To the Editor:
Sir: Dr. Ji et al. (1) have conducted a study investigating the annual trends of charcoal burning (CB) suicide, 2000 to 2011, and to examine the risk factors of CB suicide in Korea. In the study, the proportion of CB suicides among all suicide deaths reported was 0.7% (84 cases) in 2007, and since 2008 it has rapidly increased to 7.9% (1,251 cases) in 2011. Among risk factors of CB suicide in the study, the robust influence of media report about famous Korean actor Ahn's CB suicide (adjusted odds ratio, 11.69; 95% CI, 10.30-13.23) was clearly found, strikingly the risk of CB suicide was almost 12 times higher after September, 2008 compared to the months prior, indicating that the profound negative role of media report increasing copycat suicide especially in vulnerable population (e.g., 15-40s, single, and male). I would like to add up useful information along with some issues concerning a huge role of media on increasing impulsive suicidality of human and regarding proper preventive strategy to minimize such negative influence of media reporting.
Despite a positive impact of media on rapid and massive dissemination of information in a wide range of area such as science and health, such critical influence may also cause unwanted and negative results in aspect of public mental health. Most of the evidence to date for a copycat suicide effect of media report has been suggested to be indirect. However, there has been increasing evidence of copycat effect by media report today. According to studies funded by the Australian Commonwealth Department of Health and Ageing, the presentation way the media reveal stories on suicide can have a direct influence on the public's perception of suicide and its related mental health issues (2). The impact of the media on suicidal behavior is in particular strong and dangerous upon media's detailed storytelling such as specified suicide method and way to access onto lethal material; especially, such influence is more direct and profound when the suicide story is reported, modified, or portrayed intensively, dramatically and imminently (e.g., photographs of the deceased, large and stimulating headlines, repeated reports, explanation of background of suicide (people may identify difficult situation), and reports of immediate suicide celebrity (2). In this context, active lead of government and community to develop media report guideline and continuous enlightenment should be initiated and established in Korea as soon as possible. In fact, such guideline and continuous education can be highly successful in responsible manner of reporting concentrating on encouragement of help-seeking and minimization of harmful messages without discouraging intention of media report (3, 4). Likewise, there were more news reporting of suicide in 2006 and 2007 (8,363 reports) compared to 2000 and 2001 (4,813 reports) in Australia; however, the quality of suicide reporting improved overall from 57% to 75%, indicating substantial improvement of media reporting on suicide in Australia (4). Despite a number of countries as well as World Health Organization (WHO) have developed media guidelines (e.g., Centers for Disease Control and American Association of Suicidology in the United States, Mindframe in Australia) (3), there have been no such acts have not been initiated in Korea. Interestingly, unlike televized suicide stories, newspaper and internet-based suicide stories can be saved, reread, displayed on one's wall or mirror, and elaborated repeatedly; according to Stack's systematic review, televised stories was 82% less likely to report a copycat effect than newspaper stories (3). This also indicates a differential impact on suicide behavior by type of media. Independently from media's role, movies misleading to glamorize and romanticize suicide can also impact or provoke individual's suicide-related acts (5). Therefore, inappropriate media portrayal and reporting of suicidal behavior should be immediately warned, educated, and enlightened by responsible health professional, community, and self-help society as well as government along with development of proper media guideline fitting environment and situation of Korea. Comprehensive, concise and clear guidelines against all potential sources such as newspaper, television, Social Network System (SNS), and internet should be developed as proposed in different countries (6): 1) avoid technical details about the method of suicide, sensational and provoking headlines along with portrayal using specific terms (e.g., suicide epidemic), dramatic pictures or video clips, description of suicide-related cause as simple one, mentioning specific website on suicide cluster, improper use of statistics, dealing as breaking news; 2) focusing on simple suicide news itself along with mentioning self-help group and easy accessible help resource and network, and keeping considerate and responsible way of report reflecting the contagion effects.
Additionally, the awareness and interest of peoples' perspectives and self-reports on suicidal ideation have drastically increased, in particular, in the management of their current mental health today. However, health professionals' and community's interaction and individual-level approach are not properly established and settled yet in Korea. Indeed interactive communication and active collaboration between health professionals and public community such as suicide organization may substantially increase the likelihood of saving people from being plunged into such unexpected impulsiveness to commit suicide by enhancing self-awareness and insight to be helped by relevant and immediately-available community resources, even they do not go to mental health professionals. Family alertness and education for vulnerable their member should be also integrated into community-centered preventive and care model as a part of community service system to reduce, minimize, and avoid such unexpected and impulsive suicide attempt, in collaboration with health professionals under full support of government. Conclusively, needless to say immediate action on development of media reporting guideline and enlightenment of media, modern health professionals to be more attentive and respectful to the need of integration, support and coalition with public health demands, by which establishment of sufficient and efficient preventive strategies may be settled in community.
Footnotes
This work was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (HI12C0003).
The authors have no conflicts of interest to disclose.
References
- 1.Ji NJ, Hong YP, Stack SJ, Lee WY. Trends and risk factors of the epidemic of charcoal burning suicide in a recent decade among Korean people. J Korean Med Sci. 2014;29:1174–1177. doi: 10.3346/jkms.2014.29.8.1174. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Hawton K, Williams K. Influences of the media on suicide. BMJ. 2002;325:1374–1375. doi: 10.1136/bmj.325.7377.1374. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Stack S. Media coverage as a risk factor in suicide. J Epidemiol Community Health. 2003;57:238–240. doi: 10.1136/jech.57.4.238. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Pirkis J, Blood RW, Dare A, Holland K Australia Department of Health Ageing. The media monitoring project: changes in media reporting of suicide and mental health and illness in Australia: 2000/01-2006/07. Woden, A.C.T.: Dept. of Health and Ageing; 2008. [Google Scholar]
- 5.Gould M, Jamieson P, Romer D. Media contagion and suicide among the young. Am Behav Sci. 2003;46:1269–1284. [Google Scholar]
- 6.Samaritans. Media Guidelines for Reporting Suicide. [accessed on August 12 2014]. Available at http://www.samaritans.org/sites/default/files/kcfinder/files/press/Samaritans%20Media%20Guidelines%202013%20UK.pdf.
