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Reporting and portrayal of suicidal behaviour in the media may have potentially negative influences and facilitate suicidal acts by people exposed to such stimuli. Recent systematic reviews by others and ourselves (unpublished) have found overwhelming evidence for such effects.1 Evidence for the influence of media on suicidal behaviour has been shown for newspaper and television reports of actual suicides, film and television portrayals of suicides, and suicide in literature, especially suicide manuals. The potential for “suicide sites” on the internet influencing suicidal behaviour remains to be proved, but anecdotal evidence of negative influences is accumulating. 2 3 The impact of the media on suicidal behaviour seems to be most likely when a method of suicide is specified—especially when presented in detail—when the story is reported or portrayed dramatically …
gators may have been biased in assessing outcomes in
patients undergoing ultrasound guidance. Randolph et
al point out a limitation of interpreting these
variable definition of failed catheterisation
across the studies and possibly in the same study. Most
remarkably, in three of these eight trials the investigators
did not even define the primary end point of their study.
When unblinded studies give no a priori definition of
failed placement, it is possible that more attempts could
have been allowed with the ultrasound method. Bias of
doctors is even more likely in unblinded studies when
patients were quasi-randomised, particularly in view of
the preference of most operators to use the ultrasound
guided technique.
Another concern is the number of patients investi-
gated in the trials that compare techniques using ana-
tomical landmarks with ultrasound guided cannula-
tions. In a power analysis based on published data
Lefrant et al hoped to detect a 10% reduction in com-
plications, which were estimated to have an incidence
of 15%.
Therefore a study including 276 patients was
calculated to provide an 80% probability of rejecting
the null hypothesis. Therefore one should assume that
the sample size of reliable studies should substantially
exceed 100 patients. Central venous catheterisation is a
daily practice for specialists in anaesthaesia and inten-
sive care, so why is the sample size of most randomised
trials less than 80
which means less than 40 patients
per group. Focusing on randomised studies including
more than 100 patients does not show a significant dif-
ference in carotid punctures and the overall success
rate of cannulations.
Ultrasound guidance improved
the number of attempts per cannulation and successful
first attempts for catheterisation of the internal jugular
vein but not the subclavian approach.
3 7–10
designed trials have given firm evidence for the appli-
cation of real time two dimensional ultrasonography in
children with respect to overall success, speed, and
incidence of carotid puncture.
Observational and randomised studies give sugges-
tive evidence for the benefits of ultrasound guided cath-
eterisation for selected patients at high risk of
complications and when difficult central venous access is
12 4
Additionally, inexperienced doctors
might benefit from ultrasound guidance.
To minimise
complications of central venous access, the operators
should limit the number of stabs with both the seeker
needle and the definitive needle and have a plan for
either to choose another landmark or to use
ultrasound support.
Every anaesthetist and intensive care doctor should
be able to place central venous catheters without an
ultrasound device but with a dedicated knowledge of
all methods of how to maximise the success and mini-
mise the incidence of complications. Ultrasound assist-
ance is a potential useful back up technique after failed
attempts of blind cannulation and for patients in
whom catheterisation is likely to be difficult and
complications could be serious.
Manfred Muhm professor of anaesthesiology
Department of Cardiothoracic and Vascular Anaesthesia and
Intensive Care, University of Vienna, Austria
Competing interest: None declared.
1 Rosen M,Latto P, Ng S. Percutaneous central venous catheterisation. London:
W B Saunders, 1992.
2 Legler D, Nugent M. Doppler localization of the internal jugular vein
facilitates central venous cannulation. Anesthesiology 1984;60:481-2.
3 Armstrong PF, Cullen M, Scott DHT. The “SiteRite” ultrasound
an aid to internal jugular vein cannulation. Anaesthesia
4 Gilbert TB, Seneff MG, Becker RB. Facilitation of internal jugular venous
cannulation using an audio-guided Doppler ultrasound vascular access
device: results from a prospective, dual center, randomized, crossover
clinical study. Crit Care Med 1995;23:60-5.
5 Randolph AG, Cook DJ, Gonzales CA. Ultrasound guidance for
placement of central venous catheters: a meta-analysis of the literature.
Crit Care Med 1996;24:2053-8.
6 Denys BG, Uretsky BF, Reddy PS. Ultrasound-assisted cannulation of the
internal jugular vein: a prospective comparison to the external
landmark-guided technique. Circulation 1993;87:1557-62.
7 Lefrant JY, Cuvillon P, Benezet JF, Dauzat M, Peray P, Saissi G, et al. Pulsed
Doppler ultrasonography guidance for catheterization of the subclavian
vein: a randomized study. Anesthesiology 1998;88:1195-201.
8 Bold RJ, Winchester DJ, Madary AR, Gregurich MA, Mansfield PF.
Prospective, randomized trial of Doppler-assisted subclavial vein
catheterization. Arch Surg 1998;133:1089-93.
9 Troianos CA, Jobes DR, Ellison N. Ultrasound-guided cannulation of the
internal jugular vein: a prospective, randomized study. Anesth Analg
10 Slama M, Novara A, Safavian A, Ossart M, Safar M, Fagon JY.
Improvement of internal jugular vein cannulation using an ultrasound-
guided technique. Intensive Care Med 1997;23:916-9.
11 Verghese ST, McGill WA, Patel RI, Sell JE, Midgley FM, Ruttimann UE.
Ultrasound-guided internal jugular venous cannulation in infants: a pro-
spective comparison with the traditional palpation method. Anesthesiology
12 Hatfield A, Bodenham A. Portable ultrasound for difficult central venous
access. Br J Anaesth 1999;82:822-6.
Influences of the media on suicide
Researchers, policy makers, and media personnel need to collaborate on guidelines
eporting and portrayal of suicidal behaviour in
the media may have potentially negative influ-
ences and facilitate suicidal acts by people
exposed to such stimuli. Recent systematic reviews by
others and ourselves (unpublished) have found
overwhelming evidence for such effects.
Evidence for
the influence of media on suicidal behaviour has been
shown for newspaper and television reports of actual
suicides, film and television portrayals of suicides, and
suicide in literature, especially suicide manuals. The
potential for “suicide sites” on the internet influencing
suicidal behaviour remains to be proved, but anecdotal
evidence of negative influences is accumulating.
The impact of the media on suicidal behaviour
seems to be most likely when a method of suicide is
especially when presented in detail
the story is reported or portrayed dramatically and
for example with photographs of the
deceased or large headlines
and when suicides of
celebrities are reported.
Younger people seem to be
most vulnerable to the influence of the media,
although limited evidence also shows an impact on
elderly people. Another factor is similarity between the
media stimulus or model and the observer in terms of
age, sex, and nationality. An important aspect of the
presentation of suicide in the media is that it usually
BMJ 2002;325:1374–5
1374 BMJ VOLUME 325 14 DECEMBER 2002
oversimplifies the causes, attributing the act to single
factors such as financial disasters, broken relationships,
or failure in examinations. The most common factor
leading to suicide, mental illness, is often overlooked.
Tackling this problem is one component of
preventing suicides, and it is included in the recently
published National Suicide Prevention Strategy for
Relevant questions are, therefore, how this
should be done and whether it can be effective. One
approach has been to produce guidelines for the
media, of which there are now several.
All these
emphasise the need to avoid dramatic reporting or
portrayal of suicide and specifying means used. Most
highlight the desirability of providing accurate facts
about causes, including due emphasis on mental health
problems. At present no clear policy exists for the
problem of “suicide sites” on the internet.
One potential drawback of guidelines is that, in iso-
lation, they may be seen as dictating what the media
can or cannot do and as threatening freedom of
speech. Firstly, for them to have credibility with
authorities in the media and with journalists they must
be based on evidence. Secondly, they should be
produced ideally as a collaboration between research-
ers, public health policy makers, and senior media per-
sonnel. Thirdly, which is perhaps most difficult, they
should be shown to work. Some limited evidence exists
of this. In an initiative in Switzerland it was shown that
collaboration between researchers and the media
resulted in a reduction of sensational and lengthy
reports of suicides in newspapers.
No attempt was
made, however, to measure the impact on suicide.
Efforts to limit the reporting of subway suicides in
Vienna through the collaboration of researchers and
journalists were followed by a reduction in the number
of suicides and suicide attempts by this method.
A further but unanswered question is whether
media portrayal of positive coping with adversity in
circumstances that might have led to suicidal acts could
provide a model that might also reduce suicidal behav-
iour. Steps in this direction are worth exploring but will
also need collaborative initiatives. Their evaluation will
present a considerable but surmountable challenge.
Possibly the most influential approach to the prob-
lem of media and suicide will be through ensuring that
training courses for careers in the media pay adequate
attention to this important topic. Similar initiatives
should be made available to those already established
in media careers. Finally, inappropriate media por-
trayal and reporting of suicidal behaviour should be
immediately highlighted. This should encourage
producers and editors to remain aware of their poten-
tially influential role in future suicides.
Keith Hawton director
Kathryn Williams researcher
Centre for Suicide Research, University Department of Psychiatry,
Warneford Hospital, Oxford OX3 7JX
Competing interests: The authors have received funding for
research from Syngenta.
1 Pirkis J, Blood RW. Suicide and the media: a critical review. Canberra: Com-
monwealth Department of Health and Aged Care, 2001.
2 Baume P, Cantor CH, Rolfe A. Cybersuicide: the role of interactive
suicide notes on the internet. Crisis 1997;18:73-9.
3 Alao AO, Yolles JC, Armenta W. Cybersuicide: the internet and suicide.
Am J Psychiatry 1999;156:1836-7.
4 Phillips DP. The influence of suggestion on suicide: substantive and theo-
retical implications of the Werther effect. Am Sociol Rev 1974;39:340-54.
5 Hawton K, Simkin S, Deeks JJ, OConnor S, Keen A, Altman DG, et al.
Effects of a drug overdose in a television drama on presentations to hos-
pital for self poisoning: time series and questionnaire study. BMJ
6 Stack S. Celebrities and suicide: a taxonomy and analysis. Am Sociol Rev
7 Fishman G, Weimann G. Motives to commit suicide: statistical versus
mass-mediated reality. Arch Suicide Res 1997;3:199-212.
8 Department of Health. National suicide prevention strategy for England.
London: Department of Health, 2002.
9 Centers for Disease Control and Prevention, National Institute of Mental
Health, Office of the Surgeon General. Reporting on suicide: recommen-
dations for the media. Suicide Life Threat Behav 2002;32:vii-xiii. (accessed 24 Oct
10 Samaritans. Media guidelines. Portrayals of suicide. Ewell: Samaritans, 2002. (accessed 24 Oct 2002).
11 Michel K, Frey C, Wyss K, Valach L. An exercise in improving suicide
reporting in print media. Crisis 2000;21:1-10.
12 Etzersdorfer E, Sonneck G. Preventing suicide by influencing mass-media
reporting. The Viennese experience 1980-1996. Arch Suicide Res
Making progress with competing interests
Still some way to go
he BMJ and other journals are making
progress with managing the problem of
competing interests (or conflicts of interest, as
most journals call them). Today we take two further
steps forward by posting on our website the competing
interests of editors, our editorial board, and our group
executive (
interests.shtme) and by publishing a study we have
conducted that shows that readers reactions to
research are strongly influenced by statements of com-
peting interests.
We still, however, have some way to go
to the fully transparent world that is desirable.
The history of medical journals and conflict of inter-
est might be cruelly summarised as lots of rhetoric and
not much action. The International Committee of Medi-
cal Journal Editors produced a policy on conflicts of
interest as long ago as 1993,
but several studies have
shown that such conflicts are rarely declared in most
despite good evidence that most authors have
The international committee strengthened its
policy in 2001 by stating that journals should declare the
exact role of sponsors (often pharmaceutical compa-
nies) in studies and decline to publish studies where the
sponsors controlled the decision on publication.
policy too has yet to be widely implemented.
At the BMJ all authors and reviewers of original
articles, editorials, and most other material are asked to
complete competing interests forms, and declarations
of the competing interests of authors are made with
every article.
We have now instituted a system to
ensure that the role of sponsors is made clear, and any-
body submitting a rapid response is required by the
electronic system to make a statement on whether they
have competing interests. Our main means of manag-
Papers p 1391
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1375BMJ VOLUME 325 14 DECEMBER 2002
... Suicide reporting may be among the most challenging aspects of journalism ethics given both the media's duty to inform the public of newsworthy events and known risks of reporting about suicide particularly in identifiable people like celebrities (Cheng et al., 2007;Etzersdorfer et al., 2004;Gould, 2001;Hawton and Williams, 2002;Niederkrotenthaler et al., 2010Niederkrotenthaler et al., , 2012Niederkrotenthaler et al., , 2020Pirkis and Blood, 2001;Pirkis et al., 2006b;Sinyor et al., 2018a;Stack, 2003Stack, , 2005Tousignant et al., 2005). Journalists must carefully balance the competing interests of accurately reporting information in a fair and reliable manner, while also mitigating potential negative consequences of their reporting. ...
... One possible mechanism underlying this phenomenon is that individuals strongly relate to the subject of the report through vertical and/or horizontal identification. That is, the risk of 'copycat' suicide may increase when a vulnerable person reveres a celebrity (vertical identification) and/or if they see themselves as similar to the celebrity in terms of age, gender and other personal characteristics (horizontal identification) although neither is required for imitation to occur (Hawton and Williams, 2002;Niederkrotenthaler et al., 2009). ...
Objectives When journalists report on the details of a suicide, the way that they contextualize the meaning of the event (i.e. the ‘narrative’) can have significant consequences for readers. The ‘Werther’ and ‘Papageno’ narrative effects refer to increases and decreases in suicides across populations following media reports on suicidal acts or mastery of crises, respectively. The goal of this study was to investigate the impact of these different narrative constructs on subsequent suicides. Methods This study examined the change in suicide counts over time in Toronto, Canada. It used latent difference score analysis, examining suicide-related print media reports in the Toronto media market (2011–2014). Articles ( N = 6367) were coded as having a potentially harmful narrative if they described suicide in a celebrity or described a suicide death in a non-celebrity and included the suicide method. Articles were coded as having potentially protective narratives if they included at least one element of protective content (e.g. alternatives to suicide) without including any information about suicidal behaviour (i.e. suicide attempts or death). Results Latent difference score longitudinal multigroup analyses identified a dose–response relationship in which the trajectory of suicides following harmful ‘Werther’ narrative reports increased over time, while protective ‘Papageno’ narrative reports declined. The latent difference score model demonstrated significant goodness of fit and parameter estimates, with each group demonstrating different trajectories of change in reported suicides over time: (χ ² [6], N = 6367) = 13.16; χ ² /df = 2.19; Akaike information criterion = 97.16, comparative fit index = 0.96, root mean square error of approximation = 0.03. Conclusion Our findings support the notion that the ‘narrative’ matters when reporting on suicide. Specifically, ‘Werther’ narratives of suicides in celebrities and suicides in non-celebrities where the methods were described were associated with more subsequent suicides while ‘Papageno’ narratives of survival and crisis mastery without depictions of suicidal behaviours were associated with fewer subsequent suicides. These results may inform efforts to prevent imitation suicides.
... Some who may be going through distressing mental and physical health problems, serious socio-economic and or marital challenges may have at one point or another sorted for opportunity to take their own lives but lacked the 'motivation' or 'push' to act it out (Wasserman et al, 2021). Sensational reportage of suicide deaths from pesticide ingestion may 'inspire' them to eventually carrying out or completing the act using similar method (Williams, 2002). ...
... There could be a possible correlation with (i) increasing popularity of suicide reportage and (ii) media of reportage. Similar previous studies that were done prior to the recent popularity of Sniper and other insecticides as means of committing suicide found that hanging was the commonest method of suicide in this environment, for both male and female genders (Olibamoyo et al, 2021, Oyetunji et al 2021, Williams 2002. It is possible that the older generation were more exposed to hanging as a more lethal suicide method than the newly popularized use of Sniper which the younger generation is mostly exposed to through social media. ...
... Recent evidence suggests that reporting suicide through mass media has influenced trends in suicide deaths. Indeed, several researchers are concurrently studying the effect of conventional mass media on mental health [6][7][8] as well as the occurrence of copycat suicides resulting from mass media reporting [9][10][11][12]. To avoid the increased risk caused by these reports, the World Health Organization has issued recommendations for media coverage of suicides [13]. ...
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Background As the use of social media becomes more widespread, its impact on health cannot be ignored. However, limited research has been conducted on the relationship between social media and suicide. Little is known about individuals’ vulnerable to suicide, especially when social media suicide information is extremely prevalent. Objective This study aims to identify the characteristics underlying individuals’ vulnerability to suicide brought about by an increase in suicide-related tweets, thereby contributing to public health. MethodsA case-only design was used to investigate vulnerability to suicide using individual data of people who died by suicide and tweet data from January 1, 2011, through December 31, 2014. Mortality data were obtained from Japanese government statistics, and tweet data were provided by a commercial service. Tweet data identified the days when suicide-related tweets surged, and the date-keyed merging was performed by considering 3 and 7 lag days. For the merged data set for analysis, the logistic regression model was fitted with one of the personal characteristics of interest as a dependent variable and the dichotomous exposure variable. This analysis was performed to estimate the interaction between the surges in suicide-related tweets and personal characteristics of the suicide victims as case-only odds ratios (ORs) with 95% CIs. For the sensitivity analysis, unexpected deaths other than suicide were considered. ResultsDuring the study period, there were 159,490 suicides and 115,072 unexpected deaths, and the number of suicide-related tweets was 2,804,999. Following the 3-day lag of a highly tweeted day, there were significant interactions for those who were aged 40 years or younger (OR 1.09, 95% CI 1.03-1.15), male (OR 1.12, 95% CI 1.07-1.18), divorced (OR 1.11, 95% CI 1.03 1.19), unemployed (OR 1.12, 95% CI 1.02-1.22), and living in urban areas (OR 1.26, 95% CI 1.17 1.35). By contrast, widowed individuals had significantly lower interactions (OR 0.83, 95% CI 0.77-0.89). Except for unemployment, significant relationships were also observed for the 7-day lag. For the sensitivity analysis, no significant interactions were observed for other unexpected deaths in the 3-day lag, and only the widowed had a significantly larger interaction than those who were married (OR 1.08, 95% CI 1.02-1.15) in the 7-day lag. Conclusions This study revealed the interactions of personal characteristics associated with susceptibility to suicide-related tweets. In addition, a few significant relationships were observed in the sensitivity analysis, suggesting that such an interaction is specific to suicide deaths. In other words, individuals with these characteristics, such as being young, male, unemployed, and divorced, may be vulnerable to surges in suicide-related tweets. Thus, minimizing public health strain by identifying people who are vulnerable and susceptible to a surge in suicide-related information on the internet is necessary.
... Evidence suggests that media reporting of suicide significantly influences the subsequent suicidal behavior among vulnerable population. [3,4] Celebrity suicide gets extra attention by the media. When a celebrity suicide gets reported by media, it increases the risk of suicidal behavior among public. ...
Full-text available
Suicide is a global mental health challenge and suicides frequently get a wide media coverage. The media reporting of suicide and subsequent suicides are closely associated. Studies reveal country wise variations in the quality of media reporting. We aimed to do a bibliometric analysis of the published research on media reporting of suicide. All the published articles available on the PubMed database from the time of inception till August 2021 were included in the study. All the PubMed IDs of the articles were entered in Harvard Catalyst, a free online software, for bibliometric analysis, and data were extracted and verified. A total of 158 published articles were identified. The average number of authors per article was 5.108 and the average number of times an article cited was 9.639 (excluding self-citation). The h-index of the published articles was 19. The Crisis journal published the maximum number of articles (n = 24). The highest number of average citations was for systematic reviews. Maximum articles were published in 2020 (n = 27). Suicide reporting in the media is an important subject of suicide research. However, original studies on this subject are few. Large-scale studies will contribute to the development of an evidence base for future recommendations and guidelines on this important subject.
... Responsible media reporting of suicides is a well-recognized population level suicide prevention strategy [23] and may hold especial significance in this population. Imbalanced and sensational media reporting about the suicide of a fellow prisoner may trigger suicidal behavior among vulnerable prisoners, who may be experiencing shame, guilt, and emotional trauma, similar to the influence of media in the general population [24]. ...
Background Incarcerated prisoners represent a high-risk group for suicide. Little is known about the quality of media reporting of suicide in this group. Methodology Online media reports discussing suicide among prisoners in India were identified by searching three internet search engines and newspaper websites. All such reports between January 2011 to January 2021 were included. The search was carried out in English and five local Indian languages. Quality of media reporting was assessed against media reporting guidelines issued by the World Health Organization (WHO) as well as the Press council of India (PCI). Results A total of 120 relevant news reports were retrieved. Most reports pertained to death by suicide (76.7%). Majority of articles mentioned the identity (64.1%) of the person and reported the method of suicide (74.1%). Monocausal explanations (38.3%), illustration of reports with photographs (29.2%) and use of sensational language (48.3%) were commonly observed breaches in reporting. In contrast, helpful reporting practices such as discussing warning signs of suicide (1.6%) and mentioning details about suicide support services (0.8%) were rare. Conclusion Media reporting of prisoners in India is poorly adherent to WHO and PCI reporting guidelines. There is little focus on educating the reader while reporting a suicide. Concerted efforts are needed to address this important issue.
... tipo antisocial y desensibilización a la violencia, entre otros(6)(7)(8)(9)(10)(11)(12). Ante esta exposición mediática, los jóvenes son los que parecen más afectados; sin embargo, también hay evidencia del impacto adverso que tienen las noticias violentas en todo tipo de personas, indistintamente de la edad, del género y de la cultura, pues el contenido mediático muy cercano influye en la percepción que tengan de la violencia(13,14).Por tanto, es fundamental que los padres monitoreen los contenidos de los medios de comunicación que ven o escuchan sus hijos niños o adolescentes, pues así se podrá lograr un factor protector sobre su desarrollo físico, emocional, académico y social(15). Asimismo, es relevante el desarrollo de estrategias mediáticas en contra de la violencia, de manera que influyan en la diminución de la misma(16,17).3. ...
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El suicidio es una problemática grave de salud pública en México y en el mundo, el cual, de acuerdo con la Organización Mundial de la Salud, cobra la vida de alrededor de 800 mil personas al año. Pese a que la muerte autoprovocada tiene origen multifactorial, es de suma relevancia el reconocimiento de los diversos factores de riesgo y la corresponsabilidad social que se tiene en los mismos. En particular, el «efecto de contagio» del suicidio es un fenómeno que aún falta por explorar, no sólo desde las perspectivas de las ciencias de la salud o de la comunicación, sino también desde la bioética. Es por ello que en este artículo no sólo se describe el «efecto de contagio» del suicidio, sino que se analizan las implicaciones bioéticas de la influencia que tiene en la muerte autoprovocada la exposición a noticias divulgadas por los medios de comunicación que no siguen los lineamientos éticos de la Organización Mundial de la Salud.
Background In 2015 the Japanese government set a target of a 30% reduction in the total suicide rate by 2025, but deaths among adolescents have been rising since. In 2018 the overall suicide rate increased by 33% among Japanese students, as a part of a continued trend of rising suicide among adolescents. This study analysed the trends in method-specific suicide among Japanese adolescents from 1979 to 2016. Methods We conducted a cross-sectional study using data obtained from the vital statistics registration of the Ministry of Health, Labour and Welfare Japan. Poisson regression analysis was performed among 10–20-year-olds separately by sex, with year, age category, suicide method and a 1998 step variable as covariates. Results There was a sharp increase in suicide rates among boys (Incidence Rate Ratio (IRR), 1.68; 95% CI, 1.58–1.77) and girls (IRR, 1.69; 95% CI, 1.56–1.84) aged 10–20 years in 1998 when the overall suicide rate in Japan was at its peak. The commonly used method of suicide, hanging, has increased rapidly among high school and university-level aged adolescents since 1998. Limitations The computed mortality rates may have been affected by the shift in mortality coding from ICD-9 to ICD-10 in 1995. Conclusions Suicide among adolescents has been rising since the early 1990s. Several cultural factors such as notoriety of internet suicide and detergent suicide could have influenced the increase in suicide among adolescents. There is an urgent need to address suicide by hanging and gas among high school and university-aged adolescents.
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Research has indicated that excessive and sensationalized suicide reporting can lead to copycat suicides, especially when deaths involve well-known people. Little is known, however, about the impact of the reporting of suspected protestor suicide deaths during social unrest, particularly in an age of social media. In June 2019, the most substantial social unrest in Hong Kong since its handover in 1997 was triggered by the proposed Anti-Extradition Law Amendment Bill (Anti-ELAB). The social unrest subsided when Hong Kong and many parts of the world were hit by Covid-19 and very strict quarantine measures were imposed on crowd gatherings in Hong Kong at the end of January 2020. A number of reported suicides and deaths of undetermined cause took place during this 8-month period that received considerable attention. To better understand the possible effects of these highly publicized deaths, we examined media reports of suspected suicide cases before, during and after the protest period, as well as topics of suicide-related threads and their replies in social media forums. We found no clear evidence of increased rates of suicide as a result of these incidents, or during the protest period; however, it is suggested that certain narratives and attention surrounding the suspected suicides and undetermined deaths may have contributed to collective emotions such as sadness and anxiety. Some implications for misinformation (intentionally or un-intentionally) and mitigation of suicide risk during social unrest are discussed.
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Background: Imbalanced media reporting of suicide may increase suicide risk among vulnerable individuals. Aim: This study aims to assess the quality of suicide reporting in print newspapers of Odisha, a high suicide burden state in Eastern India. Materials and methods: We analyzed all eligible media reports of suicide in selected English and local language printed newspapers of Odisha between October 1, 2019, and September 30, 2020. Quality assessment was carried out against international as well as local reporting guidelines. Results: A total of 248 news reports were analyzed. Majority of the articles reported identifying details (such as name [74.2%], age [60.9%], and gender [98.4%] of deceased) as well as a detailed description about the suicide event (suicide method [87.5%] and location [84.3%]). More than half (54.8%) of the reports attributed suicide to a single cause. Conclusion: Suicide reports in print newspapers of Odisha are poorly adherent to local and international suicide reporting guidelines.
Full-text available
Objectives: To determine whether a serious paracetamol overdose in the medical television drama Casualty altered the incidence and nature of general hospital presentations for deliberate self poisoning. Design: Interrupted time series analysis of presentations for self poisoning at accident and emergency departments during three week periods before and after the broadcast. Questionnaire responses collected from self poisoning patients during the same periods. Setting: 49 accident and emergency departments and psychiatric services in United Kingdom collected incidence data; 25 services collected questionnaire data. Subjects: 4403 self poisoning patients; questionnaires completed for 1047. Main outcome measures: Change in presentation rates for self poisoning in the three weeks after the broadcast compared with the three weeks before, use of paracetamol and other drugs for self poisoning, and the nature of overdoses in viewers of the broadcast compared with non-viewers. Results: Presentations for self poisoning increased by 17% (95% confidence interval 7% to 28%) in the week after the broadcast and by 9% (0 to 19%) in the second week. Increases in paracetamol overdoses were more marked than increases in non-paracetamol overdoses. Thirty two patients who presented in the week after the broadcast and were interviewed had seen the episode-20% said that it had influenced their decision to take an overdose, and 17% said it had influenced their choice of drug. The use of paracetamol for overdose doubled among viewers of Casualty after the episode (rise of 106%; 28% to 232%). Conclusions: Broadcast of popular television dramas depicting self poisoning may have a short term influence in terms of increases in hospital presentation for overdose and changes in the choice of drug taken. This raises serious questions about the advisability of the media portraying suicidal behaviour.
This paper shows that suicides increase immediately after a suicide story has been publicized in the newspapers in Britain and in the United States, 1947-1968. The more publicity devoted to a suicide story, the larger the rise in suicides thereafter. The rise in suicides after a story is restricted mainly to the area in which the story was publicized. Alternative explanations of these findings are examined; the evidence indicates that the rise in suicides is due to the influence of suggestion on suicide, an influence not previously demonstrated on the national level of suicides. The substantive, theoretical, and methodological implications of these findings are examined.
This study, conducted in Israel, compares suicide motives as reported in the press with the official statistics. The analysis is based on two sets of data: the first includes all suicides (n = 4164) recorded from 1972-1988 by Israel's Ministry of Health, and the other contains all press reports n = 1885) relating to suicide over the same period in Israel's two daily newspapers. The news reports were subjected to systematic content analysis. The analysis indicates that press reports over-emphasize certain types of suicide while underplaying others. The effects of independent variables (age, gender, marital status and nationality) on the ascription of motives were different for the press and for the official statistics. Our findings show that the attribution of motives to suicides is socially reconstructed by the press.
This paper reports a field experiment concerning mass-media and suicide. After the implementation of the subway system in Vienna in 1978, it became increasingly acceptable as means to commit suicide, with the suicide rates showing a sharp increase. This and the fact that the mass-media reported about these events in a very dramatic way, lead to the formation of a study-group of the Austrian Association for Suicide Prevention (VSKK), which developed media guidelines and launched a media campaign in mid-1987. Subsequently, the media reports changed markedly and the number of subway-suicides and -attempts dropped more than 80% from the first to the second half of 1987, remaining at a rather low level since. Conclusions regarding the possible reduction of imitative suicidal behaviour by influencing mass-media-reports are drawn. Experiences from the media campaign are presented, as well as considerations about further research.
We found that the use of an ultrasonic Doppler provided accurate, noninvasive localization of the internal jugular vein and reduced unnecessary needle exploration. The size of our study limits definitive conclusions about complication rates; however, we believe the Doppler can be a useful aid for internal jugular cannulation.
To determine the utility of an audio-guided Doppler ultrasound device in improving success and decreasing complications in cannulation of the internal jugular vein in high-risk patients. Prospective, randomized, crossover clinical study. Two major university medical centers in critical care environments. Seventy-six consecutive, consenting adult patients with preexisting obesity or coagulopathy requiring central venous access. Subjects enrolled in the study were randomized to receive either the traditional "blind" (control) technique or the ultrasonic technique. A maximum of three cannulation attempts were allowed before crossover to three attempts with the alternative technique. All cannulations were attempted via the internal jugular vein through a high/central approach. Patient and operator characteristics were similar between groups. The initial use of an audio-guided ultrasound device was associated with increased success of cannulation (84.4% vs. 61.4%; p < .05) and decreased need to crossover to the alternative technique. Success on the first needle pass was more likely with the ultrasound technique (56.3% vs. 29.5%; p < .05). Significant complications were greater with the control technique (carotid artery puncture 16.3% vs. 2.0% [p < .02]; any significant complication 26.5% vs. 6.1% [p < .01]). The use of an audio-guided Doppler ultrasound vascular access device was associated with increased success of cannulation and a decreased frequency of significant complications in a population of high-risk patients with obesity or coagulopathy.
Central venous access is an essential part of patient management in many clinical settings and is usually achieved with a blinded, external landmark-guided technique. The purpose of this study is to evaluate whether an ultrasound technique can improve on the traditional method. We prospectively evaluated an ultrasound-guided method in 302 patients undergoing internal jugular venous cannulation and compared the results with 302 patients in whom an external landmark-guided technique was used. Ultrasound was used exclusively in an additional 626 patients. Cannulation of the internal jugular vein was achieved in all patients (100%) using ultrasound and in 266 patients (88.1%) using the landmark-guided technique (p < 0.001). The vein was entered on the first attempt in 78% of patients using ultrasound and in 38% using the landmark technique (p < 0.001). Average access time (skin to vein) was 9.8 seconds (2-68 seconds) by the ultrasound approach and 44.5 seconds (2-1,000 seconds) by the landmark approach (p < 0.001). Using ultrasound, puncture of the carotid artery occurred in 1.7% of patients, brachial plexus irritation in 0.4%, and hematoma in 0.2%. In the external landmark group, puncture of the carotid artery occurred in 8.3% of patients (p < 0.001), brachial plexus irritation in 1.7% (p < 0.001), and hematoma in 3.3% (p < 0.001). Ultrasound-guided cannulation of the internal jugular vein significantly improves success rate, decreases access time, and reduces complication rate. These results suggest that this technique may be preferred in complicated cases or when access problems are anticipated.