Preventing Suicide Contagion

Mental health encompasses cognitive, behavioural, and emotional well-being. It is about how we think, react, live and behave. Sound mental health is essential for quality life, good relationships, and ultimately good physical health. The stigma attached to mental health has greatly deterred people talk about it openly and thus has remained a hidden problem in our society, especially in our part of the world. Among many mental health issues, suicide is often associated with stigma, and reporting a suicidal event needs careful consideration. 

Suicide is preventable. It has been estimated that one person dies of suicide every 40 seconds worldwide. For every suicide, 20-25 times suicide attempts do occur. It has been estimated that every suicide affects six people greatly and up to 135 people to some extent (WHO, 2022). There are several stressors that lead a person to attempt suicide such as the loss of a loved one, economic hardship, loneliness, and mental and chronic illnesses.  Those stressors may become stressful or often traumatic for a person.

Factors

There are several factors that result in suicide. The media reports and in recent times social media coverage of suicide may lead to a surge in suicide attempts. Therefore, responsible media reporting of suicide becomes imperative in preventing suicide.  Suicide contagion is the exposure to suicide or suicidal behaviours within family, peer group, or through media reports of suicide and have been associated in an increase in suicide and suicidal behaviours.

Suicidal contagion has been shown to precede a surge in suicidal behaviour in persons at risk for suicide, especially in adolescents and young adults. The belief that media coverage of suicide could lead to suicide contagion goes back to hundreds of years. A novel “Sorrows of Young Werther” by Johann Wolfgang Goethe in 1774 resulted in copycat suicides in several European countries led to the book being banned in various places. 

The increased risk of suicide contagion as a result of media reporting can be minimised with responsible reporting. Thus, it should be based on factual and concise reports of suicide. Suicide reports should not be repetitive, as persistent exposure has been shown to increase the likelihood of suicide contagion. Suicide does not usually occur with a single factor or event but is a result of a complex interaction of many factors. Oversimplifying recent negative stressful life events or critical stressor, thus promote suicide contagion. Another important aspect in preventing suicide contagion is not to report detailed descriptions of the method used. 

Such reporting may increase possible duplication. Providing details of method used to complete the suicide may facilitate the imitation of the suicidal behaviour by other at-risk persons. Repetitive and ongoing coverage, or prominent coverage, of a suicide tends to promote suicide among most at-risk people, especially among adolescents of 15-24 years of age. Unnecessary glorification of the victim by reporting only positive messages should be avoided in media reporting of suicide. Instead, reports should carefully describe mental, social, and/or physical problems and information such as suicide prevention hotlines or other available avenues for help. 

It is, therefore, important that the media should carefully explain that the final precipitating event was not the only cause of a suicidal attempt. In fact, most people who have committed suicide have had a history of problems that may not have been recognised during the acute aftermath of the suicide. Detailed descriptions of the problems that could have played a causative role in suicide are not always necessary, but the acknowledgment of these problems should be sensibly reported.

Reporting on community expressions of grief such as public eulogies, flying flags at half-mast, and erecting permanent public memorials should be avoided as it may promote suicide contagion. Such expressions of grief may contribute to suicide contagion by suggesting to the vulnerable people that society is honouring the suicidal behaviour of the deceased person, rather than mourning the person's death. Suicide is usually an act of a troubled person who ultimately is convinced that suicide is the ultimate solution to the problem. Presentation of suicide as a means of coping with personal problems may suggest suicide as a potential coping mechanism for at-risk persons.

Counselling 

It is important that empathy for family and friends often leads to a focus on only reporting the positive aspects of a deceased life.  Often friends or family members may be quoted as saying the deceased person "was a great human being" or "had a bright future," and they avoid mentioning the troubles and problems that the deceased person experienced in his life and ultimately took his/her life.  

Often statements adoring the deceased person are often reported in the news. However, if the problems or troubles of a person who committed suicide are not acknowledged in the presence of these laudatory statements, suicidal behaviour may appear attractive to other at-risk persons and result in suicidal contagion. A responsible media professional should attempt to reduce the prominence of the news report and avoid the use of dramatic photographs related to suicide. 

It is often difficult for friends, peers, colleagues, and family members to cope with the loss due to suicide. Therefore, prompt suicidal counselling should be provided and those at risk for suicide should then be referred for additional mental health services. Lastly, there are several helplines/hotlines available in our country where we can get prompt and effective services for those who need help.

(Dr. Lohani is the clinical director at the Nepal Drug and Poison Information Centre. lohanis@gmail.com)