Media and suicide prevention: what’s going on?

It is know that media play a key role in suicide prevention, we talked about this in many previous posts (Thirteen reasons why: new episodes, debate still ongoing; Robin Williams’ death and copycat suicidesTV Series & Suicide: The End Of The F****ing World & 13 Reasons WhyEchoes of the TV series “13 reasons why” release: an ongoing scientific debate.).

Many recent articles have been published about this topic in the recent scientific literature . 

In “Media depictions of possible suicide contagion among celebrities: A cause for concern and potential opportunities for prevention” ( it is explained the concept of copycat suicide and Werther effect: celebrities suicide, but also TV series or movies about suicide, can raise awareness about the topic. Generally, celebrities’ suicides are particularly likely to be associated with increased suicide rates. The article “Increases in Demand for Crisis and Other Suicide Prevention Services After a Celebrity Suicide” ( , published on Psychiatric Services in August, examines data on acute (i.e., within 30 days) increases in suicides, help and information seeking, and service capacity after a celebrity suicide (Robin Williams’ death on August 11, 2014). In conclusion, “Dramatic increases in all three measured outcomes in the days after a celebrity suicide were noted, suggesting the need for contingency plans to meet immediate increased demand”.

An important debate took place in the scientific community following the release of the show

Thirteen Reasons Why, a Netflix Drama dealing with Anna Baker’s suicide. The article “13 Reasons Why Not: A Methodological and Meta‐Analytic Review of Evidence Regarding Suicide Contagion by Fictional Media” ( analyzes the possible effect of the serie on the population: the study results “suggest that current data do not support the theory that suicide contagion by fictional media occurs”, anyway “it is recommended that individuals exercise caution in public statements linking suicide‐themed fictional media to suicide contagion as data may not be able to support such claims”. 



On the web you can find many articles, blogs about suicide among doctors.

There are also many related initiatives which have been implemented: for example June 1st is the #CrazySocks4Docs Day, an initiative started by an Australian physician in 2017 (a cardiologist who suffered from severe depression). The initiative now involves doctors in Canada, the UK, the US, New Zealand, Spain, France, and Ireland. It is not only for doctors but also for nurses, paramedics, medical students, veterinarians and all other specialties that work in the health care field: this is a way in which it is possible to talk about the health of the Health Care Professionals, fighting the stigma.


“Il primo giorno della mia vita”

Have you ever dreamed of being alive at your funeral? That’s the main theme of the novel written by Paolo Genovese “Il primo giorno della mia vita”. The protagonists are four people with suicidal intent: Emily, a young ex-athlete girl who is disable after a bad injury during a competition; Aretha, a police woman who lost her child; Daniel, a young boy suffering from diabetes and bullied at school; Napolen, a motivator who has no apparent reason to feel hopeless and depressed. All of them want to end up their lives, but, right in the moment they commit suicide, they meet a stranger who offers them the opportunity of seeing their future, as if they were still alive. The man picks up all of
them in an old-style station wagon and guides them in a journey where they assist to their funeral and see their future. Aretha, Emily and Daniel begin to be friends, and they find out that there is a lot of love and opportunities in their future lives, despite the sufferings they are experiencing at the moment. They eventually find the strength to face their difficulties with new hope in the future and decide to take the chance to came back and live their lives. Napoleon, the only character who apparently doesn’t live any difficult existential condition, but is probably affected by major depression, doesn’t change his mind and decides to go on with his suicidal project. At the end of the story, Napoleon takes the place of the mysterious man and guides people who are going to commit suicide through the same experience of seeing their future lives, just as he did earlier.

Suicide and Ballet

Throughout ballet history, several characters die by suicide, such as Giselle, or (in some versions) Odette and the prince in Swan Lake. In the past centuries, ballet was mainly entertainment, and the protagonists’ suicide could seem somehow in contrast with the ideal of the romantic ballet. Only later (18th century) ballet became an independent art form, which could be used also as an instrument to communicate social messages. Famous example of ballets that represent suicide and suicide struggles include Giselle, Swan Lake, La Bayadère, Romeo and Juliet, Don Quixote, where the main reason for suicide is unhappy love. There is often a poor lady who has been abandoned or betrayed by her lover and commits suicide; consequently the “survivor” men have to face the burden of their beloved loss. Some ballets also deal with homicide-suicide cases and double suicide. Sometimes the theme of suicide permeates the whole representation, and the idea of suicide haunts the protagonist, who designs and programs it in detail, while other times suicide is represented as an impulsive gesture. Different suicide methods can be represented, including violent ones, but the most frequent is suicide by poisoning. Sometimes viewers find out that a character died by suicide, but are left to imagine about it, while in other works suicide is represented in detail, albeit always in elegant manners, for example using specific steps, that can simulate the act. Dancers that have to play the role of characters that commit suicide may live and perform these dramatic moments in different ways,  deeply moved by their feelings, in particular when the decision to commit suicide accompanies the characters for all the opera.

Swan lake is a ballet composed by Pyotr Ilyich Tchaikovsky in 1875–76; the choreographer of the original production was Julius Reisinger. Since then, Swan Lake has been one of the most performed ballets all over the world. Outstanding dancers, such as Carla Fracci and Rudolf Nureev performed this masterpiece in theaters, which in 2010 inspired also the movie “Black Swan” by Darren Aronofsky (see Movie of the Month).

The opera, generally presented in four acts, tells about Odette, a princess turned into a swan by an evil sorcerer’s curse. Prince Siegfried must choose a bride at the royal ball and he is really upset that he cannot marry for love. He goes out with his friends and reaches the lakeside where there are many swans and one of them transforms into a beautiful maiden, Odette, who explains that she and her companions are victims of a spell cast by the sorcerer Rothbart. The spell can only be broken if one who has never loved before swears to love Odette forever. Rothbart goes to the royal ball with his daughter Odile, transformed to look like Odette and they deceive Siegfried who proclaims to the court that he will marry “Odette” (Odile). When he realizes his mistake, he goes back to the lake to apologize with Odette, who has chosen to die, rather than remaining a swan forever. Siegfried chooses to die with her and they leap into the lake. This action breaks Rothbart’s spell over the swan maidens, causing him to lose his power over them. Rothbart eventually dies, and the swan maidens watch Siegfried and Odette ascending into the Heavens together, forever united in love.There are also many alternative endings in which Odette and Siegfried live happily ever after or kill Rothbart, and also tragic endings in which Rothbart fights with Siegfried, who is defeated and dies, leaving Rothbart to take Odette triumphantly up to the heavens.


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Suicide Hotspot: “A Long Way Down”

A Hornby’s novel, published in 2005. 

On the night of the 31th December four people, apparently with nothing in common, find themselves involved in a strange and unusual adventure. They met for the first time on the top of “The House of Suicide”, a skyscraper in London, where they went up with the intention of committing suicide. The protagonists are: Maureen, a lonely woman taking care of a seriously disabled son named Matt; Martin, a journalist who spent a period in jail after having a sexual intercourse with a 15 years old girl, and, after this fact, lost his family, friends and job; Jess, a problematic adolescent girl, with a tragic history in her past and JJ, an American pizza-boy, who was a musician in his country, but his band dissolved and he broke up with his girlfriend. All these people have different tragic past  stories and live in difficult conditions, but, when they start talking on the roof of the skyscraper and sharing their problems, they decide not to commit suicide in that moment. They start a strange friendship, and, in an unusual way, they help each other, talking with honesty, frankness and true empathy. They start to meet periodically, and everytime they postpone the decision about suicide, sharing and comparing their life problems. On the 14th February they decide to go up on the skyscraper “House of suicide”, where they find a man. They try to talk to him, but he commits suicide in front of their eyes. After that, they understand they don’t really want to end their life, and, likewise, they need to stay together, and through their particular friendship, they start to look in a different way to their life and start giving themselves a chance. They go on with a new point of view: although life is not always beautiful and easy, they try to face it step by step, and continue postponing the decision of suicide, never saying “I’ll never do that”, but just waiting for taking this decision, and, in this way, they continue with their life and friendship.

To know more about suicide hotspot visit our post about it!

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Suicide Hotspot

The hotspot is also known as “iconic site” or “suicide magnet”. It is “A specific, usually public, site which is frequently used as a location for suicide and which provides either means or opportunity for suicide”. It is almost always a jumping site; examples are the Golden Gate Bridge, the Eiffel Tower, and Niagara Falls” (National Institute for Mental Health In England, 2006). They also receive a disproportionate amount of media attention.

The “Guidance on action to be taken at suicide hotspots” (2006), developed by the National Institute for Mental Health in England, on the Suicide Prevention Resource Center Website, qualifies the suicide hotspot as follow:

“The term ‘suicide hotspot’ has two possible meanings. It is frequently used to refer to both: a) a geographical area with a relatively high rate of suicide among its resident population (e.g. a town, borough, county or country), and b) a specific, usually public, site which is frequently used as a location for suicide and which provides either means or opportunity for suicide (e.g. a particular bridge from which individuals frequently jump to their deaths)”.

The Guidance reports examples of prevention methods that may be applied to hotspots with proven efficacy: physical barriers, telephone hotlines also encouraged by placing telephones nearby the hotspot, increasing the possibility of intervention by a third party, suicide patrols or trained staff of non-health agencies working at or near hotspots, finally,  paying attention to media reporting (e.g. media guideline).

In 2013 BMC Public Health published a systematic review about suicide hotspots that highlighted quite the same methods to prevent suicide in these areas as those indicated in the Guidance (1). In the same year a meta analysis about the effectiveness of structural interventions at suicide hotspots concluded that structural interventions at ‘hotspots’ avert suicides in these sites: “Some increases in suicide are evident at neighbouring sites, but there is an overall gain in terms of a reduction in all suicides by jumping” (2).

Developing suicide prevention strategies in these places requires complex questions of ownership, responsibility and resources.

On the Center for suicide prevention website there is an interesting editorial about the topic: “Jumping and Suicide Prevention”. It talks about suicide by jumping from heights and arguments for and against barriers.

It is known that barriers and other prevention methods may not stop an individual that wants to commit suicide, but multiple efforts should be performed to prevent the event, because, as reported in the editorial:

“A barrier or another prevention measure should not be up for debate. If suicides have occurred previously in the location… it is worth the expense.
Even one suicide is too many”.

  1. Interventions to reduce suicides at suicide hotspots: a systematic review
  2. The effectiveness of structural interventions at suicide hotspots: a meta-analysis.
  3. “Jumping” and Suicide Prevention

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Thirteen reasons why: new episodes, debate still ongoing

Since 18th May 2018, new episodes of the TV series “Thirteen reasons why” are available on Netflix. Anna Baker’s story has divided the scientific community about suicide and how this difficult topic should be discussed by and through the media.

Different scientific papers have been published about this topic. On “Health communication” it has recently been published the article “#13ReasonsWhy Health Professionals and Educators are Tweeting: A Systematic Analysis of Uses and Perceptions of Show Content and Learning Outcomes” that analyses more than 700 health professionals’ and educators’ tweets about the Netflix show. In October 2017, JAMA Internal Medicine published the editorial “A Call for Social Responsibility and Suicide Risk Screening, Prevention, and Early Intervention Following the Release of the Netflix Series 13 Reasons Why” linked to the research letter “Internet Searches for Suicide Following the Release of 13 Reasons Why”. The Authors of the letter reported that suicide-related internet searches increased following the release of the series 13ReasonsWhy, even though it’s impossible to discriminate whether  the internet searches had been performed by scientists, teachers or people contemplating suicide.

On the American Journal of Maternal/Child Nursing, the article “13 Reasons Why: A Trigger for Teen Suicide?” discusses the controversy raised by the Netflix series and expressed by school officials, healthcare providers, and parents. This paper, as many dissemination websites, such as Huffington Post and Washington Post, suggests that the series may romanticize suicide and eventually lead to possible negative effects. On the other hand, hypotheses have been suggested that the series may help specialists and people from the community to discuss about the difficult topic of teenagers’ suicide.

In any case, certainly the series fostered the debate about suicide.

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Image from Pixabay

Bulgakov’s Morphine: substance use disorders and suicide

Morphine is a story written by Michail Bulgakov, published for the first time in 1927 on the magazine “The Medical Worker”.

The book, written in form of diary, is focused on the personal history of young doctor Polijakov, describing feelings and consequences of substance use disorder, until the extreme one: suicide. Polijakov has his first contact with morphine during a crisis of abdominal pain. From this moment, Polijakov’s life falls into a spiral of decadence and addiction: recruitment and research of the substance become the young doctor’s only concerns, and as a consequence he eventually neglects his work and personal relationships. Moreover, the abuse of morphine causes him physical consumption and psychiatric symptoms, with the onset of hallucinations and distress which lead the young doctor into a voluntary hospitalization in a detox clinic. This attempt fails: he escapes from the clinic and restarts abusing. Exasperated by his situation, for which he sees no way out, Polijakov writes a letter to ask for help to a university classmate, but after sending the letter, hopeless and full of remorse, he impulsively decides to take his own life; his diary is then delivered to the colleague to whom he had asked for help, who decides to publish and share Polijakov’s memories (to know more about the topic read our new reading suggestion at this link).

This tale describes drug addiction from the point of view of an addicted, depicting young doctor’s thoughts. We sew the first contact with the substance, the excuses that Polijakov gives himself to continue in the abuse of morphine, the intense craving and, when he becomes conscious of his problem and the sense of fail and hopelessness related to the awareness that he is not able to stop morphine abuse; the shame for his condition finally leads him to the extreme gesture. This book also contains many autobiographical references; the author himself has suffered from morphine addiction during his life.

We choose this book as reading suggestion for this month because substance use disorder is one of risk factors for suicide; moreover, recent review highlights the frequency of self-harm and suicide between medical doctors. Perhaps not everyone knows that Michail Bulgakov, besides being a famous writer, was a medical doctor. After graduation he worked as a physician at the Kiev Military Hospital and then, during the First World War, as a volunteer in the Red Cross to the front. Then he worked as a surgeon and was eventually appointed provincial physician.

To know more about suicide among people with substance use disorders contact us for our Flyers about the argument (to know more visit our page about Flyers).

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  • “Morphine” text by Mikhail Bulgakov
  • Wikipedia:
  • Psychosocial job stressors and suicidality: a meta-analysis and systematic review. Milner A, Witt K, LaMontagne AD, Niedhammer I, Occup Environ Med. 2018 Apr;75(4):245-253. doi: 10.1136/oemed-2017-104531. Epub 2017 Aug 29.

Image from Pixabay

Robin Williams’ death and copycat suicides

In a previous article we reported about celebrities, as Chris Cornell and Chester Bennington, who committed suicide (Click HERE to read the article). It is widely acknowledged that a celebrity suicide may influence population health, in particular suicides rate may increase in the next weeks due to copycat and Werther effect (Click HERE to know more about Werther Effect), and this may have a varying impact in different populations and cultures.

The role of media communicating the news is very important: the World Health Organization recently published an update in the guidelines “Preventing suicide: a resource for media professionals”, where there is a specific section named “Apply particular caution when reporting celebrity suicides” (Click HERE for the Guidelines).

Many articles about the topic were published after Robin Williams’ death, occurred in 2014: this is a good example in order to explain the topic. Robin Williams was a famous actor, with a 35-year career on screen, playing lead roles in different famous films (es: Dead Poets Society, Mrs. Doubtfire…). The day Williams died, the National Suicide Prevention Lifeline received the highest number phone calls ever.

A recent open access study published on PLOS One investigates suicides following the death of the actor Robin Williams: using a time-series analysis, researchers reported that suicides observed exceeded expected ones; this was observed across gender and age groups.  

LINK to articleIncrease in suicides the months after the death of Robin Williams in the US

Moreover, on Health Communication Young it was published an article about a survey on how his death influenced searches for information concerning depression, suicide, and mental health. They found, for example, that respondents who sought information about the suicide reported changes in their thoughts about suicide, most often dealing with the difficulty in spotting warning signs and the idea that “it can happen to anyone.”

LINK to the articleTweeting celebrity suicides: Users’ reaction to prominent suicide deaths on Twitter and subsequent increases in actual suicides.

Finally, the relationships between guidelines and news about suicide were assessed in a study performed at the Mental Health University Institute in Quebec by Creed and Whitley. In Canada guidelines and best practice have been recently published to help journalists writing about mental health and suicide. Creed and Whitley tried to relate these norms to the pieces written about Robin Williams’ suicide from major Canadian newspapers: they observed that articles generally followed the evidence-based guidelines when reporting about Williams’ suicide.

LINK to the article: Assessing Fidelity to Suicide Reporting Guidelines in Canadian News Media: The Death of Robin Williams

In conclusion, as described in the WHO guidelines, celebrity suicides are particularly likely to induce copycat suicides: “the effect of a report about a suicide on subsequent suicides is greater when the person described in the story is a celebrity and is held in high regard by the reader or viewer. Particular subgroups in the population (such as young people, people suffering from mental illness, persons with a history of suicidal behaviour or those bereaved by suicide) are particularly vulnerable to engaging in imitative suicidal behaviour”.

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TV Series & Suicide: The End Of The F****ing World & 13 Reasons Why

From October 2017 on Netflix is available a new series named “The End Of The F****ing World”. The story is about  two teens, Alyssa and James,  who run away from home and start a journey together, full of serious difficulties, in which they learn something about themselves and each other.  

Exactly like “13 Reasons Why”, another Netflix series, the theme of suicide is the key of the story. In “The End Of The F****ing World”, many flashbacks help the viewer to understand James’s family history. The young boy is grieving the devastating loss of his mother and this influences many of his behaviors.

In “The End Of The F****ing World” and  in “13 Reasons Why” we can find how suicidal behaviors influence other people’s life: suicide is a complex tragedy without one singular cause but may affect many people’s life, “the survivors” (to know more about the topic Survivor you can also read our article: “Chris Cornell, Chester Bennington ans Survivors of Suicide Loss“). 

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