INTRODUCTION

\s1Suicide is one of the most important mental health problems throughout the world. Psychiatric disorders are the prime responsible factors for suicide (World Health Organization [WHO], 2017; Zalsman and others, 2016). Additionally, several other factors contribute to suicide in a causal role where identification of monocausality has fundamentally challenged by empirical studies. Media reporting of suicide serves a significant purpose of building awareness and formulating suicide prevention policy in the general population. Additionally, irresponsible media reporting can lead to an increased risk of suicide contagion or copy-cat suicide (Niederkrotenthaler and others, 2020; Zalsman and others, 2016; WHO, 2017).

The World Health Organization (WHO)and the International Association for Suicide Prevention (IASP)formulated guidelines on media reporting of suicide to reduce irresponsible media reporting (WHO, 2017). However, the media reporting guidelines on suicide are poorly implemented and followed in most Muslim countries (Arafat and others, 2020a). Although the prevalence of suicide is found to be low in Islamic countries like Iran, in comparison to Western countries, there is evidence of under-reporting of suicide cases in Islamic countries including in Iran (Pritchard and others, 2020). The total suicide rate in Iran is 5.3 per 100,000 people and male versus female is 3.6 vs 7 (Mirhashemi and others, 2016). The suicide rate is more in the urban population and drug overdose and self-immolation are the common methods of suicide.

Media reporting of suicide influences the suicidal behaviour of the general population, particularly those who are at risk of suicide. However, it hasn t been assessed adequately as there is only one recent study published assessing the quality of media reporting of suicide in Iran (Nabardi and others, 2021). No subsequent reports was identified specially during the Covid-19 pandemic. Therefore, we aimed to assess the quality of news reporting on suicide in Iran during the pandemic to compare and compile with existing findings in the country.

METHODS

Data collection

An exploratory search was conducted in March and April 2021 on Googleusing the term suicide news in Iran (in the Farsi language: [Akhbare khodkoshi dar Iran), and online news stories published between January and December 2020 in the Farsi language were extracted. Iran has been devastatingly affected by Covid-19 pandemic during 2020. Scrutiny was performed to analyse the contents of the reports against the WHO mentioned potentially harmful and help characteristics of media reporting. Three authors (ARA, AKS, & OF) collected the data those have expertise in Farsi. Among the data enumerators, Farsi is the first language of one author (OF), and rest two authors have the expertise as a second language (). We attempted to include a maximum number of reports in a year and included all the available news reports on suicidal behaviour. The estimation of circulation was challenging as we included only online news reports.

Inclusion and exclusion criteria

We included news of Iranian citizens living in Iran who had died by suicide or had non-fatal attempts. We excluded the news reports with any sort of controversies such as ambiguity on whether it was suicide, homicide or accidental death. We intended to exclude the reports of suicide bombings and reports related to physician-assisted suicide, but we couldn t find any during the study period (January to December 2020).

Instrument

We used a standardised instrument that had previously been used in studies evaluating the accuracy of media coverage in Iraq and Bangladesh (Arafat and others 2020b; Arafat and others, 2022). The tool adopted WHO criteria for reporting suicides in the media (WHO, 2017). The WHO guidelines examined variables linked to suicidal activity, as well as potentially harmful and helpful reporting features. We looked at the potentially negative aspects of WHO media guidelines including mentioning the deceased s identity (name, occupation), identifying, and detailing the means of suicide, analysing news headlines for the word suicide in it, mentioning the method in it, mentioning any precipitating life event, nd sharing photos of the deceased. We also looked at the WHO media guideline s potentially helpful characteristics, such as mentioning the role of mental illness and addiction, providing suicide and suicide prevention education, expert opinions on suicide, discussing research findings, explaining suicide statistics, mentioning available prevention programmes, and giving contact information for suicide prevention. Although we conducted the study during the Covid-19 pandemic we didn t assess any association of suicide with the Covid-19 infection, impact, and/or containment strategies. We focused on the WHO criteria so that this study can be compared to others conducted during the Covid-19 free days.

Statistical analysis

Data was analysed by the Statistical Program for the Social Science (SPSS) version 21 and the Microsoft Excel 2007 version. The data were presented using descriptive statistics (frequency and percentage).

Ethical statement

No formal ethical approval was obtained because the analysis reviewed publicly accessible news reports. While conducting the study, we conformed to Helsinki s declaration (1964).

RESULTS

Distribution of the news reports

A total of 125 news reports published in Farsi was retrieved from 13 newspapers. The highest number (n=19; 15.2%) of reports was collected from the Etemad followed by the Mehr (n=17; 13.6%), the Khorasan (n=16, 12.8%), the Tasnim (n=16, 12.8%), the Borna (n=13, 10.4%), the Sharq, the Hamshahri, the Shahrvand, the Dunyaye Eqtesad, the Aftab Yazd, the Aftabnews, the Jame Jam, and the Bahar (Table 1). The majority of the reports (n=33, 26.4%) were published in October, followed by November (n=24, 19.2%), September (n=16, 12.8%), August (n=13, 10.4%), May, and others (Table 1).

Potentially harmful characteristics

Among the 125 reports, 50 (40%) mentioned the name, and 62 (49.6%) mentioned the occupation of the deceased. The name of the method was mentioned in 111 (88.9%) reports, monocausality was reported in 49 reports (39.2%), the word suicide was mentioned in the headline in 117 reports (93.6%), and the suicide method was reported in the title of 34 reports (27.2%) (Table 2). In ten reports (8%), suicidal notes were found and in six reports (4.8%) quotes from those notes were mentioned.

Among the 125 reports, 106 (84.8%) published a photo, and 32 (25.6%) published the photo of the deceased (Table 2). The rest of the reports provided different images such as scenes, material, and symbolic photos.

Potentially helpful characteristics

Among the 125 reports, only four (3.2%) reports mentioned psychiatric disorders, two (1.6%) reports mentioned substance abuse, 13 (10.4%) disseminate expert opinion, and none of the reports mentioned prevention programmes, helpful contact identity, and educative information (Table 3).

DISCUSSION

Main findings of the study

The major finding of the study was that Farsi news reports in Iran were poorly adherent to suicide reporting guidelines while describing suicide stories. On the one hand, potentially harmful reporting characteristics such as mentioning the identity of the deceased, naming the method used by the decedent, monocausal attributions of suicide, and illustrating the report with photographs of the deceased and location of suicide were commonly observed (Table 2). On the other hand, there was very little focus on educating the public and spreading awareness about suicide prevention resources; none of the reports included details about suicide support services such as helplines (Table 3).

Implication of study findings

Our study findings broadly concur with few available reports on media suicide reporting trends from Muslim nations (Arafat and others, 2022; Arafat and others, 2019; Mesbah, 2014; Nisa and others, 2020; Komboh and Ittefaq, 2019) and suggest a need for remedial measures though elsewhere, the quality of media reporting of suicide appears to be improving (McTernan and others, 2018). Use of detailed language to describe the identity of the person such as name (40%) and occupation of the method (49.6%) was a common practice; these figures are lesser compared to reports from Kashmir, Indonesia, and Bangladesh (Shoib and Arafat, 2021; Nisa and others, 2020, Arafat and others, 2020b) comparable to studies from other South Asian countries (Arafat and others, 2021), and much higher than developed nations. Likewise, frequency of reporting violations such as mentioning the name (88.8%) and details (48.8%) of the suicide method were comparable with figures from Muslim nations namely, Egypt, Indonesia, and Bangladesh (Mesbah, 2014; Arafat and others, 2019; Nisa and others, 2020). A robust body of evidence suggests a clear link between explicit media portrayal of the suicide methods and imitative suicide probably by serving as a model to those vulnerable (Fink and others, 2018; Hegerl and others, 2013).

More than a third of the reports (39.2%) offered monocausal explanations for suicide. These figures are in line with reporting trends from Islamic countries like Pakistan, and Bangladesh (Komboh and Ittefaq, 2019;Arafat and others, 2020b) and non-Islamic Asian nations like India, and Sri Lanka) (Armstrong and others, 2018; Brandt S\'f8rensen and others, 2019) though such practices were less common in the Western countries (Niederkrotenthaler and others, 2010; McTernan and others, 2018). Attributing suicide to a single cause is neither likely to be accurate or valid as suicide is a complex multidimensional human behaviour; worse, ascribing suicide to a single cause, such as job loss, may promote identification with the deceased and imitative suicidal behaviour by those experiencing similar stressors (The Samaritans, 2013). Hence, this practice is should be considered a major concern at least in Iran.

The majority (84.8%) of Farsi news report suicide stories also had an accompanying photograph with over a quarter (25.6%) of reports carrying a photograph of the deceased and others choosing to provide images of the suicide scene or location. Prior reports from Asia have shown wide variation in this aspect. Whereas some Muslim nations namely Bangladesh, and Egypt (Arafat and others, 2020b; Mesbah, 2014) and other Asian countries namely, India and Sri Lanka (Brandt S\'f8rensen and others, 2019; Arafat and others, 202) have shown lower rates of pictorial representation, figures from a neighboring country (Iraq) were comparable (Arafat and others, 2022). Vivid, pictorial illustrations of suicide news are a clear breach of reporting guidelines and can influence vulnerable readers; in particular, adding images of location has been shown to attract distressed readers to suicide hot-spots (Reisch and others, 2005; The Samaritans, 2013) and so this reporting trend must be curbed.

We also observed a minimal focus on helpful reporting aspects; few reports included any educational content and none discussed suicide prevention resources. These findings concur with that of Asian Muslim, non-Muslim, nations (Arafat and others, 2022; Arafat and others, 2020a,b; Arafat and others, 2019; Mesbah, 2014; Komboh and Ittefaq, 2019;Brandt S\'f8rensen and others, 2019) have shown better compliance regarding the inclusion of information on suicide help lines, often crucial for readers who may be contemplating suicide. Overall, these findings suggest a lack of awareness among media professionals about the role of media in educating the public about suicide and its complex, multidimensional nature.

Responsible factors and recommendations

Several factors may be responsible for the observed sub-optimal adherence to suicide reporting guidelines in Iran. Under-reporting of suicide due to religious and cultural stigma as well as discrepancies in suicide data collection methods between the Ministry of Health and Iranian Legal Medicine Organization, the two nodal agencies involved in suicide surveillance in Iran, hinder accurate national suicide statistics and formulation of effective national policies on suicide prevention (Hassanian-Moghaddam and Zamani, 2017). Further, qualitative studies of media journalists in Asian nations point to systemic barriers in reporting; these include the constant pressure on journalists to create newsworthy content where the focus is often on the speed of breaking news than the accuracy or quality of reporting (Armstrong and others, 2020). Adequate awareness among the reporters and editors regarding the impact of insensible reporting could be the fundamental initiative. Enduring training and motivation should be implemented to monitor and sustain the quality of media reporting. A meaningful collaboration between media and mental health professionals would be an important addition. Also, given the systemic barriers to responsible and accurate media reporting of suicide, a practical strategy based on collaboration, advocacy, and support for media professionals is desirable (Arafat and others, 2020b). Country-specific research, using qualitative designs, should be undertaken to elicit data on awareness and perceived barriers to reporting; this information would support the formulation of reporting guidelines with greater uptake and impact. Formulation of a national media monitoring agency could be tested as proposed by a group of authors (Menon and others, 2021) to improve the status quo of suicide reporting in Farsi.

Strengths of the study

This is one of the studies evaluating the quality of news reporting during the COVID-19 pandemic and will serve as the framework for formulating suicide strategy in the general population and recommends policymakers about the depth of the problem.

Limitations

The study has several limitations. Firstly, the sample size was comparatively small that may be due to effect of the COVID-19 pandemic. Secondly, the news reports were searched and collected by Google search that may exclude a portion of reports published in print newspapers. Thirdly, we analysed reports published in only the Farsi languge which may hinder the generalisation study results as news reports published in English would reveal different scenarios. Fourthly, we analysed reports of one year duration. However, follow-up studies with a longer study duration may reveal a different context. Fifthly, data was collected during the COVID-19 pandemic in Iran and that might have an effect on the reporting. Sixthly, inter-rater variability of data was not assessed which could be a potential source of bias.

CONCLUSION

The study showed that Farsi news reports were not firmly compliant with WHO guidelines for reporting suicide during the COVID-19 pandemic. On the one hand, potentially harmful reporting characteristics were commonly observed. However, there was little focus on educating the public and spreading awareness about suicide prevention resources. Additional research studies are warranted to consider these findings, to ensure accountable media reporting and to assess and modify the national suicide prevention strategies in Iran.

Data availability statement:

The raw data supporting the conclusions of this paper will be provided on request to the corresponding author.

Author contributions:

ARA, AKS, and OF contributed to data collection and writing. SMYA, contributed to the concept, design, and writing. All authors contributed to manuscript writing, revision, read, and approved the submitted version.

Funding:

None.

Conflict of Interest:

The authors state that, in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest, the research was conducted.

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