Covering Suicide: New Science, New Guidelines
We know more about suicide than ever before, says epidemiologist Madelyn Gould. New recommendations tell journalists how to use that knowledge, and a classroom guide tells journalism educators how to teach it.
At the beginning of her career as public health researcher, Madelyn Gould learned of a cluster of suicides by teenagers in New York’s Westchester County. “As an epidemiologist,” she recalls, “I had been taught about clusters of leukemia, clusters of health issues near power lines, and research techniques to either debunk or prove these events to be related. I asked, ‘What’s a cluster of suicide about?’” Although the psychology of individual suicide had long fascinated psychiatrists and psychologists, she was interested in suicide contagion from a public health standpoint. "You know – let’s figure out the risk factors, the policy implications, community interventions.”
After a quarter-century of research, Gould is a leading authority on suicide prevention. A Professor of Clinical Epidemiology in Psychiatry at Columbia University’s College of Physicians and Surgeons, she is also a key advisor for new recommendations for journalists on reporting suicide, developed by an international consortium of researchers and health-policy organizations ranging from the Centers for Disease Control in the U.S. to universities in Austria and New Zealand. The recommendations – endorsed in the U.S. by the Associated Press Managing Editors and the National Press Photographers Association – begin with a simple declaration: “Suicide is a public health issue.”
I spoke with Gould in her office at Columbia in May 2011.
I got a call about two weeks ago from a student reporter at a student newspaper at a large midwestern university. There had been a suicide in the student body. She wanted to know three things: Should she and the newspaper cover this and say what happened? If so, which aspects of it should they cover and not cover? And how should she approach the family?
The first question I would have asked her is: How publicly known is the suicide?
I believe in this case the individual’s death had been reported in the off-campus news media as a suicide.
So that already changes the situation and my range of responses. In fact each of the questions gets you to a fork in the road, leading to very different choice points. The fact that the suicide was already reported elsewhere, and that people were already talking about it means you could consider it this student journalist’s responsibility to report it.
But I would hope it would be reported in a way that students could get something productive out of the story: to convey what resources are available for students feeling troubled and having a difficult time coping with their own feelings about this suicide; to use the story as a means to educate people concerning what we know about suicide risk, which is really considerable compared to what we knew 20 years ago.
I hope the reporting would emphasize that completed suicide is actually rare. You don’t want reporting that could lend itself to the belief system that “oh, if everybody is doing it… then it’s ok.“ There are choices even in irrational thinking; what you get fixated on can be shaped by the environment. You don’t want people to be fixated on the idea that suicide is the way to get out of their problems. So what I would say to that student journalist: Yes, report it but make sure that before you even contact any close family members or friends, talk to the folks at the local counseling center to see what specific suggestions they have with regard to resources, warning signs, things like that.
What about calling a family member?
Recognize that when you do talk to a surviving family member in the immediate aftermath of a suicide, they’re in shock. You may get a very distorted picture. We’ve learned that we get very different information, for instance, three months later, when we conduct what is called a psychological autopsy.
What have you learned from these “psychological autopsies”?
We have learned that it’s usually not one triggering event that is responsible for the suicide. We’ve learned that there definitely can be a single stressful event, or chronic source of stress, that can increase your vulnerability to suicide. But once you do a psychological autopsy, generally a complex series of events or circumstances will arise. You may find out that the person has been depressed or anxious to the point of having a disorder that wasn’t recognized. And then the person suffers a failure and they don’t know how to cope with it.
Or you have the “perfect” people who kill themselves. Such people are very perplexing to the media – the football star who for all intents and purposes seems to have no problems, for instance. You do a psychological autopsy months later and you find out about a substance problem or an underlying serious anxiety problem.
You seem to be hinting at a tension for reporters: On the one hand news coverage should make it clear that there is rarely one simple explanation for suicide; and on the other hand, your research has identified specific risk factors that news stories can tell people about. It’s important for the public to understand that alcohol abuse or bullying are associated with higher suicide risk, for instance.
There is a suicide-prevention policy tension as well. For instance: We found that bullying behavior is associated clearly with an increased risk of suicide attempts and suicidal behavior among teenagers. Do you develop a bullying prevention program that focuses on bullying alone? Or suicide prevention more broadly? Where do you put your money?
Research is constantly shaping these arguments. For instance, among researchers there is a new term: "attempt survivors” – meaning those who have already made non-fatal suicide attempts. There is a lot of new focus on that group, who used to be discharged by emergency departments with little follow up.
Because of new research in suicide prevention we are now focusing on stories of recovery after suicide attempts. This is one place journalists can help. There is a major stigma to admitting to even going for care. If someone were to confide that they had attempted suicide, most people would react in a negative way: “This person is unpredictable, unstable, scary. Can I hire that person? Would that person be reliable?” But we know now that there are people who have recovered, who have functioning lives.
You were talking earlier about the choices, the forks in the road. What do you know about those forks in the road? When an individual is contemplating suicide, what can they hear, what gets through?
It depends on what stage along the path to suicide they are – and what stage of life.
So here’s a kid in elementary school who might be at risk of conduct problems, by virtue of the family environment and so on. And you say well gee, what’s that got to do with suicide? But if you looked at his life-trajectory, those childhood conduct problems might mean substance abuse later on, or getting in trouble with the law – both associated, statistically, with higher risk of suicide. So a couple of decades ago, people from Johns Hopkins implemented a program in the first grade called the good behavior game. It was focused on inner city youth, and the goal was narrowly focused on conduct disorders. Recently the American Journal of Public Health published a study – a controlled trial – following those kids over years. It showed that those kids had a significantly lower rate of suicide attempts and a lower rate of suicide ideation.
Now let’s look at high school, especially 17-year-olds, 18-year-olds or early college-aged youths. They are already starting to get into the age of onset for schizophrenia, or the first time they may have their first depressive break. In high school and college there are lots of things you can do. You can screen kids for risk; you can encourage awareness of family history. You can convey messages that encourage people to get help, or which try to change the environment in a school to emphasize connectedness between young people and trusted adults.
How important a role does the media – not just journalism but media generally – play in suicide contagion and prevention?
Suicide modeling and contagion is real and important, but it is still a relatively minor piece of the suicide puzzle compared to an underlying psychiatric problem, or the triggers and stress events, such as trouble at school, trouble with the law, humiliation, bullying, so on.
At the same time we can’t ignore the role that news reports and other media play. In Vienna in the 1980s, jumping in front of subways was a prevalent form of suicide. In 1987 recommendations came out that media either stop reporting subway suicides or report them in a more responsible way. That brought a 75 percent drop in subway suicides. And that was mostly old media. Because the internet is so pervasive, it has more of a potential to shape people’s attitudes about suicide.
You’ve worked in this field for 30 years. Have your views of suicide and prevention changed?
I used to see suicide as a somewhat narrower issue. You know: Here are the risk factors, here are the vulnerabilities and that’s it. Now I think there are many more vulnerable people than I used to recognize, and I see life changes having an enormous impact. Sleep deprivation, trauma during war, economic problems, disruption of life. Or people in the helping professions: There are high rates of suicide among physicians, for instance. So self-care is a real issue.
Let’s talk about the new guidelines for journalists covering suicide, which you helped the American Suicide Prevention Foundation draft. What prompted these new guidelines? What are you hoping to accomplish?
What initially prompted these guidelines was the wave of new media. The last set date back to 2001. The Substance Abuse and Mental Health Services Administration convened a meeting on suicide and the media in 2009. The point was to get new-media folks in the room with suicide-prevention people, who with rare exception weren’t very fluent in new media technology. We wanted to know if there were ways to use new media for suicide-prevention purposes.
The thing that concerns me is the speed in which a story gets out in new media. Luckily, Facebook and other social networking sites have been very responsible in working with the National Suicide Prevention Lifeline and developing now protocols for dealing with posting of suicidal content.
On the flip side there are some studies now that are looking at help-seeking behavior via the Internet. It’s important to emphasize the silver lining in all this: We really hope to enhance the Internet’s capacity to be helpful as a connector to resources and support, not just a source of suicide contagion.
Can investigative reporters take suicide prevention beyond individual cases? What can reporters look at to determine if a school, a university or a town are following best practice for suicide prevention?
If a reporter wanted to do this and had the time, the first thing would be to start segmenting different populations within a community or region. Take school-age kids; health class is not enough. Does a school or school system at least have some program that focuses on the development of coping skills or wellness screening or peer leadership? Then look at the capacity of the community to reach out to others who are at higher risk such as people who drop out of school and people on the fringe, such as the elderly.
If I were a reporter the biggest question I would want to ask is: what is the continuity of care, in other words, the chain of care in the community. We’re better at identifying people who are at risk of suicide, but too often there is still a broken chain of care, or no chain of care at all. That is a real story.