Introduction

Suicide is a major public health issue in India. As per the latest report of the National Crime Records Bureau (NCRB), the suicide rate in India was 12.4 per 100,000 population in the year 2022 (NCRB, 2023). Many of those attempting suicide leave notes providing some idea of their mental state (Foster, 2003;Freuchen and Grøholt, 2015;Mejías-Martín et al., 2023;Namratha et al., 2015). Prior studies that analysed such notes found major themes such as reasons for suicide; feelings of shame/guilt/apology; concerns and love for those left behind; feeling of being a burden; instruction or guidance about practical affairs; and hopelessness (Foster, 2003;Freuchen and Grøholt, 2015;Namratha et al., 2015). Understanding the content of suicide notes may help mental health professionals understand the underlying issues, thus, formulating a suicide prevention plan for vulnerable individuals. These notes are also indicative of the lethality of suicide attempts: when an individual with suicidal ideation writes a note, it increases the risk of attempting suicide (Huppert et al., 2023).

Suicide, being a horrifying event, often catches the attention of the media which often narrates the suicide stories in a detailed, explicit, and at times, sensational manner (Arafat, Shoib, et al. 2020;Arafat, Kar, et al., 2020 ;Arafat et al., 2021;Armstrong et al., 2018, 2018 ;Chandra et al., 2014 ; Menon, Kar, et al., 2020). This manner of reporting of suicide has detrimental effects on vulnerable individuals in society (Niederkrotenthaler et al., 2010a, 2010b). To regulate the media reporting of suicide, several guidelines and recommendations have been issued by the World Health Organization (WHO) and other international bodies (Acosta Artiles et al., 2017; Menon, Kar, Ransing, et al., 2021). According to the WHO recommendations, mention of suicide notes in media reports is potentially harmful as it may glorify, romanticize, and identify the individual and family members (Acosta Artiles et al., 2017). There is a prevalence of reporting of suicide notes in the media. However there is a wide variation in how this is presented to the public (Arafat, Kar, et al., 2020;Arafat et al., 2021 ;Armstrong et al., 2018 ;Chandra et al., 2014; Kar et al., 2021, 2022; Menon, Kar, et al., 2020; Menon, Mani, et al., 2021)4 from Bangladesh, one from Indonesia, one from Sri Lanka and one from Bhutan. In this study, we attempt to analyse the content of media reports on suicide, focusing on the descriptions of the suicide notes.

Methods

A total of seven investigators screened media reports on suicide published in Odia, Malayalam and English, published in Odisha and Kerala. We extracted details from previous data used for assessing the quality of media reporting in India (Odisha and Kerla) (Kar et al., 2022; Menon, Mani, et al., 2021). Investigators searching for suicide reports in English and Odia, used printed newspapers, whereas those searching in Malayalam used online news portals. This search was from mid-2019 to mid-2020. The data was extracted in a predesigned sheet. Information about different components of suicide notes such as direct quotes, summary, photograph of the note, reference to any person, mention of shame, blame, guilt or any other attributes, were extracted from the media reports on suicides that occurred in the jurisdiction of Odisha and Kerala. Reports of suicide bombings, medically assisted suicide and mass suicides were excluded. The newspapers selected were on the basis of their wider readership in the region.

Formal ethical approval was not required as the data is taken from publicly available and accessible information. Data extracted from the excel sheet was presented using descriptive statistics (as frequencies and percentages) and analyzed using R (R Core Team, 2023).

Results

There were 625 news reports on suicide (English, n=277; Malayalam, n=218; Odia, n=130) were identified, out of which 10.7% (n=67) mentioned a suicide note. Most were in English language reports (n=41), followed by Malayalam (n=20) and Odia (n=6). The summary of the suicide note was mentioned in nearly 3/5ths of the reports (n=40). About 41% (n=27) of the suicide notes had reference to other persons. Only 44% (n=29) had attributed reasons like shame, blame or guilt. No reports mentioned a photo of the suicide note (Table 1).

Table 1

Discussion

We sought to analyze media reports on suicide that mentioned suicide notes and published between mid-2019 and mid-2020 in English newspapers and vernacular dailies. The main finding was that there is mention of suicide notes with a majority providing a summary of the note. There were more reports on suicide notes in English language dailies than in local vernacular dailies. This is a potentially harmful reporting practice and a clear breach of the WHO recommendations, 2023 (Preventing Suicide, 2023).

Such a focused analysis of suicide note content has been infrequent. Previous studies have mentioned the presence of suicide notes in media reports; figures quoted were in the range of 4.7%-10.5% (Menon et al., 2022, 2023, 2023; Menon, Kaliamoorthy, et al., 2020; Menon, Kar, Marthoenis, et al., 2021) there has been no systematic analysis of media reporting of suicide in Puducherry, a consistently high suicide burden state in India. Providing a summary of the suicide note mentioning the reference to any person and attributing reasons of shame, guilt, and others has significant implications. The audience of such newspaper reports, especially online, would be much larger. Firstly, it is distressing for the family and friends of the deceased. Secondly, it results in the glorification of suicide, which could potentially trigger imitative suicides among vulnerable individuals via identification or similarity bias (Preventing Suicide, 2023). Previous studies that have analysed the actual suicide notes reported that many of them had content suggesting an apology or feelings of shame and guilt (Mejías-Martín et al., 2023;Namratha et al., 2015), similar to the present study. A recent qualitative study among media professionals has highlighted that it is routine to mention if there is a suicide note or not in news reports thus increasing the newsworthiness of the report, especially when there is a reference to a particular person or a causal situation. The general notion is that the suicide victim did not lie and conveyed their emotions/feelings and reasons through the note. Also, crime-beat reporters and the police play a critical role in suicide reporting. Police personnel must be educated to refrain from providing confidential details like suicide notes to reporters or any media professionals (Armstrong et al., 2020). Additionally, adequate awareness among news reporters is warranted, highlighting the harmful impact of reporting details of suicide notes and the importance of sensible reporting.

Our study has certain limitations. Due to practical difficulties, not all local language newspapers could be included. Observer bias could result from the use of single coders analysing the reports: this was minimised by an initial training session given by a senior psychiatrist with prior experience of conducting such studies on the questionnaire responses and data coding.

Conclusion

The study revealed the quality of media reporting of suicide, with a specific focus on suicide notes in India. It presents a similar quality of media reporting like other domains that predominate a high presence of negative characteristics and a negligible presence of positive reporting characteristics.

DECLARATIONS

Acknowledgements

None

Authors’ contribution

Conceptualisation: Sujita Kumar Kar, Vikas Menon

Data extraction: Sujita Kumar Kar, Natarajan Varadharajan, Jigyansa Ipsita Pattnaik, Rosali Bhoi, Anu Mary Mani, Neetu Kurian, Sreeja Sahadevan, Sreeja Sreekumar, Sandesh Venu

Data analysis: Sujita Kumar Kar

Manuscript writing: Sujita Kumar Kar, Natarajan Varadharajan, S. M. Yasir Arafat, Vikas Menon, Jigyansa Ipsita Pattnaik, Susanta Kumar Padhy

Manuscript editing: Sujita Kumar Kar, S. M. Yasir Arafat, Vikas Menon, Susanta Kumar Padhy

All authors approved the final version of the paper.

Conflicts of interest

None

Ethical approval

Not applicable.

Funding

None

Informed consent

Not applicable

Study registration

None

References

1. Acosta Artiles FJ, Rodriguez Rodríguez-Caro CJ and Cejas Méndez MR (2017) [Reporting on Suicide. WHO recommendations for the Media.]. Revista Espanola De Salud Publica 91: e201710040.
2. Arafat SMY, Shoib S, Marthoenis M, et al. (2020) Media reporting of suicide in Muslim countries. Mental Health, Religion & Culture 3(10), 941–944..DOI
3. Arafat SMY, Kar SK, Marthoenis M, et al. (2020) Quality of media reporting of suicidal behaviors in South-East Asia. Neurology, Psychiatry and Brain Research 37: 21–26..DOI
4. Menon, V., Kar, S. K., Varadharajan, N., Kaliamoorthy, C., Pattnaik, J. I., Sharma, G., Mukherjee, S., Shirahatti, N. B., Ransing, R., Padhy, S. K., & Arafat, S. M. Y. (2022). Quality of media reporting following a celebrity suicide in India. Journal of public health (Oxford, England), 44(1), e133–e140..DOI
5. Armstrong G, Vijayakumar L, Niederkrotenthaler T, et al. (2018) Assessing the quality of media reporting of suicide news in India against World Health Organization guidelines: A content analysis study of nine major newspapers in Tamil Nadu. Australian & New Zealand Journal of Psychiatry 52(9):856–863..DOI
6. Armstrong G, Vijayakumar L, Cherian AV, et al. (2020) “It’s a battle for eyeballs and suicide is clickbait”: The media experience of suicide reporting in India. PLOS ONE 15(9): e0239280..DOI
7. Chandra PS, Doraiswamy P, Padmanabh A, et al. (2014) Do newspaper reports of suicides comply with standard suicide reporting guidelines? A study from Bangalore, India. International journal of social psychiatry 60(7): 687–694..DOI
8. Foster T (2003) Suicide note themes and suicide prevention. International Journal of Psychiatry in Medicine 33(4): 323–331..DOI
9. Freuchen A and Grøholt B (2015) Characteristics of suicide notes of children and young adolescents: an examination of the notes from suicide victims 15 years and younger. Clinical Child Psychology and Psychiatry 20(2): 194–206..DOI
10. Huppert TK, Fruhbauerova M, Kerbrat AH, et al. (2023) Suicide Notes, Attempts, and Attempt Lethality During Episodes of Ideation Among Suicidal Soldiers and Marines. Archives of Suicide Research 27(2): 261–274..DOI
11. Kar, S. K., Shukla, S., Rai, S., Sharma, N., Roy, D., Menon, V., & Arafat, S. M. Y. (2022). Assessing the Quality of Suicide Reporting in Online Newspapers in Uttar Pradesh, India, According to World Health Organization Guidelines. Crisis, 43(2), 142–148..DOI
12. Kar SK, Padhy SK, Bhoi R, et al. (2022) Quality of newspaper reporting of suicide in Odisha, India, against the World Health Organization guidelines. Indian Journal of Psychiatry 64(1): 80. 10.4103/indianjpsychiatry.indianjpsychiatry_398_21.
13. Mejías-Martín Y, Martí-García C, Rodríguez-Mejías Y, et al. (2023a) Understanding for Prevention: Qualitative and Quantitative Analyses of Suicide Notes and Forensic Reports. International Journal of Environmental Research and Public Health 20(3): 2281..DOI
14. Menon V, Kaliamoorthy C, Sridhar VK, et al. (2020) Do Tamil newspapers educate the public about suicide? Content analysis from a high suicide Union Territory in India. The International Journal of Social Psychiatry 66(8): 785–791..DOI
15. Menon, V., Kar, S. K., Varadharajan, N., Kaliamoorthy, C., Pattnaik, J. I., Sharma, G., Mukherjee, S., Shirahatti, N. B., Ransing, R., Padhy, S. K., & Arafat, S. M. Y. (2022). Quality of media reporting following a celebrity suicide in India. Journal of public health (Oxford, England), 44(1), e133–e140..DOI
16. Menon V, Kar SK, Marthoenis M, et al. (2021) Is there any link between celebrity suicide and further suicidal behaviour in India? The International Journal of Social Psychiatry 67(5): 453–460..DOI
17. Menon V, Kar SK, Ransing R, et al. (2021) National Media Monitoring Agency for reporting of suicide: An idea whose time has come? Asian Journal of Psychiatry 55: 102516..DOI
18. Menon V, Mani AM, Kurian N, et al. (2021) Newspaper reporting of suicide news in a high suicide burden state in India: Is it compliant with international reporting guidelines? Asian Journal of Psychiatry 60: 102647..DOI
19. Menon V, Kar SK, Ransing R, et al. (2022) Changing trends in quality of media reporting of suicide in the community following a celebrity suicide in India. The Australian and New Zealand Journal of Psychiatry 56(1): 81–90..DOI
20. Menon V, Kar SK, Ransing R, et al. (2023) Long-Term Changes in the Quality of Media Reporting of Suicide Following a Celebrity Suicide in India. Omega : 302228231189849..DOI
21. Namratha P, Kishor M, Sathyanarayana Rao TS, et al. (2015) Mysore study: A study of suicide notes. Indian Journal of Psychiatry 57(4): 379–382..DOI
22. NCRB (2023) Accidental Deaths & Suicides in India (ADSI). National Crime Records Bureau. Available at: https://ncrb.gov.in/uploads/nationalcrimerecordsbureau/custom/adsiyearwise2022/170161093707Chapter-2Suicides.pdf (accessed 9 January 2024).
23. Niederkrotenthaler T, Voracek M, Herberth A, et al. (2010a) Papageno v Werther effect. BMJ: British Medical Journal (Online) 341..DOI
24. Niederkrotenthaler T, Voracek M, Herberth A, et al. (2010b) Role of media reports in completed and prevented suicide: Werther v. Papageno effects. The British Journal of Psychiatry 197(3):234–243..DOI
25. Preventing Suicide (2023) Geneva: World Health Organization. https://www.who.int/publications/i/item/9789240076846.
26. R Core Team (2023). R: A Language and Environment for Statistical Computing_. R Foundation for Statistical Computing, Vienna, Austria. <https://www.R-project.org/>.).