Fidelity assessment of the suicide reporting guidelines in Korean newspapers

According to World Health Organization (WHO) suicide data [1], nearly 800,000 people die of suicide every year. Suicide not only accounts for 1.4% of all deaths worldwide but is also the second leading cause of death among 15–29-year-olds globally. Of the Organisation for Economic Co-operation and Development countries, South Korea has by far the highest suicide rate. While South Korea’s suicide rate reached 26.5% per 100,000 people in 2015, the country with the second highest suicide rate, Hungary, had a rate of 19.4% in the same year [2, 3]. Suicide is especially high among the elderly population and it is the first cause of death among 10–30-year-olds in South Korea [4].

Based on several theoretical studies, it has been found that the frequency with which a person is exposed to suicide coverage can have a significant impact on his/her making an actual suicide attempt [5‐9]. For example, in social learning theory, the greater the similarity between the model and the learner, the more likely it is that the learner will imitate the model’s behavior; this is labeled as “copycat suicide” [5]. Modeling theory suggests that a particular pattern of behavior described in the media can become a model for the audience [6]. Thom et al. [9] suggest that when the media covers suicide stories with detailed methods, visual items, glamorization, emphasis on celebrities, or sensationalism, the number of imitation suicides surges and the audience starts to perceive suicide as a reasonable solution for life challenges.

Suicide reported cases on media is unknowingly pervading into our daily lives, thoughts, and action. According to the Korea Association for Suicide Prevention, following the two-month period after the suicide of a Korean actress in 2008, the number of people committing suicide increased by 41.4% (2007 = 1807/2008 = 3081) because of the Werther effect [10]. Werther effect refers to an increase in the number of suicides in a population triggered by media reporting on a suicide case [11]. Similarly, the number of railway suicidal acts increased by 18.8% compared to the 2-year period before the railway suicide of a famous German goalkeeper [11].

Since people attempt to commit suicide or feel sympathy toward the person involved in the suicidal act [12‐14], media should feel more responsible to abide by suicide reporting guidelines than any others. Gould et al. [8] proposed that the amount, duration, and prominence of media coverage are proportionate to an increase in suicide rates. Newspapers were more influential medium causing copycat suicides than television by 82% [15]. This is because, unlike television, which sends out visualized news coverage in a short time, newspapers can convey more details to the public without a time limit [15]. Newspaper articles can be easily accessed, saved, and reread through various media as well thus it enables the readers to regurgitate the materials [16]. Additionally, unlike printed newspapers, online articles can be reproduced continuously and without limit, exposing the readers more frequently to suicide contents [17].

Given the amount of research conducted in this field, suicide reporting guidelines should have a considerable impact on preventing suicide. Acknowledging such importance, a number of international and nationwide organizations, such as the WHO, the Centers for Disease Control and Prevention (CDC), Samaritans, Mindset, and Korean Ministry of Health and Welfare have established their own suicide reporting guidelines [18‐22].

The WHO launched its first guidelines for suicide prevention in 1999 and the current guidelines are the second set to address specific social and professional groups for preventing suicide [21]. The CDC suicide guidelines are based on more than 50 international studies on suicide contagion and were initially developed by the American Foundation for Suicide Prevention and several leading experts in suicide prevention, along with several public and media organizations [18]. Samaritans produced the UK media guidelines following extensive consultation with journalists and editors throughout the industry [19]. Its guideline provides practical recommendations for reporting on suicide across all types of media to support high-quality journalism and help reporters avoid common pitfalls [19]. Mindset’s guidelines are commonly used in Canada; however, its work is the result of collaboration between the American Association of Suicidology and the Canadian Association for Suicide Prevention [20]. Mindset’s guideline consists of general statements to aid in the responsible presentation of information about suicide [20].

In Korea, the first suicide reporting guidelines were announced by the Korean Ministry of Health and Welfare in 2004, and they were updated on September 9, 2013, with three additional principles and one revised [22]. Principles such as respecting the bereaved family, not mentioning the details of the suicide, not romanticizing the act, and avoiding sensationalized expression remained the same in the updated version. However, more specific and preventive measures, such as principles 2 (usage of direct wording), 7 (information regarding consequences), 8 (conveying accurate information about suicide prevention), and 9 (paying special attention to online reports) have been added in the new guidelines (Table 1).

The levels of concordance and discordance of media reports with suicide guidelines can provide important implications for further research and the improvement of the current guidelines. Creed and Whitley [23] found that 55% of the Canadian newspapers that reported on the suicide of a famous figure had adhered to Mindset’s guidelines by up to 80%. In the study of Ramadas and Kuttichira [24], they referred to the WHO guidelines and the suggestions of professionals in the related field to create their analytical framework. They observed an increase in the percentage of guideline concordance following the development of suicide reporting guidelines in India. Harshe et al. utilized the guidelines formulated by the Indian Psychiatric Society [25]. Having to see the increasing numbers of detailed news stories after a celebrity suicide, they expressed concern over the possible spurts of copycat suicide in India. In the United Kingdom, the online media was poorly compliant with Samaritans’ guidelines in reporting suicide cases [26]. As a result, researchers of this study saw the need to implement responsible and clear guidelines that could improve the poor quality of online media reporting and to train journalists appropriately.

However, unlike other countries, South Korea is significantly lacking in the study of suicide reporting guidelines. Kim [27] analyzed the difference in the number of suicide reports before and after the implementation of “Suicide Reporting Guideline 1.0” in 2004. Only two items were statistically significant, making it hard to conclude that the intervention was effective. Yeo and Lee [28] highlighted problems and suggested solutions for the existing suicide reporting guidelines; however, their study only focused on the coverage of specific celebrity suicides in three Korean broadcasting channels. In addition, Yu [29] carried out an exploratory study for establishing more realistic media guidelines for the reporting of suicides. Rather than analyzing newspaper articles, the study carried out a survey asking what factors should be included in the guidelines.

While the importance of developing suicide guidelines continuously rises, only a few studies have explored their fidelity. Therefore, the purpose of this study is to investigate how well Korean newspapers follow suicide reporting guidelines and to explore the potential problems and limitations regarding the current guidelines.

From 368 cases, the number of suicide reports was the highest in 2014 (38.9%), but overall, the number decreased from 143 cases in 2014 to 65 cases in 2017. In general, most of the suicide coverage from the five mainstream Korean newspapers adhered well to guidelines 1 (sensational coverage), 2 (overstatement), 6 (use of visual contents), 8 (generalization), 9 (speculation), 10 (romanticization), and 11 (interview). However, four items appeared to be incompliant with the guidelines and frequently appeared in reports of suicide. Direct wording was present in 63.9% of the total cases. Mentioning the method used and providing details about the site and location were high, at 68.2 and 74.5%, respectively. As many as 44.6% of the articles included the contents of the suicide note. On the recommended side, both guidelines 12 (inclusion of accurate information) and 13 (educating the public) were absent from nearly all suicide reports, and respectively only 1.4 and 2.2% of the reports included such information.

This study explored how effective five Korean newspapers are at following the country’s suicide reporting guidelines. Owing to the exposure of high risk in suicide, strengthening the suicide reporting guidelines is essential in South Korea. Our findings on using direct wording (63.9%), providing detailed information (74.5%), and reporting the contents of the suicide note (44.6%) were very similar to those of Kim’s [27] study, where percentage of these items were 64, 75 and 45%, respectively. The overall percentage of articles speculating or jumping to conclusions (36.7%) was similar to the results of Creed and Whitley (34.8%) [23] and Utterson et al.’s (30.1%) [26] studies. Similarly, the results for providing hotline information (1.4%) and educating the public (2.2%) aligned with the studies by Ramadas and Kuttichira [24] and Harshe et al. [25], who found nearly zero cases for these guideline items. Contrary to other international studies that showed less than 30% of discordance in providing extensive details about the method, site/location, and suicide note, our findings showed much higher percentages of discordance with these items—68.2, 74.5 and 44.6%, respectively—in South Korea [16, 25, 26, 37].

More than half of the articles included direct wording (63.9%), made mention of the location (74.5%), and made mention of the method used (68.2%). This is especially problematic in that it provides information for potential attempters to execute the act [38]. The public is already familiar with popular suicide methods and locations such as burning charcoal in closed rooms or jumping off a bridge over the Han River in Seoul, Korea [27]. Moreover, special attention should be paid to the adolescent population. According to Phillips and Carstensen [39], the impact of suicide stories on subsequently completed suicides have been reported to be the greatest among teenagers. The chances of adolescents committing copycat suicides are high, as their self-identities are not yet fully developed; this allows them to be easily influenced by celebrities [40]. Additionally, the youth are likely to be influenced by newspaper stories that are more prominent (e.g., front-page placement or inclusion of a picture), more explicit (e.g., with headlines containing the word “suicide” or specifying the method used), or more detailed (e.g., including the name of the deceased, the details of the method, or a suicide note) [41].

Another critical issue lies on having so few articles with help-seeking information or factual information about suicide. The need to provide appropriate suicide information becomes a significant task. Additionally, when leaving out such information, suicide becomes the problem of one individual, rather than a social or general public health problem of which we must all be aware [38].

Moreover, the results of this study provide important insights for examining the weaknesses in the existing Korean suicide reporting guidelines. Even though visual contents and suicide notes are proven to be influential factors for the actual suicide attempt [18, 21, 41], references to those items were left out of Suicide Reporting Guideline 2.0. In the study by Ramadas and Kuttichira [24], 37% of cases (N = 3270) included photographs of the deceased, the method, and the scene. Harshe et al. [25] separated the visual contents section into three specific guideline items. Out of 708 cases, 20.29% had “a photograph of the victim,” 11.98% had “a photograph of the location” and 14.42% had “a graphical illustration to depict the suicide/location,” meaning that in total, 46.69% included some type of visual contents within the article. In an analysis of Chinese newspapers, 57.5% of articles had photos and 4.7% had graphics; in other words, 62.2% had visual content items [42]. Having to confirm the prevalence and importance of this particular guideline item, those covering visual contents or suicide notes should be included in the updated version of the Korean suicide reporting guidelines. However, most importantly, media as a primary stakeholder should engage more proactively with these guideline items.

Currently, there are three organizations that monitor suicide coverage in the media: the Korea Suicide Prevention Center, the Korea Communications Standards Commission, and the Journalists Association of Korea [43, 44]. The Korea Suicide Prevention Center [44] has established the Suicide Prevention Committee with various stakeholders to broaden the monitoring area, educate the public, publish the monitoring guide, and raise public awareness on the issue of suicide prevention. Despite the importance of this role, a lack of staff and budget limit the organization’s scope. According to the Korea Communications Standards Commission [43], suicide coverage with too much detail, romanticization or justification, and speculation is prohibited in broadcasting. However, there were too many instances whereby this clause was violated thus Korea Communications Standards Commission has announced a desire to strengthen the monitoring regulations [43]. However, these agencies generally lack the structure and power to effectively manage suicide prevention on a nationwide scale. Considering the gravity of this issue, the Korean government should reinforce the monitoring system and implement a stricter editorial policy to effectively counteract against the reckless suicide coverages released on media.

For the establishment of an efficient monitoring system, we may refer to the National Strategy for Suicide Prevention proposed by the Government of the United Kingdom. The Government of the United Kingdom made a collective effort in suicide prevention by setting up several goals and forming an alliance system that are “supporting the media in delivering sensitive approaches to suicide and suicidal behavior,” “supporting research, data collection, and monitoring,” and creating “the National Suicide Prevention Alliance” [45]. Under the current administration, Korea has recently announced a 5-year “National Suicide Prevention Action Plan (2018-22)” aiming to reduce the high suicide rate in the country. According to the Korean Ministry of Health and Welfare [46], the action plan has four main pillars: 1) providing a basis for a suicide prevention policy, 2) conducting a high-risk suicide population assessment, 3) establishing active intervention management for the high-risk population, and 4) providing follow-up service and support for suicide attempters. However, creating stronger regulations for suicide reporting guidelines and monitoring suicide coverage in the media has not been included in this plan. The results of our study may provide a basis and be a helpful resource for the establishment of stronger regulations for suicide reporting guidelines as well as a structured national surveillance system on suicide coverage in the media.

Although this study did not cover online suicide reporting, the number of online articles outweighs the number of printed articles; therefore, the problem with suicide coverage is expected to be greater when online articles are taken into account. This is because online journalists who compete with one another for more clicks and views tend to use sensational headlines and content to attract readers [47]. Reporting about suicide is especially problematic in that many focus on highlighting the issue as something shocking and gossip-worthy; nothing more [17, 47]. As such, an online regulation policy and penalty system (when too many details or overly sensational information are given) should also be considered as part of a suicide prevention policy.

Our study provides an important rationale as to why there should be stronger regulations for suicide reporting guidelines. However, it has some limitations. First, our sample was limited to “printed” articles that were available online. We could have missed articles that were not yet uploaded or available online. Second, choosing only five mainstream Korean newspapers for the analysis might have influenced the overall results of the study. Despite these limitations, this was the first study to be conducted after the revision of the Korean guidelines in 2013; thus, our findings will be a useful source for further studies of this kind.

This study is notable in that South Korea currently lacks studies on suicide reporting guidelines. From our study, it became clear that the current guidelines are ineffective. To reduce suicide rates and attempts and to yield more positive outcomes for the future, our study strongly suggests avoiding the word “suicide” and detailed descriptions, but rather providing factual yet helpful information to those who are considering suicide. We expect our findings to be utilized in many suicide-related studies and to contribute to the establishment of more effective and concrete suicide reporting guidelines as well as monitoring systems.