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ORIGINAL ARTICLE
Year : 2021  |  Volume : 35  |  Issue : 1  |  Page : 7-12

Media and suicidality during the surge of Thai student suicides in 2019: A hospital-based study


Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

Date of Submission05-Feb-2021
Date of Decision19-Jun-2021
Date of Acceptance24-Jun-2021
Date of Web Publication04-Aug-2021

Correspondence Address:
Chonnakarn Jatchavala
Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jms.jms_29_21

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  Abstract 


Background: During the 2 months of February and March 2019, more than 10 Thai university students were official reported to have committed suicide, which may impact on others' suicidality.
Aims: This study aims to examine media and other factors influenced suicidal ideation among Thai university students, during the crisis of suicidal height in March–April 2019.
Methods: The study was of a retrospective and cross-sectional design. Patients, who were university students and accessed the psychiatric outpatient clinic in March–April 2019, were recruited. Data collected by the hospital's databased system included patient profiles, perceptions of media influencing suicidality, and the Thai version of the suicide screening test.
Results: Of the 68 participants, most participants were female (75.0%). They mostly stated that they were at a high risk of suicide (35.0%); whereas those who reported that the media influenced them were shown to have 3.5 times, higher risk of suicide (P = 0.012). Moreover, the moderate risk of suicide was statistically significantly associated with media, while other variables did not associate with suicidal risk (P = 0.03).
Conclusion: During the crisis of copycat suicides, among Thai university students; most of whom were psychiatric outpatients, were at high risk for suicide. In addition, those who reported that the media had influenced them demonstrated a higher risk of suicide. Moreover, those who were at moderate risk for suicide were significantly associated with media.

Keywords: Imitative behavior, media, student, suicide, Thailand


How to cite this article:
Jatchavala C, Pongthanawisut S. Media and suicidality during the surge of Thai student suicides in 2019: A hospital-based study. J Med Soc 2021;35:7-12

How to cite this URL:
Jatchavala C, Pongthanawisut S. Media and suicidality during the surge of Thai student suicides in 2019: A hospital-based study. J Med Soc [serial online] 2021 [cited 2021 Oct 22];35:7-12. Available from: https://www.jmedsoc.org/text.asp?2021/35/1/7/323159




  Introduction Top


Globally, suicide is a serious mental health problem, and it is the second leading cause of death among young people (15–29 years of age).[1] Suicide and mental illnesses have been especially associated with depression and alcohol use disorders.[1] The WHO also reported that 79.0% of suicides occur globally in low- and middle-income countries, which includes Thailand.[1] Even though the highest suicidal rate is in adulthood, there is an increasing rate of suicides in young people, with previous suicide attempts being the strongest predictor.[2] One method of prevention and control, as testified by the WHO (2019), is “responsible reporting” in the media.[1]

Although many studies have shown that suicide is a complex phenomenon, that includes risk factors, causes, and outcomes, “social learning” is a theoretical ground of suicide; especially copycat suicide or suicide contagion.[3] However, suicide contagion or: “exposure to suicide behavior” (ESB), by the mass media remains to be a debatable issue, as to whether it is a factor in suicidality. This is because most studies that support the concept of suicide contagion develop an association between the rate of suicide and mass media platforms.[4] However, it can also be said that mass media creates copycat suicides when the social influence is “strong.[3] Howbeit, “celebrity status” was found to be the only predictor of copycat suicides, while the female gender was a risk factor of suicide contagion among young people exposed to suicidality of family and friends.[5],[6] Several researchers argue that suicide contagion occurs only in a specific, valuable population, for example, the unemployed.[7],[8] Mental illnesses, such as depression and alcohol addiction, were reported to be strongly associated to all kinds of suicide.[1] Although the major risk factors for suicide among Chinese university students were depression and anxiety, while loneliness and anxiety were found as risk factors in South East Asian adolescents.[9],[10]

Cognitive dissonance was reported as the trigger for suicide contagion among high school students in the US, which is a result from mass media's coverage;[11] although, another study reported that social media was not related to suicidal ideation, rather being a protective factor among university students in Mexico.[12] However, no previous study has specifically addressed suicide contagion and involvement of the media in Thailand. Particularly between the 2 months of February and March 2019; wherein, more than 10, Thai, university students were reported has having committed suicide. Six of these students committed suicide, by very similar methods, during the 1st week of March [Figure 1].[13]
Figure 1: Timeline of official report of suicides among Thai university students, during the height of suicide in 2019 (nationwide)

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Hence, this study set out to determine suicidal risk and its' associated factors; especially effects of the media on suicidal ideation and suicide attempts in psychiatric outpatients; who were university students at a university hospital in Southern Thailand, during the atypical suicidal height in March 2019. The hypothesis of this study was: Some intrinsic, extrinsic factors, and media had an influence on young people's suicidal ideas and behaviors, during the phase of suicide contagion.[14] Information from this study should be beneficial for clinical practice in the critical period of suicide contagion. As well as for developing a suicide prevention strategy within Thai, university campuses, and for the national policies on suicidal intervention among Thai adolescents.


  Methods Top


This study was endorsed by the Faculty's Ethics Committee (REC.62–373–3–1) and was a part of a larger project. Thus, the design of this research was a quantitative, cross-sectional, and retrospective study of descriptive epidemiology.

Participants

The target population were university students with psychiatric diseases, who accessed the outpatient psychiatric unit, of Prince of Songkla University Hospital, located in southern Thailand; during the 4-week period between March and April 2019. Therefore, the participants were all psychiatric outpatients, who were currently studying higher education within Thai universities; aged between 18 and 25 years old, without serious physical diseases, or illegal substance use.

The participants, following the inclusion criteria, were automatically recruited and enrolled via the hospital database system during the 4-week period of suicide contagion among Thai university students. Hence, researchers collected raw data from the database, before cleaning the data for analysis preparation. Patients, having incomplete information, in regard to the study's measurement, were excluded from the study.

Measurement

Following the atypical height of suicide among Thai university students in the 1st week of March 2019, the university increased surveillance on student's suicide. Implicated interviews and measurements were urgently conducted by psychiatrists as well as other mental health care providers, as per usual practice at the psychiatric outpatient clinic.

Information from medical records, stored in the hospital's database, was collected as follows:

  1. Patient profile: Age, hometown, affiliation
  2. Psychiatric diagnoses (classified by the International Classification of Diseases (ICD)-10 code, as the Thai government officially indicated), course of treatment, and duration of untreated illness
  3. Physical comorbidities (classified by ICD-10 code, as the Thai government officially indicated)
  4. Thai version of the suicide screening test (8Q score), by the Department of Mental Health, Ministry of Public health, Thailand, which the sensitivity and specificity were found to be 0.96 and 0.91, respectively.[15]


The psychiatrists categorized and recorded 8Q scores into four groups, designed for the mental health personnel practices as:[14],[15]

  • No risk (score 0)
  • Low risk (score 1–8)
  • Moderate risk (score 9–16)
  • High risk (score 17).
  • Perception of media influenced patients' suicidality, collected from psychiatrist's direct interviews from medical records. Following discussion on their suicidal risk, from the screening test (Thai-8Q) and suicide contagion among Thai university students nationwide, psychiatrists asked the participants directly; “Have you perceived media influence on your suicidal thoughts and behaviors during the past 4-week? The results were collected from: “yes” or “no” answers.


Statistical analysis

Descriptive data were employed by univariate analysis with Chi-square for assessing associated factors of suicidal risks. Therefore, multivariate analysis, with logistic regression was conducted to determine the association between media influence and suicidal risk. All data were analyzed by Program R. A P < 0.05 indicated statistical significance


  Results Top


Demographic information

As shown in [Table 1], 68 university students (80 visits) accessed the outpatient psychiatric clinic and had all required information completed. 75.0% of them were female with an average age of 22.5 years old. Most of them were Thai, Buddhist, and lived in Southern Thailand (97.1%, 82.4%, and 92.6%, respectively). Participants mainly studied within the faculties of social science, and had been diagnosed with depressive disorders; such as dysthymia, major depress disorder, and recurrent depressive disorders (50.0%), without physical comorbidity (63.2%). The average duration of untreated diseases was 3.00 months, (interquartile range [IQR] 1.00, 12.00) and duration of treatment was 6.67 months (IQR = 1.94, 15.75).
Table 1: Demographic information

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Suicidal risk and impact of media on university students

During the 4 weeks of the survey in March and April 2019, most of the 80 visits at the outpatient psychiatric clinic, 68 university students, reported a high risk of suicide (35.0%), with a median score of 9.5, which was moderate suicidal risk. From this, 26.2% of participants perceived that the media had no influence on their suicidal ideation; whereas 61.3% of them described media, at that time, considerably induced their suicidal ideation and planning. Regarding medical records, no attempt was reported to their psychiatrists through interviewing [Table 2].
Table 2: Suicidal risk and media influence on university students, who were psychiatric outpatients' suicidal ideation

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Associated factors of suicidal risk during the height of Thai, student suicides in February and March 2019

During the times of suicidal crisis among Thai, university students in 2019 [Table 3]; gender, age, religion, faculties, hometown, main psychiatric diagnosis, and physical comorbidity did not show any statistically significant association with suicidal risk by multivariable analysis (P > 0.05). Media, which reported committed suicides among this population, was only a significant variable associated with suicidal risk by statistical analysis (P = 0.03).
Table 3: Associated factors of suicidal risk among outpatients, who were university students, during the height of Thai student suicides

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The moderate suicidal risk was shown to be associated with media. Furthermore, participants who perceived that it had some impact on their suicidality, were shown to have a 3.514 times higher risk of suicide (95% confidence interval 1.256, 11.002, P = 0.012), compared with those who did not [Table 4].
Table 4: The association between influence on media and suicide risk, using model of ordinal logistic regression

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  Discussion Top


Suicide contagion (or “ESB behaviour”), from mass media, containing information of other people's suicide and imitated suicidality is debatable.[3] Most studied supported the assumption by increasing rates of suicide following the suicide of “celebrities” from mass media platforms,[5] but not many of them directly approached the target population, following the crisis of suicide contagion among “noncelebrities;” especially populations at risk, such as young, psychiatric patients in this study; which is the first study reporting on the significant association between media and suicidal risk in Thailand. Moreover, perceived media influence on suicidal ideation was the only associated factor found in this study.

It seems to be expected that 35.0% of university students, who accessed the clinic, showed a high risk of suicide during the period of suicide contagion nationwide, while only 9.0% of the normal population, at the same age, were at risk.[16] Depressive disorders were the main diagnoses found in this survey, which are a risk factor of suicidality in themselves. However, depressive disorders were not associated with suicidal risk, as well as other mental diseases, in the same way as previous studies.[9],[10] In addition, the overall duration of untreated psychiatric diseases among the students (3.0 months) was much lower than another study.[17] During the crisis, media platforms may have played an important role of psychoeducating Thai people, both directly and indirectly by suggesting them consult mental health personnel.

This study on suicide contagion among Thai, university students, who were “noncelebrities” in 2019, showed that mental health care should be well-planned to provide support, particularly in risky groups, during every social crisis; not only after “social influence” with celebrities' suicide. During 1997–1998, the Asian economic crisis arose and during this time suicide rates surged in Thailand along with many other Asian countries.[18] In 2020, the corona disease 2019 pandemic has become a global health threat, which not only kills patients by infection but has also destroyed people by causing extremely negative socio-economic and psychological consequences.[19] This situation has now created an urgent need for suicidal prevention strategies worldwide, principally by the Thai media in this case.[20] The meaning of “Responsibility of media” is very vague and wide-ranging to practice.[1],[21] Primarily, one could argue the issue of “Freedom of the press.” Despite the authoritarian laws of censorship on media enforced in Thailand at present; a lot of violence, crimes, rapes, and suicide usually appear in both Thai media and literature, apparently.[22],[23] The results of association between higher suicidal risk and media, in this study, could be explained by this phenomenon.[20] Thus, the guidelines for media comprising of suicidal issues should be urgently developed, by involving professional organizations and stakeholders, for example, the Thai Journalists Association, the Royal College of Thai Psychiatrists, the Ministry of Public Health, and the National Broadcasting and Telecommunication Commission.[24]

Clinical implications

The measurement of influence on suicidality in this study predominantly used “direct interviews.” The results from this study were in accordance with suicidal risk, using the Thai version of the suicide screening test.[14] Therefore, mental health practitioners should be up to date as to any current, social situations, which may induce suicidal ideation in populations at risk. Regarding this study, “direct interviews” seem to be effective for surveillance of suicidality among Thai, university students. In some high-risk cases, cutting off every media related to suicide may be recommended during critical time periods, to avoid considerable triggers, such as cognitive dissonance.[11] In addition, no specific mental illness should be particularly observed for suicidal risk during suicide contagion, but mental health care providers should investigate suicide ideation in all of those who are psychiatric patients.

Limitation

Even though the data were collected during the period of a suicidal surge the study's design was cross-sectional, which could describe the association between perceived media influence on suicidal risk, neither cause nor effect. A cohort or prospective designed study is suggested, as well as a qualitative one because retrospective collecting data can miss many details. An example of this is, individual triggers, which may assist us to understand the cognitive mechanisms of suicide imitation; as an example: what type of media and the way they represent, mostly how it may introduce suicide ideation.


  Conclusion Top


During the atypical height of Thai, student suicides in February and March 2019, university students, who were psychiatric outpatients at a university hospital in Southern Thailand, mostly reported they were at high risk of suicide, without reported suicidal attempts and were diagnosed with depressive disorders. Although most of the participants indicated that the media did not have an influence on their suicidal ideations, those who stated that the media had a precise impact on them showed a considerably higher risk of suicide, than those who did not. Moreover, the media, which reported suicidality among Thai, university students during the period of contagion, was significantly associated with a moderate risk of suicide by statistical analysis.

Acknowledgments

This study was proofread by Mr. Andrew Tait, from the International Affairs Department, of the Faculty of Medicine. Both authors would like to express our deep gratitude to Asst. Prof. Pakawat Wiwattanaworraset M. D., Ms. Kruewan Jongborwanwiwat and Mrs. Nisan Werachattawanand, for their kind helps in data collection and statistical analysis. This study has been accepted for a poster presentation at the 20th WPA World Congress of Psychiatry, which will take place in Bangkok, Thailand, from March 10 to 13, 2021.

Financial support and sponsorship

This research was fully funded by the Faculty of Medicine, Prince of Songkla University, Thailand (62-373-3-1).

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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