, the results are in line with what has been observed in the United States and what would be expected if contagion were occurring. Further research in other locations is needed to increase confidence that the associations found here are causal.

Importance: On March 31, 2017, Netflix released the show 13 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 of 13 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.

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.

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 highest among those with low relationship satisfaction [corrected]. 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.

This paper reports the results of a comparative investigation of attitudes to suicide and suicidal persons in 5,572 university students from 12 countries. Participants filled out two scales measuring attitudes towards suicide and suicidal persons, a measure of psychological distress together with the questions about suicidal behavior. Results showed that the highest suicide acceptance scores were observed in Austrian, UK, Japanese and Saudi Arabian samples and the lowest scores were noted in Tunisian, Turkish, Iranian and Palestinian samples. While the highest social acceptance scores for a suicidal friend were noted in Turkish, US, Italian and Tunisian samples, the lowest scores were seen in Japanese, Saudi Arabian, Palestinian and Jordanian samples. Compared to participants with a suicidal past, those who were never suicidal displayed more internal barriers against suicidal behavior. Men were more accepting of suicide than women but women were more willing to help an imagined suicidal peer. Participants with accepting attitudes towards suicide but rejecting attitudes towards suicidal persons reported more suicidal behavior and psychological distress, and were more often from high suicide rate countries and samples than their counterparts. They are considered to be caught in a fatal trap in which most predominant feelings of suicidality such as hopelessness or helplessness are likely to occur. We conclude that in some societies such as Japan and Saudi Arabia it might be difficult for suicidal individuals to activate and make use of social support systems., (© 2016 Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

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.

Attitudes toward suicide are often investigated by means of questionnaires, most of which are overly long or of low psychometric quality. Eskin's ( 2004 ) Attitudes Towards Suicide Scale is short and first investigations suggest good psychometric properties, but its factor structure has scarcely been explored. Hence, we examined this instrument by a data-analytic approach that combines Mokken scaling and confirmatory factor analysis (CFA). Results revealed 6 factors, of which 1 possessed only weak measurement properties. CFAs indicated only borderline fit of models found in prior research, but adequate fit for the scale structures revealed by Mokken scaling. Psychometric properties of these scales were satisfactory. Both the instrument as well as the methodological approach presented here can be recommended for further research.

Context: Suicides are prone to misclassification during death ascertainment procedures. This problem has generated frequent criticism of the validity of suicide mortality statistics., Objective: To employ an external measure of the validity of cause-of-death statistics (ie, national autopsy rates) and to examine potential misclassification of suicide across countries from Europe to Central and Northern Asia., Design: Cross-national analysis., Setting: Thirty-five countries., Participants: Aggregated mortality data., Main Outcome Measures: Data from 35 countries during the period from 1979 to 2007 were used to analyze the association of suicide rates with autopsy rates and death rates of undetermined and ill-defined causes, respectively. Analyses were cross-sectional and longitudinal., Results: Cross-sectionally, a 1% difference in autopsy rates among nations was associated with a suicide rate difference of 0.49 per 100,000 population. Longitudinally, a 1% decrease in the autopsy rate aligned with a decrease of 0.42 per 100,000 population in the suicide rate. These cross-sectional and longitudinal associations were robust after adjustment for unemployment, degree of urbanization, and prevalence of undetermined or ill-defined deaths. Associations strengthened when analyses were confined to 19 European Union member countries., Conclusion: Autopsy rates may spatially and temporally affect the validity of suicide mortality statistics. Caution should be exercised in comparing international suicide rates and evaluating interventions that target suicide rate reduction.

Background: Lay theories on abnormal behavior and mental disorders have been growing as a field recently. Lester and Bean have contributed to these endeavors by developing the Lester and Bean Attribution of Causes to Suicides Scale (1992), an instrument that gauges beliefs concerning the causes of suicidal behavior (intrapsychic, interpersonal, and societal causes)., Objectives: To provide test-retest reliability figures (two-month interval) and to further validate the scale., Methods: The instrument was administered to 155 Austrian psychology undergraduates. Test-retest reliabilities, scale intercorrelations, and correlations with locus of control, among others, were ascertained., Results: Test-retest reliabilities amounted to r = 0.67 for intrapsychic, 0.53 for interpersonal, and 0.56 for societal causes, and to 0.59 for the total scale (all ps < 0.001). All three subscales were, as previously observed, significantly positively intercorrelated. Belief in intrapsychic causes was weakly positively related to the internality dimension of the locus of control construct, beliefs in interpersonal and in societal causes were significantly positively associated with societal externality, and there was a significant positive correlation of the fatalistic externality dimension with all three subscales of the Lester-Bean Scale., Conclusions: In view of the moderate internal scale consistencies, the test-retest reliabilities can be seen as satisfying. The significant intercorrelations among attributed causes of suicide further support the hypothesis that the critical dimension of lay theories of suicide is the belief that suicide has definite causes, regardless of the type of cause. Directions for future research are discussed.

Psychometric properties and demographic correlates of a German form of R. W. Hubbard and J. L. McIntosh's (1992) Revised Facts on Suicide Quiz (RFOS), an inventory for assessing overall knowledge about suicide, were investigated in a sample of 1,093 Austrian medical and psychology students. Internal consistency of the RFOS was weak, as were many of the item-total correlations, indicating a fair amount of item-content heterogeneity. Demographic variables (sex, age, field of study, and study level) were significant predictors of RFOS scores and item responses. On the whole, women, advanced, older, and medical students outperformed men, junior, younger, and psychology students. Various directions for further inquiry are discussed

Knowledge about suicide might be positively correlated with local suicide prevalence. This hypothesis was tested with a sample of 107 medical and social science undergraduates from Estonia, a country with a high suicide rate, using Hubbard and McIntosh's 1992 Revised Facts on Suicide Quiz. Compared (independent-groups t tests) with a sample of undergraduates from Austria, which has a markedly lower suicide rate, Estonians presented significantly higher overall knowledge about suicide (d = 0.39), particularly concerning demographic and epidemiological facts about suicide (d = 0.77) but not pertaining to clinical and interpersonal knowledge contents (d = -0.06). Study limitations and suggestions for extension of this preliminary inquiry are discussed.

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.

Background: The objective of this study was to assess the ecological association of dietary tryptophan intake and suicide rates across industrialized nations. Tryptophan, an essential amino acid, is the rate-limiting precursor of serotonin biosynthesis. The serotonergic system has been strongly implicated in the neurobiology of suicide., Methods: Contemporary male and female suicide rates for the general population (42 countries) and the elderly (38 countries) were correlated with national estimates of dietary tryptophan intake., Results: Measures of tryptophan intake were significantly negatively associated to national suicide rates. Controlling for national affluence, total alcohol consumption and happiness levels slightly attenuated these associations, but left all of them negative., Limitations: The effect is an ecological (group-level) finding. Estimated per capita tryptophan supply is only a proxy for actual consumption., Conclusions: Developed nations ranking high in dietary tryptophan intake rank low in suicide rates, independent of national wealth, alcohol intake and happiness.

Knowledge about suicide postvention (KSPV) is an important distal outcome in the evaluation of suicide prevention programs that focus on the bereaved. However, most scales are specifically tailored to the evaluation study in question and psychometric properties are often unsatisfactory. Therefore, we developed the KSPV scale. Scale properties were investigated with Rasch trees, a newly developed method in the framework of item response theory. Additionally, we provide cues for convergent validity. In summary, the scale shows satisfactory properties for assessing KSPV and could be used to evaluate suicide postvention programs more effectively. (Contains 2 tables and 1 figure.)

Psychometric properties and demographic correlates of a German form of R. W. Hubbard and J. L. McIntosh's (1992) Revised Facts on Suicide Quiz (RFOS), an inventory for assessing overall knowledge about suicide, were investigated in a sample of 1,093 Austrian medical and psychology students. Internal consistency of the RFOS was weak, as were many of the item-total correlations, indicating a fair amount of item-content heterogeneity. Demographic variables (sex, age, field of study, and study level) were significant predictors of RFOS scores and item responses. On the whole, women, advanced, older, and medical students outperformed men, junior, younger, and psychology students. Various directions for further inquiry are discussed. (Contains 1 table.)

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, n = 425 participants either read a news article featuring a prevention expert with one of the above versions of the same text or an article unrelated to suicide. Data on suicidal ideation, stigmatizing attitudes toward suicidal individuals, policy attitudes toward suicide prevention, help-seeking intentions, and assumptions on the prevalence of suicide-related behavior were measured with questionnaires. The assumed prevalence of suicide in the population was greater in both intervention groups than in the control group, but the articles did not have an impact on other outcomes, and there were no differences for variations in headlines and pull quotes. Impersonal suicide prevention articles appear safe to use and do not have an impact on suicide risk factors in general population samples. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the associations between religion, suicidal behavior, attitudes and psychological distress in 5572 students from 12 countries by means of a self-report questionnaire. Our results showed that an affiliation with Islam was associated with reduced risk for suicide ideation, however affiliating with Orthodox Christianity and no religion was related to increased risk for suicide ideation. While affiliating with Buddhism, Catholic religion and no religion was associated with lowered risk for attempting suicide, affiliation with Islam was related to heightened risk for attempting suicide. Affiliation with Hinduism, Orthodox Christianity, Catholicism, other religions and with no religion was associated with decreased risk for psychological distress but those reported affiliating with Islam evinced greater risk for psychological distress. The associations of the strength of religious belief to suicidal ideation and attempts were in the expected direction for most but had a positive relation in respondents affiliating with Catholicism and other religions. Students reporting affiliation with Islam, the Christian Orthodox religion and Buddhism were the least accepting of suicide but they displayed a more confronting interpersonal style to an imagined peer with a suicidal decision. It was concluded that the protective function of religion in educated segments of populations (university students) and in university students residing in Muslim countries where freedom from religion is restricted or religion is normative and/or compulsory is likely to be limited. Our findings suggest that public policies supporting religious freedom may augment the protective function of religion against suicide and psychological distress. [ABSTRACT FROM AUTHOR]

In recent years, the question whether personal suicidality is reflected in individual music preferences has been discussed. We assessed associations of preferred music genres and cumulative exposure to and rating of 50 preselected songs, including 25 suicide-related songs, with suicide risk factors in an online survey with 943 participants. Preferences for sad music were associated with high psychoticism, while fanship of music genres with predominantly joyful contents was linked to low psychoticism. There was a dose-response relationship of positive rating of suicide songs with high life satisfaction and low hopelessness. Music preferences partly reflect suicide risk factors, but enjoyment of suicide songs is negatively associated with risk factors of suicide, which may indicate a psychological defense mechanism against suicidal impulses. [ABSTRACT FROM AUTHOR]