Dr Alexandra Pitman
Alexandra is a Senior Clinical Lecturer in the UCL Division of Psychiatry and an Honorary Consultant Psychiatrist at Camden & Islington NHS Foundation Trust. She did her core training in psychiatry on the West London rotation, and her higher training in General Adult Psychiatry as a NIHR Academic Clinical Fellow on the North London/UCL rotation. Her PhD at UCL was funded by the Medical Research Council, and was followed by a MRC Centenary Early Career Award and a Guarantors of Brain post-doctoral fellowship.
Understanding and preventing copycat suicides
Recently published research in BMC Psychiatry examines people’s attitudes towards suicide following the suicide of a friend or relative. In this blog, lead author to the study, Dr Alexandra Pitman, talks about the study as well as the influences of suicide portrayed in the media.
I probably first heard the word copycat in the playground. Its childlike nature belies the now sinister connotations of this word. Research into the phenomenon of copycat suicide is important if we are to understand and prevent it, but we remain far from grasping the chain of cognitive processes and other influences involved. This blog describes a study we recently published in BMC Psychiatry and what it reveals about the influence of another’s suicide on someone’s own attitudes to suicide.
Influence of suicide in the media
In 2017 the broadcast of the controversial Netflix series 13 Reasons Why generated a media storm, provoking debate over the extent to which young people might be influenced by the suicides of other people, fictionalized or otherwise. The graphic depiction of the teenage protagonist’s death, its portrayal as inevitable, and the apparent glamorization of the aftermath of her death were criticized by those concerned about the powerful messages conveyed. Suicide researchers pointed out the potential triggering effects of the irresponsible reporting or portrayal of suicide and self-harm, as advised against in media guidelines.
These media guidelines are based on evidence that young people may be susceptible to imitating the suicidal behavior of celebrities or others known to them where those deaths are glorified.
These media guidelines are based on evidence that young people may be susceptible to imitating the suicidal behavior of celebrities or others known to them where those deaths are glorified. Analysis of internet searches in the 19 days after the series aired revealed that use of the search term ‘suicide’ rose by almost 20%. A number of cases of suicide reported in the press subsequently bore similarities to the death portrayed on screen, and were highly suggestive of a direct imitative effect.
Attitudes to suicide after the suicide of a friend or relative
Young people are also at increased risk of suicide attempt after the suicide or suicide attempt of a peer, as evidenced by large-scale US studies. This copycat behavior is thought to be explained by social learning, and has also been termed imitative suicide, suicide contagion, or suicide diffusion. Whilst the majority of research on this topic has been conducted in the US, including attempts to understand the underlying cognitionsassociated with this behavior, until now relatively little work has been done in the UK.
We recently published a British study investigating attitudes to suicide after the suicide of a friend or relative, published in BMC Psychiatry. This work provides valuable insights into whether or not a close contact’s suicide can trigger suicidal thoughts. To our knowledge, this is the published study with the largest sample size that explores qualitatively the attitudes of people bereaved by suicide towards suicide.
This is the published study with the largest sample size that explores qualitatively the attitudes of people bereaved by suicide towards suicide.
For our online survey in 2010 we sampled young adults living across Britain who had lost a friend or relative to suicide. Using an anonymous internet-based survey we established the circumstances of the death and then asked: “To what extent has their death made you fear that you may die in a similar way?”
Overall we had free text responses from 429 people, and our team of researchers analyzed these responses using the approach of thematic analysis. We were concerned to see that a minority (26%) of respondents who had given detailed responses to this question felt that following their own experience of suicide loss they now thought of suicide as a more tangible option for them. Their responses conveyed that many now felt inured to any previous fear of suicide, to the extent that it had been normalized for them.
To give one example, a young man whose brother had died by suicide some years before commented:
“If anything, it made it easier for me to consider and attempt suicide. If he had not done it, I probably would have not considered it in my lowest moments.”
Similarly a young woman whose uncle had died by suicide reflected her relief that:
“Knowing that if things get to be too difficult there’s a way out.”
This study provides evidence to support the idea of a suicide suggestion effect in a sub-group of people exposed to a peer or relative’s suicide. This represents one possible explanation for the increased risk of suicide and suicide attempt after the suicide of a friend or relative. However, there is also a positive message from this work; namely, that the majority of those responding to the survey described great aversion to the idea of attempting suicide themselves, largely because of their awareness of the negative impact on other people.
This work is important for health professionals, bereavement counselors, and the general public in raising awareness of the increased risk of imitative suicide in a sub-set of people who lose a close contact to suicide. As a psychiatrist myself, I have resolved to ask my patients about their experiences of suicide in more careful detail, exploring their attitudes sensitively, and whether they might have been influenced by the suicidal behavior of others.
I hope that this study will prompt further research work in schools, colleges, psychiatric units and social networks, to understand how attitudes to suicide might differ before and after a peer’s suicide. Improving our understanding of the phenomenon of copycat suicide offers us opportunities to intervene and prevent further suicides.
Acknowledgements: The authors of the study would like to thank the Medical Research Council for funding this work.
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