Repetitive reporting on suicide deaths or doubtlessly deadly actions has been proven to set off additional suicides, referred to as the Werther impact.1 A current meta-analysis discovered that information reporting on movie star suicides—typically extremely repetitive over the next weeks2—was related to a 13% enhance in suicides.1
Another suicide associated narratives may need preventive results—media tales of people that managed to deal with suicidal crises with out dying by suicide have been related to reductions in subsequent suicides.3 The potential protecting results of tales of hope and restoration from suicidal crises is known as the Papageno impact.3 In distinction with research on the Werther impact, most research on the Papageno impact have used experimental designs. These trials sometimes use suicidal ideas quite than suicide demise as the result. In line with the analysis proof for the Papageno impact, a few of these research point out that media narratives of hope and restoration from a suicidal disaster are related to decreased suicidal ideas, significantly in folks with some danger components for suicidal behaviour.456 A famous limitation of those research is that findings about suicidal ideas don’t essentially generalise to suicidal behaviours and, most significantly, suicides.
Suicide prevention and training efforts should harness optimistic media to teach most of the people and excessive danger teams about suicide prevention with out doing hurt to people in danger. However a serious dilemma for analysis on this space has been that tales of hope and restoration obtain a lot much less media protection than tales of suicide demise.
On 28 April 2017, the American hip hop artist Logic launched his track “1-800-273-8255,” prominently that includes the variety of the US Nationwide Suicide Prevention Lifeline (known as Lifeline). The narrative of the track is centred round somebody calling the 1-800 quantity for Lifeline after which telling the counsellor that they don’t need to dwell anymore. The accompanying music video, which was launched 4 months later and has since obtained greater than 419 million views on YouTube, depicts a younger black man scuffling with discrimination and bullying from friends and adults for being homosexual. He prepares for his suicide, however in the end takes his cellphone and calls Lifeline, which marks a turning level in the direction of enchancment and mastery of his disaster.7
The discharge of the track in April 2017 marked the beginning of a sequence of media occasions selling the story of hope and restoration featured within the track, together with the cellphone variety of Lifeline. The track was carried out on the MTV Video Music Awards in late August 2017 to five.4 million viewers and in the end marked a breakthrough for “1-800-273-8255.”8 The track, which was labelled a “suicide prevention anthem” by the media, entered the highest 10 of the Billboard Sizzling 100 music charts within the US, remaining there for a number of weeks and rating as excessive as quantity 3 in September 2017.910 The track’s launch was additionally related to an almost 10% uptick in on-line Google searches for Lifeline within the 28 days after its launch.11 By the top of 2020, the track had surpassed one billion streams on Spotify.
Logic’s track doubtless represents the broadest and most sustained suicide prevention messaging straight linked to a narrative of hope and restoration in any location thus far and is thus a serendipitous occasion for analysis. To evaluate whether or not the track was related to assist in search of or suicides, we carried out a time sequence evaluation analyzing the associations between Logic’s track and each day calls to the Lifeline quantity in addition to each day suicides within the US.
Public consideration to Logic’s track
Three recognized distinct occasions directed robust public consideration to Logic’s track: the discharge of the track on 28 April 2017, Logic’s efficiency on the MTV Video Music Awards on 27 August 2017, and his efficiency on the Grammy Awards on 28 January 2018. All these occasions gave widespread public consideration to the message of the track—that assist from Lifeline is offered and efficient. To acquire estimates for the timespan of public consideration associated to every of the occasions as a proxy for evaluation of the impression interval, we retrieved all unique tweets geolocated to the US that contained the search phrases “Logic” and “1-800-273-8255” from Brandwatch (www.brandwatch.com). Our method was much like earlier research estimating publicity durations for suicide associated media occasions.2 Brandwatch is a knowledge reseller that shops the complete historic Twitter stream of greater than 350 million tweets per day, giving us entry to all public tweets, retweets, and replies throughout the overall remark interval. Greater than 90% of tweets could be efficiently matched to a rustic of origin.
This search allowed us to generate an exhaustive dataset with all mentions particularly associated to Logic’s track, excluding tweets produced by accounts that Twitter thought of malicious bots, from 1 March 2017 to 30 April 2018, masking the complete interval earlier than the discharge and throughout the track’s presence within the Billboard Sizzling 100.
We visually inspected the each day time sequence of tweets to determine peaks in tweeting behaviour qualitatively. In line with our research preregistration, we have been primarily within the three occasions that have been most related to dissemination of Logic’s track (track launch April 2017, MTV Video Music Awards August 2017, and Grammy Awards January 2018), however explored the time sequence of tweets for additional peaks as nicely. Subsequently, we visually assessed the period of any peak to seize the interval till the day that focus wore off. As well as, we carried out a put up hoc change-point evaluation to evaluate whether or not findings from visible inspection differed from quantitative evaluation of change-points within the time sequence information (see supplementary textual content S2 for particulars on the methodological method for figuring out peaks and their period).
Lifeline calls and suicide information
We obtained the overall variety of calls to Lifeline throughout the US straight from Lifeline. Name information have been offered as each day aggregates for the interval 1 January 2010 to 31 December 2018. Nationwide suicide information have been obtained from the Nationwide Middle for Well being Statistics (a part of the US Facilities for Illness Management and Prevention). Suicide was outlined utilizing ICD-10 (worldwide classification of illnesses, tenth revision) underlying reason behind demise codes X60–X84, Y87.0, and U03. Knowledge have been offered as each day aggregates for the interval 1 January 2010 to 31 December 2018.
Seasonal autoregressive built-in shifting common fashions to estimate baseline developments in calls and suicides have been fitted to the information as much as 6 April 2017. This closing date was chosen to permit for a 3 week preparatory interval earlier than the discharge of the track on 28 April, according to the remark that the primary tweets concerning the track have been posted as quickly as three weeks earlier than the discharge. The choice of fashions was aided by the SPSS Skilled Modeler operate, model 26 (IBM), selecting fashions with the bottom bayesian info criterion worth, highest stationary R2 worth (that’s, variance attributable to the fitted time sequence mannequin), and, when potential, a non-significant Ljung-Field Q statistic (indicating whether or not residuals may very well be assumed white noise, with said levels of freedom). The fashions derived from the baseline information have been subsequently fitted to the complete set of information for every sequence.
Based mostly on the time durations of robust social media consideration on the track, we investigated the non permanent affiliation between every of the recognized track associated occasions and calls to Lifeline and suicides. We used dummy variables to mannequin these associations as discrete pulses (that’s, we modelled them as sudden modifications from the baseline, beginning and ending with the beforehand recognized period of the occasion of curiosity). These pulses have been coded as binary variables, with a price of 0 earlier than the onset of the occasion of curiosity, 1 throughout the occasion of curiosity (for 30 days, for instance) and 0 thereafter. After becoming our fashions, we used mannequin estimates to calculate the variety of extra calls and suicides for every occasion (see supplementary textual content S1 for particulars of the statistical mannequin. Supplementary desk S7 gives an annotated syntax for the time sequence analyses ).
As an extra step, deliberate in our preregistration, we repeated the analyses of Lifeline calls and suicides utilizing a single dummy variable to mix the impact of the three most important media occasions that captured probably the most public consideration.
Potential confounding exogenous occasions
Due to potential confounding by the discharge of 13 Causes Why, a Netflix present that sparked robust criticism for violating media suggestions for secure portrayals of suicide,121314 we included a dummy variable (coded 1 from the discharge date of 13 Causes Why (31 March 2017 to 30 June 2017, and 0 in any other case).12 Notably, earlier analysis discovered that the present was related to a noticeable enhance of 5.5% in suicides (95% confidence interval 5.5% to 21.1%) within the US amongst 10 to 19 yr olds within the three months after its launch.12 Our use of a 3 month interval was according to social media information indicating that the present obtained the strongest consideration in that interval.12
To determine any additional occasions that may be related to Lifeline calls and suicides, we used an inventory of Wikipedia entries of suicides by well-known folks between 7 April 2017 (instantly earlier than the track’s launch) and 31 December 2018 (finish of remark interval). We accessed and assessed tweet volumes for all of the recognized (American and worldwide) celebrities to determine the suicides that obtained robust public consideration in order that we might modify for the prevalence of those confounding occasions within the mannequin (supplementary desk S1). Variables have been subsequently added for the suicides of Chris Cornell (18 Might 2017), Kate Spade and Anthony Bourdain (5 and eight June 2017, respectively),15 Chester Bennington (20 July 2017), and Avicii aka Tim Bergling (20 April 2018).2 In line with analysis on the affiliation between movie star suicides and subsequent suicide prevalence within the basic inhabitants, suicides of lesser recognized celebrities (Chris Cornell, Tim Bergling) have been coded as dummy variables, with worth 0 earlier than their deaths, 1 for the 30 days after their deaths, and 0 thereafter. For Chester Bennington, Anthony Bourdain, and Kate Spade, a 60 day interval was used,15 as a result of these suicides continued to obtain appreciable public consideration within the second month after their deaths (supplementary desk S1).
Lastly, World Suicide Prevention Day is held yearly on 10 September to advertise consciousness of suicide prevention.16 Within the US, World Suicide Prevention Day is a part of the annual Nationwide Suicide Prevention Week. We included dummy variables for the seven day interval of those occasions in 2017 (10-16 September) and 2018 (9-15 September).
We carried out three (not preregistered, exploratory) sensitivity analyses. First, we used each day distinctive calls to Lifeline (versus whole calls) to evaluate whether or not patterns have been related after eradicating repeat callers. Second, we modified the pre-intervention interval to finish by the day earlier than the track’s launch (27 April 2017) to research whether or not this affected key findings. Third, we carried out an extra evaluation combining all track associated media occasions (together with occasions that emerged solely from visible inspection) right into a single variable and assessed its associations with calls and suicides.
Affected person and public involvement
No sufferers or members of the general public have been straight concerned on this research due to time constraints in planning, owing to the lengthy interval between the track’s launch and the organising of this analysis. We did, nevertheless, converse to sufferers concerning the research and we requested a member of the general public to learn our manuscript after submission.
Public consideration as indicated by tweets
Logic’s track generated 81 953 tweets by 55 471 distinctive customers, posted between 1 March 2017 and 30 April 2018 (fig 1). Day by day tweets reached three peaks similar to the three most important occasions—the track’s launch in April 2017, the MTV Video Music Awards in August 2017, and the Grammy Awards in January 2018. Two smaller peaks have been recognized; based mostly on a qualitative evaluation of a pattern of particular tweets in these durations: one peak occurred across the time of the track’s video launch (17 August 2017) and the second alongside media reviews of a rise in calls to Lifeline related to the track (aired on CBS on 10 October 2017).17 All peaks emerged quickly, reaching their most inside at some point of the occasion. The period of all 5 peaks was estimated, utilizing the primary day of the rise as the beginning of the impression interval and ending the day the height had worn off.
Figure 1 reveals the estimated impression durations for every occasion (see supplementary determine S1 for a big model of this determine exhibiting the time sequence of tweets, Lifeline calls, and suicides, and the recognized impression durations).
Consideration to the track was strongest instantly after Logic’s efficiency on the 2017 MTV Video Music Awards, with a mean of 1324 each day tweets over a 28 day interval. Extra time restricted peaks have been seen after the track’s launch (1151 tweets a day for 3 days) and after the 2018 Grammy Awards (1883 tweets a day for one more three day interval). Total, 56.3% of tweets about Logic’s track between March 2017 and April 2018 have been posted within the 34 day excessive impression interval masking these three media occasions (table 1).
Affiliation with Lifeline calls
Descriptive details about Lifeline customers (gender, age, and demographic distribution of calls) is just not routinely collected and thus was not obtainable for the complete dataset; supplementary textual content S3 gives a breakdown of a not totally consultant subsample).
A statistically vital affiliation was discovered for calls to Lifeline for the 34 day interval masking the three most important occasions, however not for the 2 minor occasions (the video launch and information concerning the obvious impact of the track). The strongest enhance was seen instantly after the MTV Video Music Awards. The rise was smallest for the interval after the track’s launch. This sample was according to the noticed public consideration to those occasions, which was most pronounced for the MTV Video Music Awards (fig 1).
The noticed variety of calls throughout the durations of track associated media occasions exceeded the vary of forecasted calls (based mostly on baseline information) for the track’s launch (5.3%, 95% confidence interval 0.53% to 10.0%, three day interval), the efficiency on the MTV Video Music Awards (8.5%, 5.1% to 11.9%, 28 day interval), and the efficiency on the Grammy Awards (6.5%, 1.7% to 11.2%, three day interval) (table 2, fig 1). No vital associations have been discovered for the 2 smaller spikes in public consideration. A mixed evaluation throughout the three most important media occasions indicated an extra of 9915 calls (95% confidence interval 6594 to 13236), similar to a rise of 6.9% (95% confidence interval 4.6% to 9.2%, P<0.001). Supplementary desk S2 gives the parameter estimates for all mannequin parts.
Affiliation with suicides
The noticed variety of suicides within the durations of Logic associated media occasions have been inside the vary of forecasted values, utilizing the mannequin match to the baseline information. Estimates for the three main media occasions pointed to a lower in suicides, however these estimates weren’t considerably completely different from the anticipated variety of suicides (table 3, fig 1). Combining the information for all three main occasions right into a single variable yielded an noticed variety of suicides that was beneath the vary of the mannequin forecasts. Fashions together with a discrete pulse for these occasions indicated a big discount in suicides, amounting to a lower of 245 suicides (95% confidence interval 36 to 453 suicides). This corresponded to a discount of suicides of 5.5% (0.8% to 10.1%, P=0.02) within the 34 day interval. Supplementary desk S3 gives parameter estimates for all mannequin parts.
A sensitivity evaluation utilizing each day distinctive Lifeline calls (quite than whole each day calls) confirmed related patterns to the unique evaluation (supplementary desk S4). An extra sensitivity evaluation, utilizing a pre-intervention closing date of 27 April 2017, confirmed no deviations from the unique evaluation (supplementary desk S5). A 3rd sensitivity evaluation, combining all Logic associated media occasions (together with these not individually related to each day Lifeline calls) right into a single mannequin, indicated that the affiliation with Lifeline calls remained vital, whereas there was no vital affiliation with suicides (supplementary desk S6).
This interrupted time sequence evaluation discovered that Logic’s track “1-800-273-8255” was related to a noticeable enhance in calls to Lifeline (an extra 9915 calls or enhance of 6.9%) throughout the 34 day interval when public consideration to the track was substantial. Over the identical interval, there was some proof of a discount in suicides, amounting to 245 fewer suicides (lower of 5.5%).
These findings are according to a potential Papageno impact3 and are vital from a suicide prevention perspective. Media campaigns for suicide prevention have obtained a groundswell of help internationally, however evaluations are scarce and sometimes restricted when it comes to scope.18 Our discovering of a considerable enhance in precise assist in search of and a potential lower in suicides throughout the interval of excessive public consideration to Logic’s track help the actual world effectiveness of this intervention. Earlier peaks in calls to Lifeline have been virtually at all times related to dangerous media occasions, akin to movie star suicides.19 These occasions have been typically related to will increase in suicides,120 indicating that each will increase in calls to Lifeline and will increase in suicides may replicate appreciable misery in the neighborhood from these media occasions. The general patterns discovered for suicides by celebrities included as covariates on this evaluation have been largely according to earlier analysis. Most notably, the suicides of Kate Spade and Anthony Bourdain,15 which obtained the strongest and most sustained consideration throughout all movie star deaths within the post-intervention interval, have been clearly positively related to Lifeline calls, and will increase of suicides have been near the boundary of significance. In distinction, the patterns noticed for Logic’s track, according to the track’s narrative, indicated a rise in assist in search of behaviour accompanied by a slight discount in suicides.
The effectiveness of the track on calls to a helpline is a novel discovering. The outcomes present that it’s potential to advertise assist in search of for suicidal crises within the absence of destructive information, and point out that suicides might doubtlessly be decreased with prevention centered campaigning, akin to Logic’s track. Though the discount in suicides was small, this discovering reveals that the track didn’t lead to dangerous results on suicide prevalence, which might have been indicated by a rise in suicides. That is vital as a result of some prevention messaging that aimed to scale back suicides was in the end related to will increase in suicides.12 These narratives, nevertheless, sometimes concentrate on suicide deaths and makes an attempt, not on hope and restoration from suicidal ideas and emotions.
The quantity of publicity generated by prevention messages about hope and restoration appears to be essential in efforts to yield optimistic results on behaviours together with assist in search of and doubtlessly suicides. In accordance with probably the most sustained and strongest public consideration to Logic’s track, as indicated by tweet quantity, the uptick seen for Lifeline calls was strongest after his efficiency of the track on the MTV Video Music Awards in 2017 adopted by his efficiency on the Grammy Awards in 2018, after which the track’s launch. This sample underscores the significance of reaching giant proportions of the goal inhabitants to attain behavioural results. In contrast with different prevention occasions, public consideration for Logic’s track, as mirrored in tweet quantity, was extra sustainable, however the occasion didn’t essentially lead to extra tweets general. Based mostly on question phrases used for World Suicide Prevention Day 202016 within the US, for instance, the day resulted in a complete of roughly 94 000 tweets from 58 000 customers, together with greater than 30 000 on 10 September 2020 alone. Total social media consideration was comparable in whole magnitude to Logic’s track (82 000 tweets from 55 000 customers), however the consideration was targeting a single day, whereas Logic’s track was highlighted repeatedly over a number of particular and numerous media occasions. This quantity of consideration was, nevertheless, nonetheless significantly smaller than for some dangerous media occasions within the current previous—for instance, within the three months after the discharge of 13 Causes Why, a TV present that violated key suggestions for secure portrayals of suicide121314 and was related to a rise in teenage suicides,12 there have been tweets from 870 056 particular person customers concerning the present.12 That is greater than 15 occasions bigger than for Logic’s track. Though Logic’s track units an vital, extraordinary instance for broadly disseminated and fairly sustainable suicide prevention messaging, publicity remains to be significantly stronger for some conceivably dangerous media occasions.
Totally different pathways and mechanisms may be at play in any discount in suicides related to Logic’s track. The current evaluation signifies that durations that have been strongly related to an uptick in calls confirmed a simultaneous lower in suicides. We’ve not established whether or not calling behaviour affected individuals who did (or didn’t) die by suicide after the track’s launch. People who find themselves prone to suicide are sometimes socially withdrawn, and a few won’t constantly use helplines. The proportion of socially remoted, suicidal callers, nevertheless, has been discovered to be significantly excessive amongst frequent callers of disaster traces,21 indicating that the edge for calling a phone disaster centre is decrease than for accessing assist companies that require on-site visits. The track, nevertheless, may need triggered different or extra routes of motion beside calling Lifeline. Discovering romantic love and optimistic communication together with his household, for instance, are main contributors to the development in suicidal ideas and emotions of the protagonist seen in Logic’s music video, and a few folks may need felt impressed to achieve out for assist from different sources. In-depth qualitative analysis may assist make clear the query of whether or not and the way exactly folks with suicidal ideas and emotions have been influenced by the track.
Strengths and limitations of this research
A energy of this research is the size of the time sequence, with each day information from 2010 to 2017 obtainable to mannequin the anticipated pre-intervention suicide counts. The mannequin managed and adjusted for a number of exogenous variables (specifically, concurrent facet occasions, akin to suicides of well-known celebrities, and Nationwide Suicide Prevention Week). Traits, temporal fluctuations, and seasonality have been adjusted for within the SARIMA fashions. An extra energy of this research is using each day information, leading to exact modelling in accordance with durations when social media consideration to Logic’s track was robust, as indicated by the amount of tweets about it. Estimating publicity based mostly on social media information is extra goal than merely estimating publicity occasions within the absence of any supporting information. This refined method is according to research indicating that public consideration to social media discourse when it comes to tweets is brief lived, with lifespans of a tweet usually not extending past a couple of hours.22
The primary limitation of the research is that it was based mostly on ecological information, so it was not potential to determine whether or not the folks calling Lifeline or not dying by suicide had been uncovered to Logic’s track and associated media occasions, or what their motivations may need been for calling or not dying from suicide. The observational nature of this analysis doesn’t permit us to determine causality. Moreover, solely whole each day name and suicide information have been obtainable, with none stratified information for numerous demographic components, akin to gender, age, or location of residence. Particularly for suicides, information stratified by age or gender would have resulted in small numbers on some days. It is a limitation as a result of adolescents and younger adults are over-represented among the many viewership of the MTV Video Music Awards.23 Though this age discrepancy doesn’t equally apply to the opposite occasions associated to the track—the Grammy Awards 2018 was watched by 17% of Individuals aged 50 or older24—or to the music preferences for rap or hip hop music within the US,25 a considerably stronger publicity of younger folks appears believable. Notably, the demographic profile (in addition to major presenting issues) of callers in September 2017, the month with strongest consideration to the track, didn’t grossly deviate from different months within the remark interval after the track’s launch, thus indicating that potential age results, if current in any respect, may need been restricted (see supplementary appendix).
Different limitations of our method embody the shortcoming to evaluate long run associations past the durations of robust public curiosity. As beforehand famous, 56.3% of tweets about Logic’s track between March 2017 and April 2018 have been posted within the 34 day excessive impression interval outlined on this research, indicating that the majority of consideration was coated by the chosen interval. That is according to the widely brief lived public consideration to media occasions and associated public discourse, which requires fixed repetition to grow to be sustainable.2226 Moreover, the completely different peaks recognized have been dissimilar not solely in period but in addition within the most variety of tweets on a given day. The current impression durations have been modelled as discrete pulses, according to the idea that seen, giant modifications in consideration (quite than general variety of tweets) may almost certainly have an effect on behavioural outcomes, akin to assist in search of and suicide. That is according to associated proof that different media information, akin to these from Google Traits, typically wrestle to foretell basic suicide developments,27 whereas sudden robust modifications in Google search behaviours, as seen throughout main occasions akin to the discharge of 13 Causes Why or the covid-19 pandemic, do appear to be helpful in estimating suicide developments.2829 Research are wanted to evaluate how lengthy the consequences of suicide prevention messaging typically final and what absolute quantity and period of consideration, as mirrored in social media, is important to yield any observable results. Social media information, akin to tweets, are solely a proxy of public consideration, nevertheless, and won’t at all times reliably replicate precise publicity. Lastly, the dedication of suicide deaths is a difficult process, and suicide deaths are generally under-reported.30 Although a sure diploma of misclassification is feasible, speedy fluctuations in classification accuracy of nationwide suicide information, which might impression the current evaluation, appear unlikely.
This evaluation means that Logic’s track “1-800-273-8255” was related to a noticeable enhance in calls to Lifeline and a simultaneous small discount in suicides throughout peak social media discourse concerning the track. The latter final result is price underscoring—the prevalence of a broadly disseminated track and video was related to greater than 200 fewer suicides than anticipated. These findings emphasise the potential inhabitants well being advantages of working creatively and innovatively with different sectors, such because the music and leisure industries, to advertise new impactful tales of assist in search of that resonate with broad audiences, go away a visual footprint on social media, and are secure when it comes to not that includes doubtlessly deadly actions however quite coping and mastery of crises.13 Interventions that comply with these ideas might assist create behavioural change to extend assist in search of and forestall suicide.
What’s already recognized on this matter
The rise in suicides after media tales about suicides by celebrities is known as the Werther impact
A lot much less is thought concerning the protecting results of media tales of hope and restoration within the context of suicidal crises
Some proof from randomised managed trials reveals a useful impact of media narratives of hope and restoration on suicidal ideas and assist in search of intentions
What this research provides
Throughout 34 days of large scale public publicity to Logic’s track “1-800-273-8255,” Lifeline obtained 9915 extra calls (95% confidence interval 6594 to 13 236): 6.9% over the anticipated quantity
In the identical interval, 245 fewer suicides (95% confidence interval 36 to 453) occurred: 5.5% beneath the anticipated quantity
A media occasion supposed to inform a “suicide prevention story” was related to each a rise in calls to the Nationwide Suicide Prevention Lifeline and a simultaneous discount in suicides in america