Monday, 27 March 2006

Is it really ''stress'' what causes the main problem among Swedish students?

The fact is that women and men (particularly women) with higher education and social status are significantly more prone to declare that it is stress and psychogenic reasons those behind their problem in their working places.

And the fact is that copy-cut blaming of "stress" is not new among Swedish students. Actually, comparing old reports(2000) with new ones (2006) the "problem" has notably diminished. (The photo is from Aftonbladet 26/2, 2000)

These are my theses in this presentation:
  1. It is true that sectors among the Swedish students do experience stressful situations in association with their economy, quality and expectancy of their studies and career. The situation is however not representative of Swedish students as a whole.
  2. Rather than "stress", the contributing causes for such discomfort are rooted, apart the economic factor, in concrete practical problems associated with learning, alienation of contents and goals in the Swedish higher education, and existential problems of the kind affecting the Swedish population as a whole.
  3. At the contrary of what the politically correct assumption indicates, it is highly dangerous for the students - and the society as a whole - to wrongly identify at "mental or affective levels" the source of the problems experienced. The risk in "psychologizing" a problem which is in the root political and in its solution resort of the student movement it self (even if nowadays practically none existing in Sweden), can lead to further "poor health" by simply affirming the status quo of the causes, and by not discussing upon the real issues and contribute to their solution.
  4. Instead of playing a victimized role of passive societal actors, students should go out and fight for their right - and duty - to transform the society they criticize. They would very well start by transforming the anachronistic and antidemocratic structures at their universities, and which are partly accounted for the problem they say to suffer of.
  5. Further, based in epidemiologic methodological aspects, is safe to say that the publicized figures of university students declaring to experience stress would be much lesser than the reported.
  6. Declaring the experience of stress by answering questionnaires presenting options in form of fixed statements, is not a scientific evidence of the clinical existence of a disease-related negative stress.
  7. The actual socio-economic background of the Swedish students as a whole - particularly in an international context or comparison - highly discusses the general statement of a strict correlation between poor Swedish students and stress and poor health.
  8. The number of sick-leaves (sjukskrivningar) that can be administratively shown among the students, even if increasing, is a very, very poor proof of the existence of a high level of poor health among the students. In Sweden, the majority of sick-leaves are not decided by doctors on the base of clinical symptoms, but on the base of "patients" wishes for such a sick-leave.
  9. University students do not experience significantly more stress than the general population. University students do report more levels of stress and psychological items than the general population.
  10. University students are in this regard equalized with the social group in its majority they belong, both by education level and socioeconomic status.
  11. The facts are instead - as seen in the graphic bellow - that in Sweden there is a correlation between educational level and levels of reported stress and psychological strain.
The newspaper Expressen ran recently an article referring to a supposed growing stress among Swedish university students. This stress, according the paper, would be that aggravating or detrimental, that it is actually “decimating” the students.

Much of the article refers to the Student Union own study “Stoppa pressarna”, an investigation conducted on the mental devised to characterize the health status among the Swedish students. The study have concluded that mental health problems deteriorates increasingly, being reason for a serious concern.

I have examined this study and found that in its turn it is much based in another investigation, the TRIA-Rapport, conducted by the company REWIND, under assignment of the employees and students unions HTF, SKTF and ST.

As typical in this sort of assignments, the main question in the Tria report was not to find out whether the student experiences stress or not, but “up to which level they experience stress” (“I vilken utsträckning känner du dig stressad?”).

No wonder that their results were “that stress is a very common problem among the students”, and 52% agree with the formulation (Rewind’s formulation) that to a great or very much extent they feel them selves stressed”. Also predictably, the vast majority (61 %) of the respondents were women.

Please do note in this context that the main issue in the debate in which this population study is used, is the "increasing poor health, particularly mental health, among the Swedish university students".

So, publicly manifesting the "problem" of high levels of stress is a means of implying the students' poor health. But what is not tell explicitly is what is really what we are measuring in those studies when we refer to stress, and how established and reliable the findings can be from a clinical or an epidemiological standpoint.

First, trying to identify pathological or negative stress, we have that the questions in these sort of studies (now I refer to one study SFS in its turn praise in their cited document) are such confounding and unprofessional. For instance, they embed the item "stress", together with "worries" (oro) and feelings of "sort of anxiety" (which is not the same than proper anxiety).

Meaning the one who in a given moment has felt "oro" (and who does not that naturally from time to time) is categorized as having stress. And not only "stress". The interpretation goes for it is a "negative" stress, unhealthy stress, etc. All which in its turn would explain the need for, or the current existence of, a widespread sick leaves among the students.

So, to have "the feeling", or having the "idea" of being ill due to stress, can be sufficient according the Swedish general interpretation, for granting a sick leave to the stressed students?

As a professor in public health sciences, especially Epidemiology, I have to frankly state that the results of the Tria investigation doubtfully meet the scientific standard for reliable conclusions on the main aspects investigated. Why?

Apart of the above, the main flaw being the remarkable low response rate (33%) they achieved in their investigation, all which means the investigation had a dropout of 67 per cent! In effect, they have asked 4 500 students and they got only responses from 1 303.

As it can viewed in the diagram on the box (from an article I published in the Journal of the Swedish Medical Association, Läkartidningen), the accepted dropout for such studies (to be eligible for review or publication) in scientific journals is only five per cent (see the all article here). I will develop later a comment on the Tria-rapport in reference to socio-economic indicators characterizing the university students' situation.

Even worst, was the account of the results (contained in the above investiagtion) made by the study Stoppa pressarna (SFS). Here the authors did not even bothered to mention that the dropout responses in the Tria-Rapport conducted by Rewind were as high as 67 per cent, knowing that the hidding of this methodological fact absolutely alters a true interpretation of the results. The only thing mentioned was:

”Studenters stress” som utförts av företaget Rewind, på uppdrag av det fackliga samarbetet Tria.7 Undersökningen har besvarats av 1503 studenter. Undersökningen visar att stress är ett vanligt problem bland studenter. Mer än hälften, 53 procent, instämmer i stor eller mycket stor utsträckning med att de känner sig stressade. I undersökningen har man dessutom försökt identifiera en grupp med särskilt stora, stressrelaterade problem."

The report Stoppa pressarna - 17 punkter för att minska den psykiska ohälsan bland studenter is signed by Maria Noleryd and Pär Wiktorsson.

Why is this ecuation responses-rate versus dropout-rate so determinant?

In searching for answers "about stress among university students", those who are certainly more engaged and eager to participate in such studies are those who either experience that "stress" or have been told that the problem they confront in their existence as students is "stress" and "burn-out" (utbrändhet) and not other problems. In this fashion, the results of the population study will NOT reflect - with minimal acceptable level of certainty- the situation of the Swedish university students as a whole, but of those who felt them selves "called" for participating in the study.

And this is why the scientific journal Evidence-Based Medicine (1995) has pointed out a minimum of 80 per cent responses-rate, and 80 per cent in follow-up rates in post-tests, for a study can qualify for reviewing and eventually publication in such scientific journal. (see Bowling A., Research methods in health.Philadelphia: Open University Press; 1999:163.). This is the methological principle that, to the best of my knowledge, is applied by every serious scientist (a few of them is not) at the Karolinska Institutet.

Nevertheless, talking about students' stress, one first question is to asses whether the 310 000 students organized by SFS are much different from the rest of the Swedish population, in terms of their vulnerability for “stress” and “burn-out”.

In this respect we have the fact that students, due to their both social and intellectual position, are as equipped, as any well educated people, to better understand psychological concepts such us stress and burn-out, and to express verbally accordingly those notions.

The fact is that women and men (particularly women) with higher education and social status are significantly more prone to declare that it is stress and psychogenic reasons those behing their problem in their working places.

The above is the result of an investigation we conducted at the Karolinska Institute (Ferrada-Noli, Svanström) and which has been reported in an international conference in Hongkong.

The diagrams are part of our presentation and should not be reproduced without permission. See abstract here: :(

A second question is to clarify whether all student-branches (careers, programmes, etc) share such common situation as to refer to the Swedish university students as a whole. In this respect appears that only certain programmes, such the Law-studies programme, poses higher levels of psychological demands on the students. This is not related to the studies their selves, but to the hard requirements of highest marks in order to qualify for further positions in the juridical system of Sweden.

A third relevant question is whether this is a new situation among the students, as it is implied. Or even, as clearly manifested, if it is a situation that worsens more and more.

The problem is not new and the blaming of stress by the students started just coincidentally with the appealing to stress/utbrändhet which "stress researchers" made fashionable in näive Sweden in the begining of the 2000's. (see here my debate article in Dagens Nyheter) . In the article run by Aftonbladet 26/2 - 2000 about stress and health problems among the students it reads:

"De vanligaste psykiska besvären är stress, ångest och sömnsvårigheter. . ."

According to the Aftonbladet article six years ago, 86 per cent among the students asked by the newspaper Campus declared that their studies had a negative impact in their health.

("När universitetstidningen Campus bad studenterna berätta om sin hälsa uppgav 86 procent av de 362 som svarat att studierna påverkar dem negativt.")

Now, in 2006, the studies mentioned introductorily talks of 53 per cent of stress (Rewing study) among the students. The "stoppa pressarna" report mentions a wide range of less stress among students of different programmes. From the Humanities-faculties 8 %, from the Art programmes 39 %. Only the Law students show no change in comparison with the figures in Campus 2000.

Of course that none of the above studies emphasize that in fact it is about reports by the students of feelings of being stress, which is a totally other concept than the clinical established pathological, damaging negative stress. Not to mention the miserable figures on their responses-rate

As I concluded in a critical analysis - published in Läkartidningen - on the methodological blunders of another "utbrändhet" study authored by Arbetslivsinstitutet's Lennart Hallsten (also helping the authors of Stoppa pressarna):

"Skulle det inte vara enklare, om regeringen upplöste folket och valde ett nytt?" reflekterade Brecht.

Men det som regeringar inte fåråstadkomma kan till synes populationsstudier göra.

Genom ett stortbortfall kan befolkningens representativitet förvandlas till ett tacksamt,snävt, empiriskt urval.

Genom att omdefiniera begrepp i studiensundersökta variabler blir egenskaperna hos populationen söktaistället för undersökta – och påträffade i konsonans med studiehypotesen.

En sådan underbyggnad skulle förvandla en hypotes från illusiontill gloria, med risk att hypotesen slutligen hamnar i läget null"

To be continued

Sunday, 26 March 2006

Piel Morena. Swedish Eyes

The documentary film "Piel morena Swedish eyes" directed by Rodrigo Ferrada-Noli Stoehrel (shown today anew at the Swedish Television Channel 1) it touches upon new and different perspectives on the acculturation related phenomenon of immigrant identity.

(Photos: Utbildningsradio)

Let me first declare that I have as policy not to comment publicly my sons' and daughter’s writings or cultural production published or shown in the Swedish media, however interesting they are, as I do regard them all. Rodrigo's recent documentary, nevertheless, touch upon some cross-cultural phenomena in the line of themes discussed previously here in this blog. Following, my comments on the documentary "Piel Morena - Swedish eyes" (for sending schedule of the documentary at SVT 1, here).

Three Swedish-Chilean young fellows, born in Sweden of Chilean parents - or born in Chile but grown up in Sweden since early childhood - manifest their views on prevalent cultural values and their experiences of being regarded differently, both in Sweden and in Chile. One of the main points being that they are – naturally, because so they have factually resulted by means of acculturation processes in Sweden – different to their Chilean counterparts living in Chile. The interviewed young Chileans-Swedes (or Swedes-Chileans) really impress with their psychological well being, clarity, harmony and integrity. All of them ostensibly proud of their Chilean origin or background. The director of the documentary film is himself Swedish-born and with a family background with mixed roots in Chile, Italy, Germany, and Luxemburg.

Sofia says that she thinks as a Swede, even when she is in Chile ("I have a Swedish skeleton and mind"). It became also evident in the underlying psychology disclosed by the interview, that having a Swedish analysis perspective, values, and even point of views, does not bother (perhaps a little bid the contrary) the young immigrants.

Most interesting here is that not only Swedish viewpoints are those becoming prevalent inside the piel-morena young-immigrant’s mind, but also the overall psychological “national-attitude”. For example, Sofia declares that she feels sort of guilt. This feeeling may be understood as arising even - or particularly- in front of her Chilean counterparts. Among other because, as Sofía declares, she had got so much in Sweden, such as a fantastic school, "språk", etc.

In a closer analysis,the Swedish-born Sofia may apparently feel so because this twofold reason:

a) She does not regard herself totally as a Swede, and "why would I have had so much, considering that my family is not originally from Sweden?" "Am I entitled to a full-Swede treatment"? one could read behind her lips.

The above even in spite that she describes her exile situation as result of a forced migration, and of a political kind. Being her father a former political prisoner and tortured under months during the USA supported military dictatorship in Chile.

In this regard, I believe, she has fallen victim of the hyper nationalistic trap, the old discourse that only old Swedish ancestry would qualify for such national identity-share. It is outmost dramatic to observe how a central human right (based in jus solis) is in Sweden deleted among our younger generation. For they have absolutely equal cultural rights - not only juridical - in reference to any other Swedish-born in Swedish soil.

b) She lives with the natural and honest impression on that her Swedish way of living, thinking, etc. may be better than the Chileans in Chile, or to a great extent the result of what Sweden ("so much") gives to their youth.

But, it this not a bid of European supremacist view? Of course it is not the case of blaming Sofia and the young immigrants for this stand. It is, as I postulated above, pure and crystalline acculturation. One of the essentials, one could say, for an integrated society. Nevertheless, why Swedes would feel guilt in front of "they"? Why would we understand as less desirable the growing up under Latin-American cultural parameters, even if socio-economic indicators would appear (for us in Northern Europe) as not that "developed"? What about the quality of life?

The wide-spread national conviction that that Sweden is "best" seems to get deep into the piel morena of their young immigrants and reaching their brain and hearts.

Irene. Another main point elicited in the documentary is the view of young immigrants regarding how are they characterized by the Swedish society. The interview with Irene San Martin, a Chilean immigrant girl living in Malmö is clear and breath-taking. She asks why the Swedes keep on calling her "second-generation immigrant". What their children would be called, is a general wondering arisen in the documentary. Will they be called "third generation" and then "fourth generation immigrants", and so on and so for?

Just how many years paying taxes in Sweden would be requested from the integrated immigrants of the suburbs, how much sweat and health has to be tributed from the immigrant women, how much hard-work contribution from the part of immigrant workers to the Swedish well-being and welfare would ever suffy, for their children, and the children of their children, to be regarded as SWEDES?

(In the photos, left: Laura Albanesi and Rodrigo Ferrada-Noli Stoehrel, Right; Esther Latorre)

The interviewed Rodrigo Avellán takes up yet another very interesting aspect.

He tells how his Chilean colleagues actually listen - and are ready to wide their horizon - when he comes with "Swedish solutions" for local problems the Chileans in his branch may encounter. What is the outmost interesting here is not what it is manifestly said in this regard in the documentary, but what surely it comes as immediately reflection by the viewer. Namely, that the Swedes hardly listen at the immigrants at their workshops and jobsites, even knowing that many of these have a well reputed professional background, etc. In fact, many Swedish institutions - structurally - neglect the immigrant manpower and their potential knowledge and aid.

Making us to think further

In sum, a positive, critical, and very interesting documentary, which has the main merit of invite for analysis and reflection on how Swedes and their immigrants can find yet a better path for enrichment of all cultures, here and abroad. In other words, as documentary films should be.

One more thing, viewing perspectives on the so called integration:

When acculturation ends and alienation begins?

Thursday, 16 March 2006

The contribution of ethnic discrimination to suicide.

For individuals already at risk for suicidal behaviour, discrimination added to social frustration may produce devastating effects.

I was asked today by a journalist student from Denmark for a statement concerning possible associations between discrimination and the increasing of suicidal attempts in Denmark among asylum-applicants. Quoting sources of the Danish Red Cross, he referred that such suicide attempts in Denmark "have increased from 1.8 pct in 2004 to 3.0 pct in 2005."
My painting One-way ride, 2004. Oil on canvas 70 x 80 . Click to enlarge

I have previously stated (in a SIDA conference at Stockholm University) that the hazards of negative or forced acculturation, problems in adaptation and uncertain existential conditions in the host country, and paramount, the psychiatric effects of posttraumatic statuses, make the individual vulnerable for the elicit of PTSD comorbidity (depression) or the enhancing of the eventually existing depressive states or traits.

Particularly sensitive with regard to suicidal behaviour are ideations of guilt arisen in exile (“I survived, others died”, etc) and in general the debut or worsening of the PTSD depressive symptoms or onset of depressive disorders as secondary diagnoses to PTSD.

But, what would be the contribution of ethnic discrimination to suicide?

Thinking in today's main debate article in Dagens Nyheter authored by a professor colleague (Jerzy Sarnecki), and in which I believe he had two main points:

a) He empirically confirmed that immigrants are sentenced to harder penalties than Swedes do, for the same crimes. Clearly, being this discrimination.

b) Discrimination, which leads to utanförskap, may lead through this towards criminal behaviour.

This is my reflection:

I wonder if the same dynamics may apply to suicidal behaviour. Discrimination reinforces psychological isolation, alienation, and the sense of unfulfilled life through the deprivation of social means necessary to accomplish social integration.

For individuals already at risk for suicidal behaviour, discrimination added to social frustration may produce devastating effects.
  • On the scale describing levels of acceptance of a society towards their immigrants, we use to say that at one end we find total integration, and at the other end we find total isolation. But the true is that the opposite of integration is in fact implosion.
  • Implosion, as in demolition, is the negation of integration and cohesion.
  • The ultimate probe or confirmation of a total lack of integration would be suicide.

The political question being, who is responsible for such discrimination.

The abstract of my presentation (at the Sida Conference) "Why do PTSD comorbidity and the suicidal behaviour of refugees and torture victims increase in exile? A social psychiatric hypothesis". here

Full text of my article in Läkartidningen (Journal of the Swedish Medical Association) "Traumatic stress and suicidal behaviour among refugees" (Traumatisk stress och flyktingars suicidbeteende ­ epidemiologiska fynd) here

To be continued

Wednesday, 15 March 2006

A mourning sea. Just a human tragedy. . .

What other name would you give to this painting?

Click on the picture for a larger view

I have shown this piece to the public only once, at my art exhibition organized by the Chilean Embassy in Stockholm. I have now, just a few days ago, been asked by Dr Liz Herbert McAvoy - on behalf of the organizers of an international conference to be held at the University of Wales, Swansea - for this painting's rights and with the purpose of using the painting as the pictorial motive for the poster, conference programme, etc.

Well, I would be honoured. That is one thing.

Nevertheless, reflecting on the possible risks and consequences commented in the blog next below, I wonder whether this painting may help to stress my point also there. You are welcome to read it, state your opinion (address: and suggest a name for the painting.

Friday, 10 March 2006

Dagens Nyheter's “suicide advertisement” made in disregard of potential increasing of fatalities.

Besides, flirting with such risks - for the sake of commercial advertising- might become a risk in it self. Negative reactions of ethics-minded advertisers and readers may probe to exceed expected profits for sexig advertising.

So, Dagens Nyheter responsible editors have decided to republish the criticized poster wich may be interpreted as containing - according to several I have interviewed - a hidden appeal for suicidal behaviour [see the blog next below or here]. This is made after a communication that DN has received, warning on further possible risks of an increasing of suicidal behaviour due to the republication of such ad.

The publication anew of the ad was made as illustration of an article by Lilian Öhrström, published in both the printed and web editions of the newspaper, on March the 1oth (see picture above). The particular is that Lilian Öhström, DN's own läsarombudsmannen, is also critical towards the publication of the ad.

According to DN läsarombudsmannen, the criticism to this publication that had arise among DN readers, apparently it focused on the "unpleasant associations" the advertisement evokes.

There are however other reasons, far more gravitating, which have been argued against the publication of such ad:

Dagens Nyheter does not mention in that context the serious warning they have received - based on internationally published scientific suicide research - on the eventual risk for increasing fatalities related to that ad publication. That appeal was expressly delivered by me to the DN editors on March the 8th (see box further down).

My contention is that there is a risk that such suicide-related imagery (like the full page ad - depicting a tie as if were a hanging rope) when published by main media, such as in this case the most important Swedish newspaper, may act as a trigger for underlying suicidal behaviour among indivuduals already at risk.

Well, on the other hand, someone can argue, among all the national groups in Sweden, those exhibiting significantly higher suicide incidences are not the Swedes, but the foreign-born immigrants.

This fact should be know by Dagens Nyheter since they have previously published a full-page article in DN Debate - authored by myself - focusing in the phenomenon of such overrepresentation of immigrants in the Swedish suicide statistics.

Further, it is also known that foreign-born immigrants are overrepresented in the statistics for unemployment or labour mobility and expectancy. It is of outmost relevance to have the above in mind when analysing the publicly declaration made yesterday by Jan Wifstrand, DN’s chief editor in which he said, defending the publication of the ad: “The advertisement shall be interpreted bildligt (picture-wise). If one uses the expressions that it feels as a rope around the neck it does not mean that some one shall commit suicide. An advertisement shall call for attention and reflection”, said Jan Wifstrand (DN 10/3/06) "

- Annonsen ska förstås tolkas bildligt. Om man använder uttrycket att det känns som en snara runt halsen betyder det inte att man ska begå självmord. En annons ska väcka uppmärksamhet och funderingar, säger chefredaktör Jan Wifstrand."(DN 10/3/06)

So, what is specifically the attention/reflection DN wants to call for in the ad?

"When the morning you do not want to go to the job becomes the rule rather than the exception"

And, what are your options if your are unemployed, or stack in your depressive job, or with none chances of getting a new job or a job at all? In other words, if you most likely are a bloody immigrant?

According to DN's instructions on that "of course the advertisement shall be interpreted bildligt (picture-wise)" .

So, one option would be to rush and buy Thursday edition of DN, in order to catch with their expensive job-ads allocated in the paper.

But if you are an immigrant who have tried hundreds of times to get a new job, or a job at all, your possibilities of changing your situation are statistically very small.

Another option DN offers you in the ad (you are supossed to "interpret picture-wise") is to go and use the hanging tie in the fashion depicted in the add, as seen in the picture to the rigth.

Some of my students, by the way, even “saw” the half of a funeral coffin at the right of the picture’s background.

Playing with this pictorial symbols is a highly risky business wich attempts straight against suicide prevention. The amount of international research on this topic, on the direct impact media has in increasing suicidal behaviour, is huge:

Only during the last decade over 230 scientific articles have been published internationally on such relashionships between suicides and the media (indexed by Medline).

That is why I had written a letter to DN editors - which receipt they opted for not to acknowledge. And now, through their insistence in publishing the poster in spite of being fully aware of such warning on possible fatal risks, DN clearly gives the impression that they do not care of such possible consequences.

Here in the box a shorter version of my letter to DN editors

Dagens Nyheter can certainly exercise their right to ignore proven scientific knowledge whenever they wish, like in this case when that knowledge apparently goes against a rigid advertising policy. If not just a simple square case of Swedish-authoritarian "prestige" behaviour: Never publicly recognise being wrong.

But by doing this, DN shows not only lack of empathy towards an important cohort of human misery, but also an absurd ostrich standpoint.

Namely, ignoring a scientific research does not eliminate the scientific findings they refer to. Facts remain.

Monday, 6 March 2006

A question for suicide research

Click the picture to enlarge
Appealing herald of a hanging tie. A new case of the Werther effect?
- Not, we hope.

Would the white-collar suicide incidence for the period March - April 2006 increase in Sweden (in comparison to previous period-prevalence & trend)?

The picture at the left, which may suggest the impression of a tie as a "hanging rope", is a full-page sized advertisement in today’s edition of the main Swedish newspaper Dagens Nyheter. The published picture is in colours and the legend reads:

"When the morning you do not want to go to the job becomes the rule rather than the exception"

The newspaper is marketing their own supplement (to appear later in the week) on advertised job opportunities. But, with a raising unemployment rate and a high competitive labour market, what are the options suggested to the one who can not change job or has been unable to get a new job, or a job at all?

In fact, the scientific literature has since very many years informs from time to time on the risks of suicide-oriented clues by the media (even if not produced with that intent, as it surely is the case of Dagens Nyheter), or of information on suicidal behaviour related subjects in the media, done by "non-professional" people.
Some of the latest of these empirical based publications appeared in the journal Academic Psychiatry, in Social Science and Medicine, and in Archives of Suicide Research. Here below are the abstracts of the articles with the corresponding reference.

Acad Psychiatry. 2005 Nov-Dec;29(5):495-9.

The media and suicide.
By Sudak HS, Sudak DM. Department of Psychiatry, University of Pennsylvania School of Medicine, USA.
OBJECTIVE: The authors aim to inform readers of the theory that when newspapers, film, and television describe suicidal deaths, additional suicides may result by virtue of contagion or copy-cat effects; to review data that support and refute this theory; to present some promising and recommended ways to prevent copy-cat suicide; and to cite news-media examples of both particularly bad and good reporting. METHODS: A review of the literature on media-related suicide was conducted, which included reviewing materials published in scientific journals and data published by the U.S. Public Health Service, Centers for Disease Control, and materials from private, not-for-profit agencies. RESULTS: Data support an increased number of suicides resulting from media accounts of suicide that romanticize or dramatize the description of suicidal deaths. Specific guidelines for the media that may be able to decrease these additional deaths have been devised. CONCLUSION: Psychiatrists should be familiar with the harm that may result from improper reporting of suicide in the media since they may be called upon by reporters or family members following the suicide of one of their patients or following the suicide of a newsworthy person. Following the media guidelines available may prevent such contagion effects from occurring.

Soc Sci Med. 2005 Dec 29;

The relationship between media reporting of suicide and actual suicide in Australia.
By Pirkis JE, Burgess PM, Francis C, Blood RW, Jolley DJ. University of Melbourne, Melbourne, Victoria, Australia.
The dead of Socrates. David, Jacques-Louis (1748-1825)
This study aimed to determine whether media items about suicide were associated with differential increases in actual suicides. Data were available on 4635 suicide-related items appearing in Australian newspapers and on radio and television news and current affairs shows between March 2000 and February 2001. These data were combined with national data on completed suicides occurring during the same period, by a process that involved identifying the date and geographical reach of the media items and determining the number of suicides occurring in the same location in selected weeks pre- and post-item. Regression analyses were conducted to determine whether the likelihood of an increase in post-item suicides could be explained by particular item characteristics. We found that 39% of media items were followed by an increase in male suicides, and 31% by an increase in female suicides. Media items were more likely to be associated with increases in both male and female suicides if they occurred in the context of multiple other reports on suicide (versus occurring in isolation), if they were broadcast on television (versus other media), and if they were about completed suicide (versus attempted suicide or suicidal ideation). Different item content appeared to be influential for males and females, with an increase in male suicides being associated with items about an individual's experience of suicide and opinion pieces, and an increase in female suicides being associated with items about mass- or murder-suicide. Item prominence and quality were not differentially associated with increases in male or female suicides. Further research on this topic is required, but in the meantime there is a need to remain vigilant about how suicide news is reported. Mental health professionals and suicide experts should collaborate with media professionals to try to balance 'public interest' against the risk of harm.

Arch Suicide Res. 2004;8(2):137-45.

A dose-response relationship between imitational suicides and newspaper distribution.
By Etzersdorfer E, Voracek M, Sonneck G.
Although the Werther effect is well known, up to now a correlation between the differential distribution of particular media reports and subsequent imitational suicides could not be found. This study investigates a celebrity suicide by gun in Austria, which led to extensive reports in the largest Austrian newspaper, whose distribution shows substantial regional differences. The numbers of suicides by firearm in the 3 weeks after the reporting showed an increase over the 3 weeks prior. Regional analysis revealed a strong correlation of suicides by firearm and distribution of the newspaper (log odds ratios; r(9) = .62; p = .04, one-tailed). This dose-response effect explains 40% of the variability of changes. These results underline the influence of media reports on suicidal behavior.