Reason for cautious optimism? two studies suggesting reduced stigma against suicide

Suicide is the 11th leading cause of death in the United States, and more people die by suicide than by HIV/AIDS or homicide (Kochanek, Murphy, Anderson, & Scott, 2004). Despite this, suicide research programs receive a fraction of the funding that research programs for other, sometimes less fatal diseases or conditions do (Curry, De, Ikeda, & Thacker, 2006). Specifically, in 2003 the Center for Disease Control's research budget for suicide was one-third of one percent, whereas the research budget for homicide was four times as much, and the research budget for HIV/AIDS was 50 times as much. Why is it that suicide research is literally paid so little attention? The dearth of funding for suicide research may in part be due to the stigma associated with suicide. The stigma surrounding suicide is complex, and partially stems from the way it has been regarded by religion and the law. For centuries, suicide was considered a mortal sin by the Catholic Church. Historically, those who died by suicide were denied funeral rites, and those who survived an attempt were excommunicated (Alvarez, 1970). As a way of illustrating the condemnation placed upon those who died by suicide, in Dante's Inferno, suicide decedents were banished to the seventh circle of hell, a position below even that of murderers and heretics (Alighieri, 1971; Joiner, 2005). Today, many religions still consider suicide to be a sinful act, and clergy have been found to be more condemning of suicide than are physicians, social workers, or psychologists (Domino & Swain, 1985–86). Suicide has also been harshly censured legally. During the 17th and 18th centuries suicide was considered to be a triple crime (murder, treason, and heresy; Farberow, 1975). Moreover, during this period, punishments for death by suicide included loss of property, violation of the deceased's body, and harsh restrictions regarding burial (Smith et al., 2008). Not only were those who died by suicide punished, their families often were as well (Stillion & Stillion, 1998–99). Though these harsh legal punishments no longer apply in the United States, it was not until the late 20th century that suicide was decriminalized in every state (Berman, 1990). Another source of suicide stigmatization results from misunderstandings about the causes of suicide. For example, many people erroneously believe that people who die by suicide are selfish or weak (Joiner, in press; Pompili, Girardi, Lester, & Tatarelli, 2007). Due to these and other misunderstandings about suicide, some people attempt to distance themselves from people and topics associated with suicide. Social distance is akin to stigmatization, and refers to the intimacy, indifference, or hostility one displays towards particular people or groups. A study conducted in the 1960s found that people desired more social distance from those who had attempted suicide than from ethnic and religious groups typically discriminated against at the time (Kalish, 1966). A replication of this same study 25 years later found that participants still put considerable distance between themselves and someone who had attempted suicide, though they were willing to put themselves slightly closer than were participants in the earlier study (Lester, 1992–1993). The stigma associated with suicide is widespread, affecting suicide attempters, the loved ones of the deceased, and even those experiencing suicidal ideation or desire. A suicide attempt should register as a clear sign that the person who made the attempt is in need of help. Unfortunately, those who survive a suicide attempt often experience severe stigmatization; for example, they may be labeled as “attention-seekers” (Sudak, Maxim, & Carpenter, 2008). The family members of a person who has died by suicide have also been found to experience significantly greater perceived rejection, shame, and stigma than other bereaved groups (Sveen, & Walaby, 2007). For example, family members may be asked to lie about their loved one's cause of death in obituaries, or they may be told that their loved one is “going to hell” or that they have “suicide germs” (Ball, 2005). Moreover, due to the various misunderstandings about suicide, people experiencing suicidal ideation or desire may be reluctant to seek treatment (Pompili,et al., 2007). This reluctance may ultimately jeopardize their personal safety and mental health. In order to decrease the widespread stigma surrounding suicide, as well as to prevent suicide, in recent years public health and education campaigns have taken root. For example, the current theme of the American Foundation for Suicide Prevention's youth campaign is: “Suicide Shouldn't Be a Secret.” This campaign includes televised public service announcements that aim to reach 88 million viewers nationwide (American Foundation for Suicide Prevention [AFSP], 2009). Other media efforts include educational specials on widely viewed shows, such as “The Dr. Phil Show” (e.g., “The Bridge Controversy,” Dr. Phil.com). There has also been a recent shift away from sensationalizing suicide in the media to providing accurate information about prevention (Ball, 2005). Other anti-stigma efforts include updating the suicide lexicon in order to remove connotations of sinfulness or wrongdoing. For example, suicide researchers and survivors generally use the term “died by suicide” as opposed to “committed suicide” (Ball, 2005). There is some evidence that these efforts are helping to change attitudes about suicide. For example, at a recent National Suicide Prevention Lifeline meeting it was reported that, for the first time, 100 percent of suicide hotline phone counselors responded that they “very much disagreed” with the statement “Suicide is wrong” (T. E. Joiner, personal communication, April 20, 2009). Moreover, after the completion of a Cleveland area suicide prevention campaign (with the message, “Suicide is Preventable. Its Causes are Treatable.”), calls to a suicide hotline increased 29 percent (Oliver et al., 2008). Even more striking, calls to 1-800-273-TALK (a national suicide prevention hotline) increased 300 percent after the hotline was advertised on a Dr. Phil show (T. E. Joiner, personal communication, May 5, 2009). Furthermore, those exposed to Quebec's Suicide Prevention Week – which involved newspaper, television, and radio advertisements – were found to have increased knowledge about suicide prevention (Daigle et al., 2006). Although suicide stigmatization is a centuries-old, far-reaching and widespread problem, there is some preliminary evidence that attitudes towards suicide have recently begun to improve. Yet few studies have investigated changing attitudes towards suicide, and even fewer still have examined this issue since the earnest advent of suicide education campaigns over the past 20 years. Thus, the aim of the current studies was to empirically test whether contemporary attitudes towards suicide are improving through the use of both experimental and longitudinal methods.