The study reveals that the content of media reports is also important, with more prominent stories (ie, published on the front page) and those that describe the suicide in considerable detail more likely to be associated with so-called copycat suicides.
"Our findings indicate that the more sensational the coverage of the suicides, and the more details the story provides, then the more likely there are to be more suicides", explains lead author Dr Madelyn Gould from the New York State Psychiatric Institute in the USA.*
It is the first time that researchers have compared a national sample of adolescent suicide clusters with a matched control of non-cluster suicides. The case-control study identified 48 suicide clusters in young people aged between 13 and 20 years old from across the USA between 1988 and 1996. Each cluster included three to 11 victims who killed themselves within 6 months of the first suicide. All cluster communities were matched with two non-cluster control communities in which suicides of similarly aged young people occurred, from non-adjacent counties within the same state.
The researchers retrospectively examined 469 newspapers for stories about suicide published in the days between the first and second suicides in the cluster communities, and for the same length of time after the control suicide in non-cluster communities. The researchers found that significantly more newspaper stories about suicidal individuals were published after the first (index) cluster suicide (average 7.42 stories) than after a suicide that was not part of a cluster (average 5.14). These stories were also more likely to be printed on the front page, include headlines containing the word suicide, provide a detailed description of the method used, or have accompanying pictures.
Further analysis showed that the location and method of death of the first cluster and non-cluster suicides did not differ significantly. This reduced the likelihood that the cluster index cases were, because of their very nature (eg, more well known or dramatic), followed by both more newspaper reporting and suicides.
According to Dr Gould, "Although we cannot show causality, our study indicates that media portrayals of suicide might have a role in the emergence of some teenage suicide clusters. The findings constitute the first available information on the circumstances differentiating a suicide that leads to a suicide cluster from one that does not. Our research also emphasises the importance of adherence to media guidelines that discourage reporters from using too much detailed or graphic representations of suicides."*
Writing in a linked Comment, Jane Pirkis and Jo Robinson from the University of Melbourne in Australia say, "[This study suggests] that incautious newspaper reporting of suicide might compound the risk of an individual suicide becoming part of a cluster, at least in young people.
This effect might be exacerbated for newer forms of internet-media that might be favoured by young people over newspapers. It makes intuitive sense that less regulated, more volatile, and more interactive media might have an even greater effect, particularly because young people are not only major consumers of these forms of media, but also the creators of their content. Investigating the role of newer media in suicide clusters—both mass clusters and point clusters—is the next logical step."