The impact of suicide reporting may not be restricted to harmful effects; rather, coverage of positive coping in adverse circumstances, as covered in media items about suicidal ideation, may have protective effects.

Objective To examine the association between reporting on suicides, especially deaths of celebrities by suicide, and subsequent suicides in the general population. Design Systematic review and meta-analysis. Data sources PubMed/Medline, PsychInfo, Scopus, Web of Science, Embase, and Google Scholar, searched up to September 2019. Review methods Studies were included if they compared at least one time point before and one time point after media reports on suicide; follow-up was two months or less; the outcome was death by suicide; and the media reports were about non-fictional suicides. Data from studies adopting an interrupted time series design, or single or multiple arm before and after comparisons, were reviewed. Results 31 studies were identified and analysed, and 20 studies at moderate risk of bias were included in the main analyses. The risk of suicide increased by 13% in the period after the media reported a death of a celebrity by suicide (rate ratio 1.13, 95% confidence interval 1.08 to 1.18; 14 studies; median follow-up 28 days, range 7-60 days). When the suicide method used by the celebrity was reported, there was an associated 30% increase in deaths by the same method (rate ratio 1.30, 95% confidence interval 1.18 to 1.44; 11 studies; median follow-up 28 days, range 14-60 days). For general reporting of suicide, the rate ratio was 1.002 (0.997 to 1.008; five studies; median follow-up 1 day, range 1-8 days) for a one article increase in the number of reports on suicide. Heterogeneity was large and partially explained by celebrity and methodological factors. Enhanced funnel plots suggested some publication bias in the literature. Conclusions Reporting of deaths of celebrities by suicide appears to have made a meaningful impact on total suicides in the general population. The effect was larger for increases by the same method as used by the celebrity. General reporting of suicide did not appear to be associated with suicide although associations for certain types of reporting cannot be excluded. The best available intervention at the population level to deal with the harmful effects of media reports is guidelines for responsible reporting. These guidelines should be more widely implemented and promoted, especially when reporting on deaths of celebrities by suicide. Systematic review registration PROSPERO CRD42019086559.

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IMPORTANCE On March 31, 2017, Netflix released the show 13 Reasons Why, sparking immediate criticism from suicide prevention organizations for not following media recommendations for responsible suicide portrayal and for possible suicide contagion by media. To date, little research has been conducted into the associations between the show and suicide counts among its young target audience. OBJECTIVE To analyze the changes in suicide counts after the release of 13 Reasons Why. DESIGN, SETTING, AND PARTICIPANTS For this time series analysis, monthly suicide data for the age groups 10 to 19 years, 20 to 29 years, and 30 years or older for both US males and females from January 1, 1999, to December 31, 2017, were extracted from the Centers for Disease Control and Prevention's WONDER (Wide-ranging Online Data for Epidemiologic Research) database. Twitter and Instagram posts were used as a proxy to estimate the amount of attention the show received through social media from April 1, 2017, to June 30, 2017. Autoregressive integrated moving average time series models were fitted to the pre-April 2017 period to estimate suicides among the age groups and to identify changes in specific suicide methods used. The models were fitted to the full time series with dummy variables for (1)