Part of the mission of #SPSM chat is to generate rapidly curated, peer developed expertise in response to current suicide related social media. At this week’s chat, we’ll need your insight and recommendations to do this.

The Tweets for this chat will be archived on Storify.

After last week’s chat, with the mention of Martin Manley’s website about his suicide, and Nedra’s experience with the Larryshipper’s suicide social media content, one this is abundantly clear. When it comes to suicide and social media, guidelines about responding from experienced mental health professionals is conspicuously absent.

This is exactly why #SPSM chat is essential. Social media events happen rapidly, spontaneously, and often need immediate and expert response. If you have a fire, you can call the fire department. But when it comes to suicide related social media, all we seem to have are ad hoc community members forming bucket brigades, and hoping to keep people safe.

With this in mind, Dr. Bill Schmitz and Dr. Foreman consulted an expert in suicide and media, Dr. Steven Stack. What follows is his response, dated 8/19/13, on the state of the research. What we know and what we don’t. If you have a chance, read this before the chat. We hope you will be bringing your own expert insights and recommendations. We will be curating your thoughts, in an effort to design the SPSM “fire department” of the future.

Dear Bill & April:

**non-related personal details from greeting redacted**

I am pleased that you find my work of interest & relevance. I started to read the extensive web page- which is essentially a very long, electronic suicide note of Martin Manley but have not finished it yet.

My work has been mostly on news stories -television and newspapers. I also did the largest meta analysis to date of about 500 findings (2005 sltb) and have been collecting subsequent copycat studies for an updated meta analysis. To the best of my knowledge, there has been very little rigorous research on social media and suicide completions. There are a good deal of anecdotal type case studies, but I am not aware of a large body of work using large samples of suicides and controls which asks significant others of the deceased if social media exposure was involved in the actual completed suicides.

At the macro level, the level which I have focused on I my own work, I am also unaware of investigations exploring the variation in measures of social media exposure to suicide content and the rates of suicide in ecological units of analysis such as cities, metro areas, counties, states or nations.

I have reviewed one or two such studies in the last year, but I do not know if they have been published. The findings in them were mixed/inconsistent.

There may very well be such studies- I often am surprised/embarrassed  when I find a study that I should have been aware of.

So I can only offer hunches or best guesses.

There is a large body of research that has found that investigations involving the suicides of entertainment/political celebrities are 5 times more apt to find copycat effects than investigations involving the suicides of other types of suicide victims. I am not that familiar with the Morley case, but I believe he was a popular sports reporter. He might qualify as a mass celebrity with a large following. If so, the greater the publicity concerning his suicide, the greater the suicide increase.

I do not know if the amount of press coverage of  his suicide was as great as other entertainment celebrities in the scholarly research (In US Marilyn Monroe, freddie prinz, etc.). The papers coming in from SE Asia typically focus on actors/rock stars who have extremely large followings in places like Taiwan and South Korea.  There is actually very little American work on copycat suicide anymore. New research has been mostly from Austria, Korea, Taiwan, & the UK. My impression has long been that NIMH has not been very supportive of proposals in this area of suicide research, although they used to fund such work back in the 1980’s under different leadership.

It is important to note that many types of suicide coverage have no or little impact on suicide rates, and in some cases have apparent protective effects. A majority of 493 findings I reviewed reported no copycat effect. This is often missed in discussions of the werther effect. Phillips’ 1974 classic investigation, for example, found no werther effect for a good many suicide cases. Thomas Niederkrotenthaler of Austria recently discovered that, in Austria, stories concerning suicide ATTEMPTS as opposed to completions are actually associated with a decrease in Austrian suicide rates. He terms this the Popageno effect named after Mozart’s last opera where the protagonist contemplates suicide, but in the end finds joy with his lover. I also found in my 2005 meta analysis in SLTB that stories portraying suicide in negative terms (e.g., pictures of the rotting bodies in Jonestown in the 1978 mass suicide there) were also associated with a decline in suicide. Suicide attempts are thought to convey a message that life goes on, that attempters pull together and endure (Popageno Effect) .

I believe that some attention needs to be drawn to a rather neglected media- suicide movies. Recently in an unfunded pilot study Michael Kral and I found that for every additional suicide movie watched the probability of a suicide attempt increased by a large amount (77%). The paper comes out in the next issue Sociological Focus.  The sample was small- only 350 undergraduate students. Instead of a laboratory study design where one group watches a suicide movie chosen by the investigators and another watches a non suicide movie, we used a retroactive design asking each subject to check which movies they had seen from a list (actually 50 popular movies where the star of the movie suicide). This design using a cumulative measure of exposure was borrowed from smoking studies where exposure to smoking movies over time was actually the best predictor of initiation of smoking among youth. In response, Disney took smoking scenes out of its movies in one division of its films. It may be that suicide prevention specialists may want to expand their attention to include suicide movies. There are about 20 such movies produced each year and from where I sit, it seems as though they have not been given the attention they deserve. Watching movies has become the #1 leisure time pursuit in the US. We found that there are apparent cult like suicide movies that were produced when the students in our study were infants (e,g. Shawshank Redemption). With DVD’s and film rentals on the web old movies may actually trigger suicide attempts as much or more as some of the more lethal new movies.

Basically, given that I have little knowledge base on social media and suicide, I hesitate to make any recommendations at this point.

I can offer some data from an unfunded study. I have found, in a recent study, that a very controversial suicide blog concerning suicides on the Skyway Bridge in Tampa Florida was associated with a rather large, unanticipated suicide rate from the bridge. The blog opened in 1999. In the ten years after the number of suicides from the bridge doubled from about 48 (previous 10 years) to 108. It is not clear if the advertising about suicide through the web page (which often publishes statements from friends/observers/families  & links to victims’  facebook pages, etc) was responsible for the doubling in suicides from the bridge. However, even after correcting for the rise in unemployment during the Great recession, the large uptick in bridge suicides remained. I am revising the paper and hopefully SLTB will accept it publication this Fall.

I would guess that negative portrayals of suicides, calls for help seeking, and other modalities of intervention might be useful techniques for using socil media- including stories of suicide attempters who found happiness (Popageno effect).

I might caution, however, that Hollywood has produced over 1,000 movies- all containing rich narratives, stories with many points of identification for their audience- and it is rare for any suicidal characters to seek professional help. Those that do often suicide afterwards!  In addition, my recent analysis of suicide attempt movies has found that it is also rare for such persons who fail in their suicide attempts to seek professional help. They often recover through sexual relationships with lovers instead (related to Popageno effect).  The message that suicidal persons should seek professional help has not come across in the cinema. In fact, I count more cases of suicidal help seekers completing suicide than not!

Calls for help seeking in the social media may not be reinforced by the movies. In the suicide attempt movies the protagonists typically recover through establishing a relationship with a lover, not a therapist/professional. This may be, in part, why many suicidal youth do not seek help from professionals.

A small group of 12 media & suicide professionals (e.g., Neiderkrotenthaler, Pirkis, Yip) met in Stockholm last April. We discussed many issues including social media- we were actually divided in whether or not one can study the protective/risk factors for suicide in this new media given the methodological challenges involved. There are many complexities involved in measuring key constructs such as exposure and issues regarding representative samples of users.

Be well,

Dr. Steven Stack