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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

Objective: Specific content characteristics of suicide media reporting might differentially impact suicides in the population, but studies have not considered the overarching theme of the respective media stories and other relevant outcomes besides suicide, such as help-seeking behaviours. Methods: We obtained 5652 media reports related to suicide from 6 print, 44 broadcast and 251 online sources in Oregon and Washington states, published between April 2019 and March 2020. We conducted a content analysis of stories regarding their overarching focus and specific content characteristics based on media recommendations for suicide reporting. We applied logistic regression analyses to assess how focus and content characteristics were associated with subsequent calls to the US National Suicide Prevention Lifeline (Lifeline) and suicides in these two states in the week after publication compared to a control time period. Results: Compared to a focus on suicide death, a focus on suicidal ideation, suicide prevention, healing stories, community suicide crises/suicide clusters and homicide suicide was associated with more calls. As compared to a focus on suicide death, stories on suicide prevention and stories on community suicide crises/suicide clusters were also associated with no increase in suicides. Regarding specific content characteristics, there were associations that were largely consistent with previous work in the area, for example, an association of celebrity suicide reporting with increases in suicide. Conclusion: The overall focus of a media story may influence help-seeking and suicides, and several story characteristics appear to be related to both outcomes. More research is needed to investigate possible causal effects and pathways.

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.

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.

Abstract. Background: One strategy to prevent youth suicide is awareness-raising video campaigns. To date, little is known about how best to include adolescents in the production process, and how they experience their involvement. Aims: This study used a participatory qualitative research approach to explore the experiences of adolescents producing suicide prevention videos targeting other adolescents in a school setting. Method: The project was conducted in Vienna, Austria, from 09/2018 to 01/2019. Eighteen high school students aged 15-19 produced suicide prevention videos. Focus group discussions with 17 of these students captured qualitative information on their experiences related to the process. Focus group content was analyzed following the documentary method. Results: Students produced seven suicide prevention videos in groups of two to three individuals. The production process was found to be positive, and numerous benefits and learning effects were noted. Limitations: No conclusions can be made about video effects on adolescents not involved in the process. Conclusion: Including adolescents in the process of developing suicide prevention videos has multiple benefits. The process researched here can inform similar campaigns with adolescents.

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.

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

In recent years, efforts in suicide prevention in the United States and Europe have been made to change the conversation on suicide to incorporate more preventive aspects. The majority of information-seeking occurs online. Structured analyses assessing qualitative changes in retrieved online material on suicide over time, however, are scarce. We replicated a content analysis of suicide-related websites retrieved with popular search engines in the United States and Austria aiming to assess how suicide-related online portrayals have changed in the past five years.We retrieved 396 websites using the search term suicide, method-related search terms (e.g., how to hang yourself), and help-related search terms (e.g., suicide help) in the United States and 286 websites from Austrian searches. We performed a content analysis based on media recommendations for suicide reporting and compared the findings to 335 websites in the United States and 396 websites in Austria retrieved in 2013 with the same procedure.In both countries, the number of both protective (United States: p .001, Austria: p .001) and harmful characteristics (United States: p .001, Austria: p .001) increased. The ratio of protective to harmful characteristics improved to 3.3:1 in the United States and to 2.4:1 in Austria.No assumptions about the actual impact of the retrieved contents can be assumed.There has been an increase in potentially protective aspects in online portrayals of suicidality, but also an increase in potentially harmful characteristics, which may suggest an increasing polarization of suicide-related contents. Future prevention efforts need to address this potential polarization.

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.

Summary: Background: There is strong evidence that suicides increase after media stories about suicides by celebrities, particularly those that highlight the suicide method (the Werther effect). Much less is known about the Papageno effect—the protective effects of media stories of hope and recovery from suicidal crises. A synthesis of the retrievable evidence is lacking. We aim to summarise findings from randomised controlled trials about the effects of stories of hope and recovery on individuals with some degree of vulnerability to suicide. Methods: For this systematic review and individual participant data meta-analysis, we searched PubMed (including MEDLINE), Scopus, Embase, PsycInfo, Web of Science, and Google Scholar published from inception to Sept 6, 2021, without language restrictions. We included trials that reported suicidal ideation (the primary outcome) or help-seeking attitudes or intentions (the secondary outcome) and tested a media narrative of hope and recovery. Studies were excluded if they did not feature a clearly positive story of hope and recovery, or had a control group exposed to suicide-related stimulus material. We contacted the lead or senior authors of all original studies to obtain participant-level data for this study. The primary analysis was restricted to individuals with some vulnerability to suicide. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomised trials. The study is registered with PROSPERO, number CRD42020221341. Findings: Our search yielded 7347 records. 3920 records were screened by title and abstract, and 25 full-text records assessed for eligibility. There were eight eligible studies with 2350 participants for which individual participant data were sought. For suicidal ideation, six studies met the inclusion criteria for the primary analysis. Follow-up responses were available for 569 (90%) of 633 participants who were randomised with high vulnerability (345 [55%] allocated to the intervention group and 288 [45%] to the control group). The pooled standardised mean difference (SMD) indicated a small reduction in suicidal ideation of –0·22 (95% CI –0·39 to –0·04, p=0·017; six studies) in the intervention group. For help-seeking attitudes and intentions, four studies met the inclusion criteria and follow-up data were available for 362 (86%) of 420 participants (247 [59%] allocated to the intervention group and 173 [41%] to the control group). The pooled SMD showed no evidence of a difference between the groups (SMD=0·14, 95% CI –0·15 to 0·43, p=0·35; four studies). Low levels of cross-study heterogeneity effects were observed for both analyses (I2=5% [suicidal ideation] and I2=36% [help-seeking attitudes and intentions]). We found no evidence of publication bias. Interpretation: Media narratives of hope and recovery from suicidal crises appear to have a beneficial effect on suicidal ideation in individuals with some vulnerability, but there is insufficient evidence regarding help-seeking attitudes and intentions. These findings provide new evidence about narratives for suicide prevention. Funding: None.

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.

ZusammenfassungSuizidales Verhalten wird durch Suiziddarstellungen in den Massenmedien beeinflusst. In zahlreichen Studien konnte gezeigt werden, dass sensationsträchtige Darstellungen von Suizid in den Medien zu Imitationssuiziden führen. Dieses Phänomen ist in der Wissenschaft auch unter dem Begriff „Werther-Effekt“ bekannt. In einer Reihe von Ländern wurden daher von Expert_Innen für Suizidprävention Medienempfehlungen zur Berichterstattung über Suizid entwickelt, um die Qualität der Berichterstattung über Suizid zu verbessern und in weiterer Folge Imitationssuizide zu verhindern. Nicht alle Darstellungen von Suizid in den Medien sind dabei schädlich. In mehreren Studien konnte gezeigt werden, dass Medienberichte, die auf Personen fokussieren, die sich in einer suizidalen Krise befunden haben, aber in der Lage waren, diese Krise zu bewältigen, zu einem Rückgang an Suizidalität bei Rezipient_Innen führen. In Anlehung an Papageno, den Protagonisten in Mozarts Oper Die Zauberflöte, der seine suizidale Krise bewältigt, wird dieser protektive Effekt in der wissenschaftlichen Literatur auch als „Papageno-Effekt“ bezeichnet. In dieser Übersichtsarbeit werden der gegenwärtige Forschungsstand und die rezentesten Studien zum Werther- und Papageno-Effekt diskutiert. Diese Befunde können Aufschluss darüber geben, wie effektive Medienkampagnen zur Suizidprävention gestaltet sein müssen, um eine möglichst protektive Wirkung ohne Risiko eines schädlichen Effekts zu erzielen. Da die psychologischen Mechanismen des Papageno-Effekts nach wie vor nicht vollständig erforscht sind, sind weitere Untersuchungen zur protektiven Wirkung von Medienberichten über Krisenbewältigungen notwendig, insbesondere Studien mit klinischen Populationen oder anderen Risikogruppen.

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.

ObjectiveTo assess changes in daily call volumes to the US National Suicide Prevention Lifeline and in suicides during periods of wide scale public attention to the song “1-800-273-8255” by American hip hop artist Logic.DesignTime series analysis.SettingUnited States, 1 January 2010 to 31 December 2018.ParticipantsTotal US population. Lifeline calls and suicide data were obtained from Lifeline and the Centers for Disease Control and Prevention.Main outcome measuresDaily Lifeline calls and suicide data before and after the release of the song. Twitter posts were used to estimate the amount and duration of attention the song received. Seasonal autoregressive integrated moving average time series models were fitted to the pre-release period to estimate Lifeline calls and suicides. Models were fitted to the full time series with dummy variables for periods of strong attention to the song.ResultsIn the 34 day period after the three events with the strongest public attention (the song’s release, the MTV Video Music Awards 2017, and Grammy Awards 2018), Lifeline received an excess of 9915 calls (95% confidence interval 6594 to 13 236), an increase of 6.9% (95% confidence interval 4.6% to 9.2%, PConclusionsLogic’s song “1-800-273-8255” was associated with a large increase in calls to Lifeline. A reduction in suicides was observed in the periods with the most social media discourse about the song.

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.

Abstract. Background: For several decades, the question of whether personal suicidality is reflected in individual music preferences has been the subject of debate in suicide research. Despite many studies investigating the relationship between music use and suicidal behavior, it is still unclear whether suicide risk is reflected in individual music preferences. Aims: The present study aimed to assess whether music preferences are reflected in suicide risk factors. Method: We assessed suicidal ideation, depression, and hopelessness among 943 participants in a cross-sectional online survey. Participants provided up to five examples of their favorite music. We conducted a content analysis and coded all reported songs as suicide-related, coping-related, or unrelated to suicide. Results: Multivariate analyses controlling for gender, age, education level, and amount of daily music use indicated associations of preferences for suicide-related songs with suicidal ideation and depression. Limitations: Limitations of the present study include the use of a convenience sample and a cross-sectional design, the small number of participants with preferences for coping-related songs, and the relatively small effect size of the associations found. Conclusion: Music preferences appear to reflect suicide risk factors, with individuals who prefer suicide-related songs scoring higher in terms of suicidal ideation and depression.

Background: Educating the public about suicide is an important component of suicide prevention. So far, little is known about whether common misconceptions of suicide are related to individual tabloid newspaper use. Aims: This study aimed to investigate associations of time spent reading tabloids with endorsement of suicide myths, suicide-related knowledge, and with stigmatizing attitudes toward suicidal individuals. Method: In this cross-sectional online survey, we assessed suicide-related knowledge and stigmatizing attitudes toward suicidal individuals among 456 study participants in Austria together with their endorsement of five common suicide myths (e.g., "suicidal individuals do not communicate their intent"). Furthermore, we assessed participants' time spent reading tabloids. Results: Multivariate analyses controlling for gender, age, education, and the time spent reading broadsheet newspapers and watching television indicated that participants' time spent reading tabloids was associated with higher endorsement of suicide myths as well as with a lower level of suicide-related knowledge and a higher level of stigmatizing attitudes toward suicidal individuals. Limitations: Due to the study's cross-sectional design, causality concerning these associations could not be assessed. Conclusion: The present findings confirm that readers of tabloids are an important target group for suicide education efforts.

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

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.

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.

Et betydelig antall studier har vist at sensasjonspregete skildringer av selvmord i media kan utløse imitasjonsselvmord; dette er ofte omtalt som «Werther-effekten». For å forhindre skadelige medieeffekter, har nasjonale og internasjonale organisasjoner utviklet anbefalinger for omtale av selvmord i mediene for å endre praksis i hvordan selvmord beskrives og for å styrke fokuset på selvmordsforebyggende aspekter. I løpet av det siste tiåret har man fått mer kunnskaper som viser at visse typer medieomtale av selvmord kan ha forebyggende effekt. Særlig medie- saker som beskriver personlige erfaringer med selvmords- tanker og hvordan man kan overvinne og takle vanskelige livssituasjoner, har vist seg å redusere suicidalitet i enkelte grupper. Denne beskyttende effekten har blitt kalt Papageno-effekten. I denne artikkelen gir vi en selektiv oversikt over aktuell litteratur om Werther- og Papagenoeffektene for forskjellige typer medier, og legger særlig vekt på nye kunnskaper om Papageno-effekten generert fra randomisert kontrollerte studier. Vi viser hvordan disse effektene kan utnyttes i selvmordsforebyggende arbeid ved samarbeid med media, og peker på fortsatte mangler i kunnskapene som må fokuseres i fremtidig forskning.

Zusammenfassung. Hintergrund: Kinder mit Migrationshintergrund zeigen meist in einer oder beiden Sprachen ungenügende Kompetenzen. In der folgenden Untersuchung sollen die Sprachmuster türkisch-österreichischer Migrantenkinder untersucht und Faktoren gefunden werden, die darauf Einfluss haben. Methode: 52 Kinder im Alter von 5 bis 6 Jahren und ihre Eltern wurden untersucht. Für die Eltern galten folgende Einschlusskriterien: türkischer Migrationshintergrund und zu Hause Türkisch zu sprechen. Für die Kinder galten keine Hörstörung, keine Blindheit, keine chronische Erkrankung, eine zumindest durchschnittliche allgemeine Entwicklung, in Österreich geboren zu sein und Kindergartenbesuch als Einschlusskriterien. Die Evaluierung der Sprachentwicklung Türkisch und Deutsch wurde mit Havas 5 durchgeführt. Weiter wurde den Eltern ein soziodemografischer Fragebogen sowie der CCLO-Fragebogen vorgegeben. Ergebnisse: Die Sprachleistungen der Kinder waren signifikant besser im Türkischen als im Deutschen. Darüber hinaus waren die Sprachkompetenzen sowohl auf Türkisch als auch auf Deutsch höher, je mehr den Kindern zu Hause öfter auf Türkisch vorgelesen wurde. Diskussion: Kinder beherrschen vor Schuleintritt ein strukturell einfaches Türkisch, haben jedoch geringe Deutschkenntnisse. Vorlesen in der Muttersprache ist nicht nur förderlich für den Mutterspracherwerb, sondern auch für den Deutscherwerb. Schlussfolgerung: In Projekte zur Förderung des Vorlesens sollen verstärkt Migrantensprachen eingebunden werden.

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.

Online searches for information on suicide are very common but studies on how the topic is addressed on one of the the most relevant platforms, YouTube, are missing. We performed a content analysis of German-language videos retrieved with the basic term "suicide", a method-related search term ("how to hang yourself"), and a help-related term ("suicide prevention"). We assessed the quality of n=232 randomly selected videos based on media recommendations for suicide reporting. Characteristics of videos retrieved with the method- and help-related search term, were compared to search results for "suicide". Videos retrieved with the help-related term had more potentially protective and fewer harmful characteristics than those retrieved with the other search terms. For example, these videos significantly more often debunked suicide myths and provided contact information to help services. In total, the mean number of harmful and protective characteristics per video were 1.6 and 1.3 for basic searches; 1.7 and 1.0 for method-related searches, and 0.4 and 2.8 for help-related searches, respectively. Videos retrieved in the help-related search were often from help organizations. Only 3% and 8% of videos retrieved with "suicide" and "how to hang yourself", respectively, were age-restricted. Collaborations between suicide prevention and Youtube are warranted to improve the visibility of protective contents and ensure a better implementation of Youtube's own policies regarding self-harm.

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

Previous studies suggest that distorted representations of reality on television can lead to distorted perceptions of reality among viewers. In this study, 322 individuals in Austria reported their weekly television consumption and whether they believe that there is active practice of capital punishment in Austria, which has been abolished since 1968. The more television participants watched, the more likely they mistakenly believed that there is, or recently was, capital punishment in Austria, even when controlling for participants' age and education. It seems that television has the potential to influence viewers' perception and knowledge of core aspects of society.

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.

Abstract. Background: Research on factors that influence the intention to read suicide awareness material is lacking. Aims: To identify how social and state similarities between the featured protagonist of a suicide awareness story and the audience impact on the intent to read similar stories. Method: Laboratory experiment with n = 104 students. Participants were randomly assigned to study groups. In the first group, the role model provided his personal story of crisis and was a student. In the second group, the content was identical but the model was socially dissimilar. The third group read about a topic unrelated to suicide. Depression, identification, and exposure intent were measured after the experiment. Conditional process analysis was carried out. Results: In the group featuring a once-suicidal role model with high social similarity, depression in the audience increased the intention to read similar material in the future via identification with the role model; 82% of individuals wanted to read similar material in the future, but only 50% wanted to do so in the group featuring a dissimilar person. Conclusion: Exposure intention increases via identification when role model and audience characteristics align regarding social traits and the experience of depression. These factors are relevant when developing campaigns targeting individuals with stories of recovery.

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).