Transcript: Twitter Journal Club Eleventh Meeting 8pm, Sunday 18th September 2011

Niederkrotenthaler et al. (2010) Role of media reports in completed and prevented suicide, BJPsych Available at http://bit.ly/rnoOGP Hosted by Fi Douglas

twitjournalclub Hi everyone. Good evening and welcome to this week's #TwitJC, looking at this paper on the media and suicides: http://t.co/KzFmPZPl -8:00 PM twitjournalclub Running thing this week is myself (@fidouglas). You can find out more about the paper here: http://t.co/5ixvsIHW #TwitJC -8:02 PM PaedsSHO Sorry I'm missing this week, busy looking after little people. Look forward to the transcript. #twitjc -8:02 PM twitjournalclub If we can start with people introducing themselves... #TwitJC -8:03 PM fidouglas I'll go first. Fi here, also running the discussion. Med student about to go into third year. Will be tweeting from both accounts. #TwitJC -8:04 PM peds_id_doc RT @twitjournalclub: Running thing this week is myself (@fidouglas). You can find out more about the paper here: http://t.co/5ixvsIHW #TwitJC -8:09 PM MargoJMilne @fidouglas If there's nobody else around, howsabout we just do the context stuff? #twitjc -8:09 PM epidemiologista @fidouglas Hi Fi! Linda here, soon to be 2nd year PhD student Epidemiology #TwitJC -8:09 PM Dr_Stuart Hope #TwitJC goes well tonight - one of the most positive uses of #Twitter by doctors. 8:10 PM Assidens RT @Dr_Stuart: Hope #TwitJC goes well tonight - one of the most positive uses of #Twitter by doctors. -8:10 PM twitjournalclub We'll begin with the first discussion point, and see who turns up... #TwitJC -8:11 PM twitjournalclub This study uses an unorthodox set of methods to arrive at its conclusions. Is the methodology sound enough to give robust results? #TwitJC -8:12 PM behrouzn RT @twitjournalclub: Hi everyone. Good evening and welcome to this week's #TwitJC, looking at this paper on the media and suicides: http://t.co/KzFmPZPl -8:12 PM MargoJMilne Hi, I'm a non-medic. Clinical experience is pre-hospital, academic background is in death/dying/disability. #twitjc -8:12 PM shanemuk @Dr_Stuart Well I wonder why THAT isn't being reported in the #DailyMail? #twitjc 8:12 PM silv24 I am trying to multitask (finish a MRCP paper and join in tonight...) #twitjc -8:12 PM silv24 RT @Dr_Stuart: Hope #TwitJC goes well tonight - one of the most positive uses of #Twitter by doctors. -8:14 PM fidouglas There is an attempt to make something which is rather qualitative, quantitative. I guess we should looks at flaws in this? #TwitJC -8:14 PM

doseofnuxvomica hi. sarah. psychiatry trainee. #twitjc -8:15 PM MargoJMilne Is it inherently qualitative? #twitjc -8:15 PM silv24 @shanemuk @dr_stuart thank you both, #twitjc is a bit special to @fidouglas and myself!! 8:15 PM fidouglas @MargoJMilne Not all aspects, but many. "Emotionality" is quite difficult to classify, I would have thought. #TwitJC -8:17 PM JoinedU1 RT @fidouglas: Which reminds me to remind you that this week's #TwitJC will look at media portrayal of suicide, examining this paper: http://t.co/rcXw9Bh -8:17 PM KateT_health #Twitjc content analysis is like that (quant/qual) + fairly well established method. Correlations outside more unusual but not unique -8:17 PM MargoJMilne @fidouglas Right, so it's not so much that they're qualitative as that they're hard to measure #twitjc -8:18 PM KateT_health #Twitjc skipped the intro I'm a sociology/soc pol lecturer in a Health faculty -8:18 PM Assidens Hi I'm Kay, nurse working in Public Health, sorry a bit late to the party this eve, will try and read the paper pronto! #twitjc -8:18 PM fidouglas @MargoJMilne So, bearing this in mind, do we think it affects the reliability of the results? #TwitJC -8:19 PM epidemiologista #TwitJC Reliability of results might be more affected by the ecological design: esp as suicide rates are v low and affected by many things -8:21 PM KateT_health #Twitjc I do agree on the emotionality scoring thing, interesting - and replicable I guess - but may or may not have meaning/validity -8:21 PM fidouglas Or rather, can we take the results of this paper as being likely to be accurate, or do we need to be wary of them? #TwitJC -8:22 PM endless_psych @twitjournalclub It is not unorthodox it is simply I suspect unfamiliar to medical researchers. #twitjc -8:24 PM fidouglas @JoinedU1 as nonmedic tryin 2 supprt bettr mh services why wont GOV reinstate suicide indicatrs?Needed 2 keep new Strategy active? #TwitJC -8:24 PM twitjournalclub Another potential issue is that this study is limited to one country; how applicable are the results to other countries & cultures? #TwitJC -8:26 PM MargoJMilne @twitjournalclub Any result is always going to have to be considered for generalisability- always likely to be further trials needed #twitjc -8:28 PM KateT_health #Twitjc I confess to being almost entirely lost with the 'latent class analysis' part. Have to take their word for it re results. -8:29 PM endless_psych If there is a methodological flaw with the paper it ill hinge on how they quantified the qualitative data and if that biased LCA #twitjc -8:29 PM fidouglas @KateT_health Yeah, I'm by no means an expert on medical stats. I got lots about halfway through the methods section I'm afraid. #TwitJC -8:30 PM endless_psych Also just as a brief point "ecological" design or validity was originally a term relating to a specific bespoke sampling method #twitjc -8:30 PM endless_psych What's wrong with just using representative design? #twitjc -8:31 PM

fidouglas As for extrapolating, not knowing much about Austrian culture, I guess it's difficult to say how similar it is to others. #TwitJC -8:31 PM endless_psych LCA is a valid method and I see nowt in their analysis that seems untoward #twitjc -8:32 PM KateT_health #Twitjc I'm neither a medic nor a psychologist (nor a fully trained sociologist, stats wise) - should this be comprehensible to 'us'?? -8:32 PM fidouglas But obviously different cultures have different attitudes to suicide, which would likely affect the results if study were repeated. #TwitJC -8:32 PM Assidens @twitjournalclub that was my first thought as I was just reading it, esp in relation to British media? #twitjc -8:33 PM KateT_health #Twitjc thanks for insight @endless_psych . Take your word for it! -8:33 PM MargoJMilne @fidouglas Yes, vastly, vastly different attitudes #twitjc -8:33 PM endless_psych LCA is generally used in sociology in large scale secondary analysis of survey data #twitjc So even most psychs won't have encountered -8:34 PM fidouglas Despite cultural differences, the study shows the media have the power to have *an* effect, whatever it may be. #TwitJC -8:35 PM Assidens @fidouglas yes, good point #twitjc -8:35 PM KateT_health Agree re cultural diffs-not only in attitudes but type of lang used /conventions of reporting etc. Interesting to test tho #Twitjc -8:35 PM endless_psych The explanation on wiki is actually quite good and medically orientated for what LCA does http://t.co/pYidETJM #twitjc -8:35 PM twitjournalclub Do the study's results indicate a greater need for education among journalists & more stringent guidelines on reporting of suicides? #TwitJC -8:36 PM KateT_health Thanks for the wikipedia tip @endless_psych - may explore. #Twitjc -8:37 PM epidemiologista @twitjournalclub Hard to say - it's still an ecological designed study so the evidence is still weak at best #twitJC -8:38 PM Assidens @endless_psych thanks for that link , very interesting #twitjc -8:38 PM ram3481 @fidouglas #TwitJC yeah it should. but dont know if any media reporting in the eastern part of the world have had any preventive action! -8:38 PM fidouglas @76Lusa01: I think it also depends on the access to media in different cultures and countries if the results are applicable #TwitJC -8:39 PM drbrid #twitjc good analysis, could it be repeated for social media? why the delay between fieldwork and publication. Serious PH problem -8:39 PM fidouglas @drbrid: its a start, complex area, could a similar analysis be done about social media? then there are clusters (time and geog) #twitjc -8:39 PM twitjournalclub Please remember to put the hashtag on the end of your tweets so they don't get missed. :-) #TwitJC -8:40 PM fidouglas There are some guidelines for the media, from organisations like Mind and Samaritans. PCC give very limited guidance. Just say... #TwitJC -8:41 PM fidouglas "When reporting suicide, care should be taken to avoid excessive detail about the method used." #TwitJC -8:41 PM

KateT_health I *guess* there are already guidelines on reporting out there (eg in UK) but tabloid press least likely to take note..press freedom #Twitjc -8:41 PM dsdarbyshire #TwitJC Journalists are a (almost) self regulating profession.Would be interesting to hear journalists thoughts and awareness of the issue. -8:41 PM KateT_health ... And @fidouglas is way ahead of me! #Twitjc -8:42 PM GPL41 Will media change reporting for ph reasons, when driven by commercial pressures? Should drs have a role here? #twitjc -8:42 PM MargoJMilne @fidouglas In the disability community here on Twitter, links about suicide or selfharm are often marked with TRIGGER! as a warning #twitjc -8:43 PM fidouglas @MargoJMilne Yup, I looked round a few forums & found this. Patient/user selfregulation indicates that it *is* important. #TwitJC -8:44 PM fidouglas Need to balance freedom of press with safety of the public. Should papers be allowed to report in a way that increases deaths? #TwitJC -8:45 PM KateT_health That is really interesting, @MargoJMilne - impact recognised there. #Twitjc -8:46 PM dsdarbyshire #TwitJC does individual suicide risk change or does it just expedite the event? -8:46 PM endless_psych @fidouglas You can't shout fire in a crowded theatre. What freedom of the press is substantially limited by not publishing details? #twitjc -8:46 PM fidouglas @PyroClaire: @fidouglas What advice is there on reporting of columbine-type massacres? #TwitJC -8:47 PM dsdarbyshire #TwitJC is level of detail even a factor or is it number of headlines? -8:48 PM endless_psych @fidouglas @drbrid Something like the Leetaru "culturonomic" paper perhaps? http://t.co/hf6W3GvC #twitjc -8:48 PM fidouglas @dsdarbyshire Would be interesting to see if there is a subsequent decrease in suicide rate after a lag. #TwitJC -8:48 PM dsdarbyshire #TwitJC what about other forms of communication. Pumped up kicks by foster the people is about a school shooting. -8:49 PM KateT_health @dsdarbyshire I pondered individ risk issue vs 'pushing' issue too - v hard to determine #Twitjc -8:49 PM fidouglas @dsdarbyshire Repetitive reporting increases rate of suicides. Reporting location or stepby-step guide did not cause sign. rise #TwitJC -8:50 PM twitjournalclub What might be the reasons behind the protective effect of articles about suicidal ideation where suicide was not attempted? #TwitJC -8:50 PM twitjournalclub Does this indicate a potential role for the media in public education on this matter? #TwitJC -8:51 PM dsdarbyshire #TwitJC GPs are sometimes very good at responding to medical media stories, not so sure about mental health. -8:51 PM Assidens @fidouglas makes me wonder if the advent of Twitter had had any impact on rates? #twitjc -8:51 PM fidouglas @dsdarbyshire Though bizarrely, reporting of expert opinion caused an increase in suicides. #TwitJC -8:52 PM

fidouglas @Assidens Social media/forums/whathaveyou can provide patients with a support network of others experiencing the same = beneficial? #TwitJC -8:53 PM doseofnuxvomica @twitjournalclub that it's possible (& common) to have ideas but no plans or intent. evidence that you can live with and work on it. #twitjc -8:53 PM dsdarbyshire #TwitJC we seem to have 5 pieces of a 100 piece jigsaw. -8:53 PM Assidens @fidouglas yes I was thinking that, wondering both positive and negative? #twitjc -8:55 PM dsdarbyshire #TwitJC media and public education, many conflicts. Med profession using the media, better. Very grey middle. -8:55 PM fidouglas @doseofnuxvomica Would most stories about individuals who have experienced suicidal ideation be about celebrities / role models? #TwitJC -8:55 PM 76Lusa01 #twitjc Articles perhaps protect through raising awareness of suicidal tendencies of friends,collegues,...?! -8:55 PM fidouglas The "oh, he/she felt like that, but didn't try to kill themselves, and it got better in the end" thing. Maybe that's protective? #TwitJC -8:56 PM dsdarbyshire #TwitJC can celebs act publicly in the expert patient model? Some good examples come to mind. -8:56 PM PyroClaire Have noticed rolling news seems to over-dramatise more than regular news. Any research on this? #TwitJC -8:57 PM KateT_health True @PyroClaire, mainly cos rolling news have to stretch stories out so thinly, any detail even if imagined is grasped. #twitjc -8:59 PM fidouglas @dsdarbyshire Stephen Fry, Marcus Trescothick, Jack Dee... #TwitJC -8:59 PM Assidens @fidouglas yes, I would hope that talking about the issue, helping people realise they are not alone, would help #twitjc -8:59 PM endless_psych @fidouglas These things are given in the table on page 240 no? #twitjc A focus on support services is found to be protective -8:59 PM doseofnuxvomica @fidouglas i suppose, that's what came to my mind in terms of memorable articles #twitjc -8:59 PM fidouglas If people can see their role models coping, that's going to give them a sense that it's possible to manage, as @doseofnuxvomica says #TwitJC -9:00 PM endless_psych @fidouglas @dsdarbyshire Though expert opinion is grouped as one of the protective factors in the LCA model #twitjc -9:00 PM KateT_health Shameless plug: if you're interested in PH, #PHtwitJC next Sun - still time to vote for a paper http://t.co/guDf9Di2 - polls end Mon #twitjc -9:01 PM fidouglas @endless_psych Oh, what, in the multivariate analysis? Hmm, not significantly so. (P=0.06) #TwitJC -9:01 PM KateT_health Interesting stuff on role models, reporting standards and PH resps of press. I am signing off. thanks all for good #twitjc -9:01 PM twitjournalclub Final point: In what way do the results of this study have implications for other forms of media? #TwitJC -9:01 PM dsdarbyshire #TwitJC I would argue other sources lack the mass penetrance so it's a different and not applicable. -9:04 PM

fidouglas @dsdarbyshire: @endless_psych @fidouglas would that define 'celebs' as experts? #TwitJC -9:05 PM epidemiologista @dsdarbyshire Depends, something like a soap series on tv could have a big impact #twitJC -9:05 PM fidouglas @epidemiologista @dsdarbyshire Viewing figures for TV news probably rather high. I imagine that could have a role. #TwitJC -9:06 PM fidouglas @dsdarbyshire @endless_psych I think I remember reading in the paper that "experts" were psychiatrists. Can't find it now. #TwitJC -9:07 PM Assidens @twitjournalclub this study only considers print? And bearing in mind compared to twitter, print is slow and out of date. #twitjc -9:08 PM dsdarbyshire @epidemiologista #TwitJC perhaps but they lack the repeated 100s of exposures 9:08 PM doseofnuxvomica @fidouglas @dsdarbyshire @endless_psych no, celebs are less like experts and more like 'mates' I think. #twitjc -9:08 PM endless_psych @fidouglas @dsdarbyshire In general terms I don't think that celebrities would be counted as "experts" - advocates perhaps? #twitjc -9:08 PM fidouglas @dsdarbyshire @epidemiologista ...which is something this paper found was related to increased suicide rates... #TwitJC -9:08 PM dsdarbyshire @Assidens @twitjournalclub #TwitJC but millions read papers in UK. Significantly less tweet. Media report tweets though. -9:09 PM dsdarbyshire @doseofnuxvomica @fidouglas @endless_psych #twitjc perhaps social isolation is a factor -9:10 PM endless_psych @dsdarbyshire @doseofnuxvomica @fidouglas Almost certainly #twitjc -9:11 PM Assidens @endless_psych unfortunately I think celebs views are very influential to many. However could be used to positive effect #twitjc -9:11 PM fidouglas @endless_psych @dsdarbyshire @doseofnuxvomica Isn't social isolation one of the main risk factors for suicide anyway? #TwitJC -9:12 PM ram3481 @fidouglas @epidemiologista @dsdarbyshire and women watch more tv(so to believe n the east). the gender aspect needs more attention #TwitJC -9:12 PM Assidens @dsdarbyshire yes, good point #twitjc -9:12 PM dsdarbyshire @fidouglas @endless_psych @doseofnuxvomica #TwitJC exactly, missed comma = missed point, sorry -9:13 PM epidemiologista @ram3481 @fidouglas @dsdarbyshire but rates for suicide are much higher in men (ratio 3:1 I believe) #twitjc -9:13 PM brainduck RT @twitjournalclub: This evening's #TwitJC looks at the role of media reports in suicide. Intro post here: http://t.co/5ixvsIHW Discussion points to follow... -9:13 PM doseofnuxvomica @fidouglas @endless_psych @dsdarbyshire yes #twitjc -9:14 PM 76Lusa01 @ram3481 I agree, Furthermore differnet media target different groups (gender, age...) #twitjc -9:14 PM fidouglas @epidemiologista @ram3481 @fidouglas @dsdarbyshire Rates of suicide *attempts* are higher in women tho. #TwitJC -9:14 PM

endless_psych @epidemiologista @ram3481 @fidouglas @dsdarbyshire IIRC that could be down to method choice. #twitjc -9:14 PM twitjournalclub Thanks everyone for contributing this evening. I'm signing off but feel free to continue chatting. Transcript & summary to follow. #TwitJC -9:15 PM dsdarbyshire #TwitJC things like radio1 Sunday surgery are an excellent model. Targeted and conscientious. -9:16 PM doseofnuxvomica @fidouglas @epidemiologista @ram3481 @dsdarbyshire we are talking about suicide with intent to kill self. #twitjc -9:17 PM fidouglas Best reporting of suicide I've seen this year was Test Match Special's "Depression in Cricket" special. It was very, very well done. #TwitJC -9:17 PM Assidens Have to go now, thanks to @fidouglas , thanks all, thought provoking discussion :-) #twitjc -9:18 PM fidouglas @doseofnuxvomica Still, I thought more women attempted suicide, just were less likely to complete. (Ignoring non-suicidal ODs etc) #TwitJC -9:18 PM Assidens RT @dsdarbyshire: #TwitJC things like radio1 Sunday surgery are an excellent model. Targeted and conscientious. -9:18 PM fidouglas @doseofnuxvomica You're the one who's the trainee psych though! :-) I'm just going on what I've read (which may be wrong) #TwitJC -9:20 PM ram3481 @fidouglas yes I agree on that "Depression in Cricket" #TwitJC -9:23 PM brainduck @fidouglas @doseofnuxvomica yes. Women often use less effective methods. OD rather than violence. #TwitJC -9:25 PM doseofnuxvomica @brainduck @fidouglas yes but these 'suicide attempts' are not necessarily ass. with intent to kill oneself? wording is unclear. #twitjc -9:29 PM hedgehogtweets Great to see a paper about mental health on #TwitJC -9:30 PM brainduck Rowntree Trust doing interesting work on social isolation (re risk factors) #twitJC -9:30 PM fidouglas @doseofnuxvomica Oh OK. I thought non-suicidal overdoses were described as being a form of deliberate self harm. #TwitJC -9:31 PM fidouglas @doseofnuxvomica but on a patient-by-patient level I suppose sometimes it's difficult to know. #TwitJC -9:31 PM davecurtis314 @fidouglas @doseofnuxvomica Yes, ODs are classified as DSH. #twitjc -9:34 PM brainduck @doseofnuxvomica @fidouglas compliated. more women complete suicide by OD too. Intent not always clear #twitJC -9:35 PM fidouglas @davecurtis314 @doseofnuxvomica How do you ascertain if there was suicidal intent or not? Just ask the patient? #TwitJC -9:35 PM doseofnuxvomica @fidouglas @davecurtis314 yes. you have to find out what they thought the act would do to them, what they wanted to happen. #twitjc -9:37 PM fidouglas @doseofnuxvomica @davecurtis314 Oh ok, and then presumably from that you know if it was a suicide attempt or DSH? #TwitJC -9:38 PM hedgehogtweets @fidouglas @doseofnuxvomica @brainduck in Ireland now significant increase in self harm in young men since recession dont know reUK #twitjc -9:40 PM

doseofnuxvomica @fidouglas @davecurtis314 yes and it depends on patient's level of knowledge. what won't and will harm them sufficiently etc #twitjc -9:41 PM doseofnuxvomica @davecurtis314 @fidouglas yes, with my little experience, i find it easier and more accurate to describe act and intent. #twitjc -9:43 PM fidouglas @davecurtis314 @doseofnuxvomica I guess both are indicative of a pt being quite unwell & can never know for sure what intent was. #twitjc -9:45 PM davecurtis314 Plus let's not forget that there's no actual "evidence" about any of this. Just "clinical judgement". #twitjc -9:45 PM hedgehogtweets interesting NICE guidelines dropped the 'deliberate' as self harm can be 'seemingly out of the persons control or even awareness' #twitjc -9:46 PM doseofnuxvomica @davecurtis314 hence why you need to do a thorough assessment and, if necessary, discuss with colleagues #twitjc -9:47 PM