10.4185/RLCS-2018-1283en | ISSN 1138 - 5820 | RLCS, 73-2018 | |
The journalists’ use of WHO recommendations for the prevention of suicide. The case of the newspaper Abc
Antonio Eleazar Serrano-López [CV] [GS ] [ORCID ] Departamento de Biblioteconomía y Documentación, Universidad Carlos III de Madrid, España / Instituto Interuniversitario “Investigación Avanzada sobre Evaluación de la Ciencia y la Universidad” (INAECU) – firstname.lastname@example.org
Daniel Catalán-Matamoros [CV] [ GS] [ ORCID ] Departamento de Periodismo y Comunicación Audiovisual – Universidad Carlos III de Madrid, España, Grupo de Investigación Ciencias de la Salud CTS-451 – Universidad de Almería, España y Laboratorio MICA-Medios, Información, Comunicación, Artes, EA 4426, Universidad Montaigne de Burdeos, Francia – email@example.com
Translation by Yuhanny Henares
Suicide, defined by Albert Camus (1999) as the only “truly serious philosophical problem”, is an important public health issue. In Spain 3910 individuals died of suicide and self-inflicted injuries in 2014 (INE, 2016), being the first cause of non-natural death of the country. The suicide rate by every 100.000 inhabitants in Spain is 8.42 (INE, 2016). It is inferior to the average global rate, of 11.4 in 2012 compared to 7.1 of Spain that same year (WHO, 2014), and of the average rate of suicides of the European Union, which in 2013 was 11.8 and the Spanish rate was 6.7 (Eurostat, 2016). The prevention of suicides is possible and the WHO considers it a “World must”. In order to do this, member States of WHO have compromised to try to reduce the suicide rate 10% for 2020 (WHO, 2014).
Information spread about suicides on media is included among preventive interventions, because it demonstrated to reduce suicide rates. Therefore, improving the mediatic treatment of suicide is one of the key strategies to prevent it because “the appropriate diffusion of information and a sensitization campaign of the problem are essential elements for the success of prevention programs” (WHO, 2014). This way, media must have an active role in the prevention of suicide in our current society (WHO, 2000).
In 1999, the WHO launched the SUPRE program (Suicide Prevention), a world initiative for the prevention of suicide. In this strategy there is included the publication of the document ‘Suicide prevention: toolkit for media professionals’ (WHO, 2000). The text, targeted to media professionals in newspapers, television, radio and Internet, summarizes the evidence of the media impact when informing about suicides and advise communicators about how to inform about suicides. This strategy was updated and extended in 2008 and today it is considered a basic reference for media professionals regarding suicide communication.
For instance, one of the recommended guidelines to media consisted of reducing sensationalistic and extensive information about suicides in newspaper’s covers and headlines. This was done on Switzerland, observing a reduction of sensationalistic contents from 20% to 4% in covers and from 62% to 25% in headlines (Michel, Frey, Wyss and Valach, 2000). Another study found that after the introduction of mediatic guidelines in Wien (Austria) in six months there was a reduction of 80% of suicides by subway accidents, keeping in low levels since then. Besides, the global suicide rate in the Austrian city reduced (Sonneck, Etzersdorfer and Nagel-Kuess, 1994).
The responsible journalistic approach, following guidelines stablished by the scientific evidence, could have the reduction of the suicide behavior as effect. This is known as the Papageno effect, named so after the character of ‘The Magic Flute’ opera by Wolfgang Amadeus Mozart who desired to take his life but was persuaded by three children (Niederkrotenthaler et al., 2010). The most known is the Werther effect (Philips, 1974), that is, the increase of suicides after the publication of a news about a suicide. The origin of the association between suicide and its informational treatment is the novel of 1774 ‘the sufferings of young Werther’ written by Johann Wolfgang von Goethe. In the book, the protagonist takes his life with a gun shot after a love misunderstanding (Goethe, 2012). After its publication it was informed that several young lads suicided using the same method, therefore establishing a cause-effect relationship between both forbidding the book publication in several European countries (Pirkis and Blood, 2001).
Another case was the suicide of a famous singer in Austria using a firearm which caused the increase of 40% in the number of suicide by guns in the three weeks after the main newspaper of Austria dedicated extensive reports about it. The regional analysis found a strong correlation between firearm suicides and the newspaper distribution (Etzersdorfer, Voracek and Sonneck, 2004). The Werther effect seems to be greater among young people and when the suicide victim is a famous person (WHO, 2008).
The review of the scientific literature that exists about both effects concludes that the mediatic effect in suicides, suicide attempts and suicide ideas is a continuum between both effects (Sisask and Värnik, 2012; Scherr and Steinleitner, 2015). An irresponsible treatment of media can cause an increase of suicide behaviors (Werther effect) in the same way that media can help to reduce suicide behaviors by complying with recommended guidelines (Papageno effect) or not having any significative effects on suicides. However, after the suicide of the German goalkeeper Robert Enke in 2009 by throwing himself to a train, there was an increase of 120% in the suicide’s index in railways in the 28 days that followed after his death, despite the sensitive mediatic treatment and preventive measures taken (Ladwig, Kunrath, Lukaschek and Baumert, 2012). Therefore, this field of study in social communication requires performing an in-depth analysis that investigates the relationship between media and suicides, as well as the search of strategies to prevent those suicides from media.
In Spain, there are studies that have analyzed the informational treatment of suicide both in press (Herrera, Ures and Martínez, 2015) as well as in television (Olmo and García, 2014) but none have studied whether the publication of the document ‘Suicide prevention: toolkit for media professionals (WHO, 2000) as part of the SUPRE program has affected the informational treatment of suicide, suicide rates nor the evolution of the informational treatment of suicide through the years. In the bibliographic review we didn’t find any studies in any other country that has analyzed the direct effect of SUPRE in media. We only found a study conducted in Colombian media that analyzed the news about suicide published in a local newspaper during a six-year period, concluding that the newspaper did not comply with WHO recommendations (Rátiva, Ruiz and Medina-Pérez, 2013). Finally, other researchers have widened the focus and have focused on the temporary evolution of the coverage of British newspapers about mental health (Goulden et al., 2011) and in the treatment of contents about health in Swedish and (Catalán-Matamoros, Axelsson and Strid, 2007) Spanish newspapers (Rico, 2010). Therefore, the main objective of this study is to determine whether the publication of WHO recommendations had any effect in the informational treatment of suicide in the daily and generalist Spanish press. In order to do this, we will perform an analysis about the coverage of one of the national newspapers of reference in Spain, Abc.
A descriptive and observational type of study was done, using a non-experimental design. We performed a content analysis including qualitative variables. The content analysis is considered “one of the most used research techniques in social sciences to confirm and verify hypothesis applied to communicative products or communicative interactions” (Gaitán and Piñuel, 1998: 281-283). Specifically, a content analysis of publications in a national circulation newspaper was done.
2.2. Sample selection
To study the effect of WHO recommendations in the Spanish press we selected the national newspaper Abc as sample. Based on the last General Study on Media (AIMC, 2017), Abc is the sixth generalist non-free press media Abc most consumed in Spain with 418.000 daily readers. We searched for the news informing about specific suicides in three time periods: a) the year the document ‘Suicide Prevention: Toolkit for media professionals’, b) five years before and c) five years after: 1995, 2000 and 2005. We selected these years when considering it is enough time so that some significant change could be produced in the journalistic issue of the suicide topic.
The search consisted in introducing the term “suicid*” in the newspaper and periodicals library of Abc.es. This way, the different versions of the word “suicide” as well as “suicide victim”, “suiciding”, “suicidió” and “suicided” were also included. The search was done both in the Abc of Madrid as well as Abc Seville in the period ranged between January 1st and December 31 of the three years mentioned, excluding supplements and other Abc editions.
The inclusion criteria of journalistic contents were that the text talked about a suicide, several suicides, a specific suicide attempt or attempts happening up to a year prior the news publication. Articles excluded were those using the search term as a literary resource or metaphoric style (“a suicide police”), referred to the suicide of non-human animals, anniversary of events, columns, open tribunes, letter to the director, synopsis of television programs and artistic works about suicide. The cases of assisted suicide or euthanasia, suicide bombings, the news were the suicide was secondary, texts talking about suicide rates nor cultural pieces regarding suicide. If the suicide was a hypothesis and not a confirmed fact the article was discarded as well. We also discarded those duplicated contents in both editions of Abc analyzed and that were published in several days. In that case we chose the most elaborated news and with greater information about the event.
2.3. Analyzed variables
A content analysis of texts meeting inclusion criteria was done to confirm whether they met the seven recommendations of the WHO (2000) to inform about a specific suicide described as follows:
These seven points will be named in our study as 1) references to mental problems, 2) avoid descriptions of the method used and notes, 3) not presented as unexplainable or simplistic, 4) not described as method to face problems, 5) the impact over families is mentioned, 6) not to glorify victims as martyrs and 7) description of the physical consequences of suicide attempts respectively. These are qualitative variables: The first six have two possible values: complied or not complied with and the seventh one has three: complied with, not complied with and not applicable.
The frequency and proportion of the recommendations met every year were analyzed with the program ‘Statgraphics’ version ‘Centurion XVI’. The Pearson’s chi-squared test was used to compare the differences in the proportions of recommendations met and the sum of all recommendations in every period of time. If the p-value was inferior to 0.05 for a significance level of 0.95 the null hypothesis was rejected and the statistically significant variation accepted.
The search provided 5216 results. The results of this search increased in 57% between 1995 and 2000, from 1179 to 1852, and almost doubled between 1995 and 2005, with a total of 2185 results founds. The number of relevant articles, that is, that met the inclusion criteria, was 90. The number of relevant articles reduced in 51% between 1995 and 2000 and increased a 14% between 2000 and 2005, reducing to almost half between 1995 and 2005, from 43 to 25.
Table 1. Articles about suicides per year with the Pearson’s χ² test to confirm whether there is variable dependency.
The frequency and proportion of the compliance of every recommendation of WHO is shown in the three years chosen (Table 1). There was a significant increase in the proportion of articles that complied with the recommendations ‘avoid descriptions of the method used and notes’ (χ2 = 7.097; d.f. = 2; p = 0.029), ‘not presented as unexplainable or simplistic’(χ2 = 16.352; d.f. = 2; p < 0.001) and ‘not described as method to face problems’ (χ2 = 19.756; d.f. = 2; p < 0.001), as well as the total of recommendations met every year (χ2 = 10.282; d.f. = 2; p = 0.006). However, there wasn’t any statistically significant change in the proportion of articles that met the recommendations of references to mental problems (χ2 = 3.470; d.f. = 2; p = 0.176) and there is no glorification of victims as martyrs (χ2 = 4.715; d.f. = 2; p = 0.095). On the other hand, the proportion of articles that met the recommendation ‘the impact on families is mentioned’, has a significative reduction (χ2 = 7.027; d.f. = 2; p = 0.030).
Table 2. Articles about suicide attempts per year with the Pearson χ² test to confirm whether there is variable dependency.
Regarding suicide attempts, we analyzed a total of 23 cases (Table 2). From these, in 12 articles there were no physical consequences of suicide attempts or did not apply the recommendation ‘description of physical consequences of suicide attempts’ and therefore, they were not counted. We haven’t found any significative dependency between the variables considering the proportion of articles that met the recommendation (χ2 = 3.429; d.f. = 3; p = 0.175).
Table 3. Articles that comply with each one of advises. %c: Compliance Percentage of every recommendation compared to the total of news. %r: Compliance percentage of every recommendation compared to the total of recommendations.
The table 3 gathers the frequency of the recommendations compliance in the three years and the compliance percentages of each one of them and the recommendations percentages met considering the total
Table 4. Other descriptive variables of articles analyzed.
Table 4 includes other variables such as frequency and percentages of accomplished suicides, suicide attempts, individual suicides, double suicides, suicides of several people, suicides of other countries and suicides in undetermined places in the three years analyzed and in the total of news analyzed.
4. Discussion and conclusion
This study shows a certain increase in the compliance percentage of some of WHO recommendations regarding the journalistic coverage of suicide. We observed an increase regarding ‘avoid descriptions of the method used and notes’, ‘not to present as unexplainable or simplistic’ and ‘not to be described as a method to face problems’. We didn’t find significant changes in the percentage of references to mental problems nor the glorification of victims as martyrs. On the other hand, the recommendation compliance of mentioning the impact on families was reduced in the analyzed period. The recommendation of describing the physical consequences of suicide attempts has not improved its compliance percentage in the period 1995-2005 although we must indicate that only 11 news have suicide attempts, therefore we cannot get solid conclusions about its evolution. The global analysis of the seven recommendations shows an improvement in the informative treatment of suicide of Abc between 1995 and 2005. Despite thereof, Abc non-complied the recommendations set forth by WHO in most of publications about suicides repeatedly in the years analyzed.
Out of the seven recommendations for media by WHO, Abc complied with the recommendation of ‘not glorifying suicide victims in 92% of contents. Regarding mentioning the ‘impact on families’ it was the recommendation complied with by the lower percentage of news (11.1%). Considering that often news about suicides were short, it was expectable that advises such as the non-glorification of victims were complied with and others such as mentioning the psychological impact on families didn’t. The method used to commit suicide is usually considered worthy of being mentioned in the information, therefore, this advice was usually non-complied with.
Comparing these data with the data obtained in the study of Herrera et al., 2013 that analyzed the news related with the suicide appearing in the digital edition of five Spanish newspapers, including Abc on September and October 2012, we can partially compare the results of both studies. Considering that Herrera et al., 2013 does not disaggregate results by newspaper, it is not possible to compare directly their results with the results of our work. However, and considering that Abc contributed with 21% of the news we proceeded to compare data of 2012 with the period 1995-2005 to observe how trends indicated in this study could have continued but without aiming to get final conclusions due to the limitation mentioned.
The percentage of news that refer to the method (65.7%) is less than in Abc in 1995-2005 (88.9%). This bad informative practice has reduced in Abc since the publication of the document targeted to communication professionals, in agreement with the conclusion of this work. On the contrary, the percentage of news that position protagonist as hero is very similar in 2012 (7.4%) and 1995-2005 (7.8%), confirming the conclusion that this variable was not influenced by WHO recommendations. Although the percentage of news that do not refer to the backgrounds on victims’ mental health in 2012 is superior (92.6%) to the 1995-2005 (84.4), it coincides with the data of 2005 (92%). When observing a great variance in the three years analyzed in this work, we can sustain that the percentage of news mentioning mental health backgrounds keeps constant, just as presented in this study’s hypothesis.
We do appreciate a discrepancy between the hypothesis that the percentage of news telling about family suffering reduced after the publication of the WHO document. In 2012, the percentage was 81.8% and in 1995-2005 it was 93.3%. Due to this difference and because we did not find a reason why the introduction of a guideline improved the compliance of some recommendation but reduce done, we admit the hypothesis that there is no trend in ‘the impact on families is mentioned’. The correlation observed could be spurious, because the difference is not very significative and the p-value (p = 0.03) is near the region of hypothesis rejection.
The premiere in Spain in 2000 of the film Vírgenes suicidas, with its repeated appearance in every newspaper during several weeks in the Billboard section could partially explain the increase of results with the term “suicid*” despise the reduction of news talking about specific suicides. Likewise, in 2005 the texts about suicide attempts, especially in Iraq, were quite abundant and articles dedicated to 11-M that included reference to bombing terrorists in Leganes, called by the press as suicides, could have inflated the number of results obtained.
We must highlight that despite the increase of suicides in Spain, of 3.157 in 1995 to 3.399 in 2005 (INE, 2016), the number of news about suicides in the country reduced in that period. This could be die to a greater coincidence of the Werther effect and a greater caution to avoid contagion. Besides, both the style guide of El País as well as El Mundo include references to how suicide must be treated. In the case of El País, the non-free newspaper of general information with more readers daily (AIMC, 2017), it is worth mentioning that the regulation of mandatory compliance in its texts includes information about suicides on section 1 of principle 1, positioning on the first ‘useful’ page of the style guide. Due to its interest, we reproduce it completely:
El Mundo, the second newspaper of general information with more daily readers (AIMC, 2016), reserves the final part of the style guide to set forth how to inform about suicide:
Both newspapers coincide in the caution while treating suicides due to the Werther effect but omit the benefit of Papageno effect they might have if these events were treated with rigorous journalistic criteria. The style guide of Abc, the newspaper analyzed in this study, does not include guidelines to inform about suicides both in their first edition (Vigara & Editing council of Abc, 1993) as well as its second (Vigara & Editing council of Abc, 2001).
The debate about the mediatic treatment of suicides should not relate about the dilemma of informing or not for fear of the Werther effect but instead about how we can inform of those suicides that can become potential news so to try to generate a Papageno effect or at least avoid the Werther effect. To avoid informing about suicides shouldn’t be as relevant as the increase in the informative quality of suicides that are published on media. The objective of an adequate informative treatment, besides reducing suicidal attitudes, must be to increase the search of assistance by vulnerable individuals and the reduction of stigma (Niederkrotenthaler, Reidenberg, Till and Gould, 2014). A greater presence of suicide on media could help reduce the suffering of victim’s families and friends when reducing stigma about suicide (Batterham, Calear and Christensen, 2013). Further researches should analyze how media can reduce the suicide stigma without glorifying it and help that vulnerable individuals look for help.
Media professionals must be aware of WHO recommendations as well as other entities’ about how to and how not to inform about suicides. As we published before, communication influences noticeably on populations health either in a positive or negative manner (Catalán-Matamoros, Muñoz-Cruzado and Fuentes-Hervías, 2010; Catalán-Matamoros, 2015). The examples of Switzerland and Wien show that it is not only a matter of journalistic ethics but also reduces suicide attempts. Medical organizations and healthcare authorities can also play an informative role by directly informing journalistic professionals through talks or leaflets.
Media responsibles must include, like Abc’s case, in their style guide advices of the WHO’s SUPRE program. Those media (El País and El Mundo, for instance) who have advices in their style guides that do not comply with the scientific consensus and that have not updated the section that refers to suicide since the release of the WHO guideline in 2000 should update their style guides. References about the Papageno effect must be included as well as the relevant role on media to prevent suicide. Besides, the mere inclusion of recommendations in style guides is not enough since professionals must know and apply WHO’s recommendations as much as possible. Performing interviews to media professionals to know the employee’s awareness levels about WHO guidelines would be desirable. Besides sounding out the sector, this research could help that more communication professionals know the recommendations to be complied with for treating suicide mediatically, which could cause, by itself, an increase in the journalistic information about suicide.
Although this study presents innovative data, it has considerable limitations. The reliability of this study is very limited because the sample universe (n=90) is rather scarce. The fact that only three years are analyzed to look for a trend reduces the significance of trends found due to the variability of news. Studies analyzing a longer time period are desirable. However, to guarantee the validity of this study we adapted the methodology used in similar previous studies such as Goulden’s et al., 2011 and Herrera’s et al., 2015.
The variability of the informative coverage among the different newspapers makes it mandatory to choose a greater sample of newspapers before extrapolating these conclusions to the rest of publications. To avoid ideological and geographically biases, the sample must be representative of the editorial line and the geographical area of the Spanish press. We cannot conclude anything about other media without new researches analyze the evolution of the informative treatment in radio, journals and television. The decision of exclusively analyzing those news informing about specific suicides neglects other informative texts that can contribute to reducing suicide behavior. Likewise, non-informative texts, such as opinion, that have not been included in this work, should be analyzed.
Another limitation of this study is the length of texts in the sample. The great variability of news, that include from brief double pages’ reports, could affect the compliance percentage of WHO’s advice. Longer texts could facilitate that some recommendations such as not informing about the method used could be contravened but also family suffering or suicide’s mental health should be mentioned. Future studies about the relationship between the length of a text and the compliance of WHO guidelines are necessary. A qualitative analysis of media, when turning complex messages in a series of subjective generic categories, is another great limitation of the present study. Lastly, it is not possible to conclude a causality relationship between the publication of WHO guidelines and the variation of some of the news features about suicides. Many other factors could have influenced in producing this change.
Despite everything we have said, the comparison of the conclusions of this study with another similar one (Herrera et al., 2015) contributes to validate results. More longitudinal studies that analyze the variation in the informative coverage of suicide and its causes are necessary. Our study did not aim to perform an extensive approach of the problematic about communication of suicides, but instead the objective was to conduct a pilot study by analyzing the level of compliance of WHO’s recommendations by a national newspaper. Public communication about suicide is a very complex and critical field in current society, therefore we encourage other authors to investigate in this area to be able to clarify their different components and influences.
And as conclusion, our study manifests there is a certain improvement in the informative treatment of suicide in newspaper Abc between 1995 and 2005. There is a trend since 1995 in Abc to reduce the number of news of specific suicides that include descriptions of the method used and the publication of suicide notes, that present the suicide as something unexplainable or caused by a single factor and that describe it, to a greater extent as method to face problems. On the other hand, there are no changes in the percentage of news that refer to mental health problems of suicide victims, which mention the impact of a suicide in friends and family, and neither there is enough data to get conclusions about the evolution of the description of physical consequences of suicide attempts. Most news talk about accomplished individual suicides in other countries. Further research is needed to evaluate the quality of the treatment of suicides on media.
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ANNEX. LISTS OF NEWS ANALYZED
(*) Note: In bold, the Seville edition of Abc. The rest corresponds to Madrid’s edition.
How to cite this article in bibliographies / References
F Garrido-Fabián, A Eleazar Serrano-López, D Catalán-Matamoros (2018): “The journalists’ use of WHO recommendations for the prevention of suicide. The case of the newspaper Abc”. Revista Latina de Comunicación Social, 73, pp. 810 to 827.
Article received on 19 January 2018. Accepted on 21 April.