The global impact of celebrity suicides: implications for prevention
Authors: Katherine M. Keyes, Rob Whitley, David Fink, Julian Santaella, Jane Pirkis
Journal: World Psychiatry (2021)

Actor and entertainer Robin Williams died by suicide on August 11, 2014. Three studies conducted in the US, Canada and Australia have shown population level increases in suicide in the months after Williams' death. Across the three countries, the excess in suicide – beyond what is expected given the long-term trend and seasonal fluctuation – was between 10 and 16%, amounting to thousands of excess suicide deaths. The increases were primarily concentrated in those who used the same suicide method as Williams, and were demographically similar in terms of age and gender. Moreover, Williams' death elicited a strong reaction of suicidal crisis, suggesting that the excess suicides reflect the reactions to Williams' death. Decades of data confirm that irresponsible media coverage of high-profile suicides can contribute towards a population-level increase in subsequent suicides insofar as vulnerable individuals identify with the decedent. Graphic depictions and in-depth discussions of the methods used or state of mind of the decedent are specific vectors that increase risk for subsequent suicide deaths using similar methods and among those with similar demographic characteristics as the decedent. Portrayals of suicide as fixing a problem or providing a solution may also increase risk in vulnerable individuals. Because of this well-documented effect, national and international best practice suicide reporting guidelines for media professionals have been established. Williams' death received considerable international media coverage, which varied in tone and content, with major differences in adherence to suicide reporting guidelines. In Australia, the major national program Mindframe released suicide reporting guidelines in 2014, and information and briefings on how to handle the reporting of Williams' death were disseminated immediately and largely followed throughout the country. In Canada, a similar program known as Mindset released suicide reporting guidelines in 2014, which were disseminated to newsrooms throughout the country, and largely followed after Williams' death. In addition to the need for moderation in reporting of celebrity death, these guidelines often include messaging around where individuals can obtain mental health and suicide prevention support if needed, as well as messages of hope for mental health recovery. Indeed, the media can be a source of information about suicide prevention after a high-profile event. While guidelines from several authoritative health organizations were available in the US, the graphic nature of the reporting indicates that they were largely not followed in the case of Williams' death. Seemingly no detail was spared in the US media presentation of Williams' suicide, including a well-covered press conference that described not only the method of death but what Williams was wearing, where he was seated, and lurid details of his final hours. News cameras broadcast from the location of the death for days, and the 24-hours news cycle included seemingly endless discussions of Williams' state of mind and mental health. This may have increased risk among vulnerable individuals in the US, but could have spread to other areas as well. Indeed, suicides also increased after Williams' death in Canada and Australia, where at least some reporting guidelines were largely followed. One hypothesis is that dissemination of content regarding high-profile suicide deaths are not confined to national boundaries. Our information landscape is one in which obtaining minute-by-minute global news from many places in the world (especially the US) is a major mode of information transfer. Social media are replacing traditional media as a source of news and information. Citizen journalists (often without journalistic training, and largely unaware of media guidelines) are now contributing greatly to the media landscape through user-generated content in blogs, vlogs and social media channels. To our knowledge, no study has been conducted on the content of citizen journalists' or average social media users' postings after a high-profile suicide. However, it is reasonable to hypothesize that such postings will frequently violate best practice guidelines in writing about suicide. The globalization of the media and unfiltered dissemination of content via social media and citizen journalists as a new risk factor for suicide after a high-profile suicide death is concerning, especially as high-profile suicides and depictions of suicide continue to proliferate. Fictional depictions of suicide such as 13 Reasons Why on Netflix have now been documented to adversely affect adolescent suicide in the US, and the impact of this program beyond borders is likely. As Netflix, Youtube, Facebook, Snapchat and Instagram increasingly are easily available in many places across the world, public health attention to suicide prevention education needs to expand and move beyond local and traditional media. The fan base and reach of celebrities is increasingly global as well, indicating that future celebrity deaths may have a broader impact than previous events. The solutions to the globalization of information for suicide prevention are not obvious, and will require thoughtful collaboration between public health, psychiatry, journalism, and policy stakeholders. There are massive efforts underway to build online platforms that provide guidance regarding how to discuss suicide safely and informatively online. Suicide prevention should attend to new modes of information transfer, innovate the dissemination of safe reporting and suicide prevention messaging on online platforms, and actively serve to prevent suicide through scientifically accurate messaging around recovery and support. Such efforts are currently underway in several countries, and can be extended as well. Research and action on popular citizen journalists are also needed, as well as research on "average" social media users. While these groups are already incorporated into some guidelines, the extent to which guidelines are followed outside of some traditional media remains questionable. Social media platforms are both an opportunity and a threat, with incredible reach to mobilize individuals to discuss mental health and reduce stigma, as well as to be unwieldly amplifiers of misinformation and harm. The accumulating evidence of the widespread impact of a singular celebrity suicide death across countries, despite improved traditional media coverage, is an acute and tragic warning that we are in a new age for which the thoughtful and well-informed efforts to reduce suicide contagion need to be reimagined.