Background There is accumulating evidence about detrimental impacts of the pandemic on population mental health, but knowledge on risk of groups specifically affected by the pandemic and variations across time is still limited. Methods We surveyed approximately n =1,000 Austrian residents in 12 waves between April and December 2020 ( n =12,029). Outcomes were suicidality (Beck Suicidal Ideation Scale), depressive symptoms (Patient Health Questionnaire-9), anxiety (Hospital Anxiety Depression Scale), and domestic violence. We also assessed the perceived burden from the pandemic. Demographic and Covid-19 specific occupational and morbidity-related variables were used to explain outcomes in multivariable regression analyses, controlling for well-established risk factors of mental ill-health, and variations over time were analyzed. Results Young age, working in healthcare or from home, and own Covid-19 illness were consistent risk factors controlling for a wide range of known mental health risk factors. Time patterns in the perceived burden from Covid-19-related measures were consistent with the time sequence of restrictions and relaxations of governmental measures. Depression and anxiety were relatively stable over time, with some increase of depression during the second phase of lockdowns. Domestic violence increased immediately after both hard lockdowns. Suicidal ideation decreased slightly over time, with a low during the second hard lockdown. Mental health indicators for women and young people showed some deterioration over time, whereas those reporting own Covid-19 illness improved. Limitations Data from before the pandemic were not available. Conclusions Among mental health outcomes, increases in domestic violence and, to some smaller extent, depressive symptoms, appeared most closely related to the timing of hard lockdowns. Healthcare staff, individuals working from home, those with Covid-19, as well as young people and women are non-traditional risk groups who warrant heightened attention in prevention during and in the aftermath of the pandemic. Keywords: Covid-19, pandemic, mental health, survey, Austria

Background There is strong evidence that suicides increase after media stories about suicides by celebrities, particularly those that highlight the suicide method (the Werther effect). Much less is known about the Papageno effect-the protective effects of media stories of hope and recovery from suicidal crises. A synthesis of the retrievable evidence is lacking. We aim to summarise findings from randomised controlled trials about the effects of stories of hope and recovery on individuals with some degree of vulnerability to suicide.Methods For this systematic review and individual participant data meta-analysis, we searched PubMed (including MEDLINE), Scopus, Embase, PsycInfo, Web of Science, and Google Scholar published from inception to Sept 6, 2021, without language restrictions. We included trials that reported suicidal ideation (the primary outcome) or helpseeking attitudes or intentions (the secondary outcome) and tested a media narrative of hope and recovery. Studies were excluded if they did not feature a clearly positive story of hope and recovery, or had a control group exposed to suicide-related stimulus material. We contacted the lead or senior authors of all original studies to obtain participantlevel data for this study. The primary analysis was restricted to individuals with some vulnerability to suicide. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomised trials. The study is registered with PROSPERO, number CRD42020221341.Findings Our search yielded 7347 records. 3920 records were screened by title and abstract, and 25 full-text records assessed for eligibility. There were eight eligible studies with 2350 participants for which individual participant data were sought. For suicidal ideation, six studies met the inclusion criteria for the primary analysis. Follow-up responses were available for 569 (90%) of 633 participants who were randomised with high vulnerability (345 [55%] allocated to the intervention group and 288 [45%] to the control group). The pooled standardised mean difference (SMD) indicated a small reduction in suicidal ideation of -0•22 (95% CI -0•39 to -0•04, p=0•017; six studies) in the intervention group. For help-seeking attitudes and intentions, four studies met the inclusion criteria and follow-up data were available for 362 (86%) of 420 participants (247 [59%] allocated to the intervention group and 173 [41%] to the control group). The pooled SMD showed no evidence of a difference between the groups (SMD=0•14, 95% CI -0•15 to 0•43, p=0•35; four studies). Low levels of cross-study heterogeneity effects were observed for both analyses (I²=5% [suicidal ideation] and I²=36% [help-seeking attitudes and intentions]). We found no evidence of publication bias.Interpretation Media narratives of hope and recovery from suicidal crises appear to have a beneficial effect on suicidal ideation in individuals with some vulnerability, but there is insufficient evidence regarding help-seeking attitudes and intentions. These findings provide new evidence about narrative...

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Objective: Specific content characteristics of suicide media reporting might differentially impact suicides in the population, but studies have not considered the overarching theme of the respective media stories and other relevant outcomes besides suicide, such as help-seeking behaviours. Methods: We obtained 5652 media reports related to suicide from 6 print, 44 broadcast and 251 online sources in Oregon and Washington states, published between April 2019 and March 2020. We conducted a content analysis of stories regarding their overarching focus and specific content characteristics based on media recommendations for suicide reporting. We applied logistic regression analyses to assess how focus and content characteristics were associated with subsequent calls to the US National Suicide Prevention Lifeline (Lifeline) and suicides in these two states in the week after publication compared to a control time period. Results: Compared to a focus on suicide death, a focus on suicidal ideation, suicide prevention, healing stories, community suicide crises/suicide clusters and homicide suicide was associated with more calls. As compared to a focus on suicide death, stories on suicide prevention and stories on community suicide crises/suicide clusters were also associated with no increase in suicides. Regarding specific content characteristics, there were associations that were largely consistent with previous work in the area, for example, an association of celebrity suicide reporting with increases in suicide. Conclusion: The overall focus of a media story may influence help-seeking and suicides, and several story characteristics appear to be related to both outcomes. More research is needed to investigate possible causal effects and pathways.

Background: Guidelines to encourage responsible reporting of suicide in news media are a key component of suicide prevention strategies. Recent guidelines have been developed on portrayal of suicide in entertainment media although the relationship between these portrayals and subsequent suicidal behaviour has received considerably less attention in research. Methods: We conducted a systematic review and meta-analysis to examine the association between portrayals of suicide and suicide attempt in entertainment media and suicidal behaviour in the population. We searched PubMed, Scopus, Embase, PsycInfo, Web of Science and Google Scholar until April 20, 2021. We included studies adopting interrupted time series or single/multiple arm pre-post designs. Separate analyses were undertaken for studies of suicide and suicide attempts. We synthesized studies at moderate risk of bias and included studies at serious risk in a sensitivity analysis. Using a random-effects meta-analysis, we synthesized studies at moderate risk of bias and included studies at serious risk in a sensitivity analysis. Study registration: PROSPERO (CRD42020221333). Findings: Twelve studies met our inclusion criteria. Six studies were about suicide. Two of these were at moderate risk of bias and both examined the effects of the Netflix series 13 Reasons Why. The pooled rate ratio (RR) for these studies was 1¢18 (95% CI 1¢09 to 1¢27, p<0¢001). Heterogeneity was low (I 2 = 29%). Six studies focused on suicide attempts, and two of them were at moderate risk of bias. The pooled RR for these two studies was 1¢33 (95% CI 0¢84 to 2¢09, p = 0¢22). Heterogeneity was high (I 2 = 92%). Enhanced funnel plots indicated likely publication bias for studies of suicide and possible bias for studies of attempted suicide. Interpretation: Portrayals of suicide in entertainment media may increase suicides and attempted suicide in the population. More studies that limit the potential sources of bias are needed to fully understand the circumstances under which fictional portrayals may influence suicidal behaviour.

Background Young lesbian, gay, bisexual, transgender, queer as well as other sexual/gender minorities (LGBTQ+) persons have higher rates of suicidal ideation and behavior compared to their non-LGBTQ+ peers, particularly during their coming out. The “It Gets Better” project is a multi-national media campaign that aims to reduce suicide among LGBTQ+ adolescents by providing personal narratives of hope delivered by mainly adult LGBTQ+ persons. There is only little knowledge so far on how young LGBTQ+ people as well as experts in suicide prevention and counseling perceive these videos, and how to potentially improve the videos based on their perceptions. Methods A total of n = 19 LGBQ+ adolescents and young adults and n = 9 experts participated in focus groups to discuss perceptions of a selection of “It Gets Better” videos. Eight focus groups were conducted to assess perceptions on the process of watching the videos, possible effects on young LGBQ+ viewers in general, and suicidal LGBQ+ youth in particular, as well as factors that were relevant to their perceptions. Results Messages were found to be helpful in terms of promoting hope. LGBQ+ youth identified several key strategies to increase identification with messages, which they considered crucial for their effectiveness. Criticism emerged from a perceived lack of diversity in terms of portrayed sexual identities, and some shallowness in the portrayal of suicidal ideation and how things can get better. The experts’ perceptions of the videos were largely consistent with LGBQ+ youth, highlighting a positive potential of videos to support coming out and identity building processes. Conclusions Young people and experts view the videos as helpful and relevant, but identified several strategies to better tailor them to the needs of LGBTQ+ adolescents, including suicidal peers. The insights gained are useful to the increasing number of suicide prevention projects using personal narratives of coping delivered via media to help prevent suicide.

Abstract. Background: The It Gets Better project aims to help prevent suicide among lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ+) adolescents. It features personal video narratives portraying how life gets better when struggling with adversities. Research on the contents of messages is scarce. Aims: We aimed to explore the content of videos in the Austrian It Gets Better project regarding the representation of various LGBTIQ+ groups and selected content characteristics. Method: A content analysis of all German-language videos was conducted ( N = 192). Messages related to coming out, stressors experienced, suicidal ideation/behavior, and on how things get better were coded. Results: Representation was strong for gay men ( n = 45; 41.7%). Coming out to others was mainly positively framed ( n = 31; 46.3%) and seen as a tool to make things better ( n = 27; 37.5%). Social support ( n = 42; 62.7%) and self-acceptance ( n = 37; 55.2%) were prevalent topics. Common stressors included a conservative setting ( n = 18, 26.9%), and fear of outing ( n = 17; 25.4%). Suicidality ( n = 9; 4.7%) and options to get professional help ( n = 7; 8.2%) were rarely addressed. Limitations: Only aspects explicitly brought up in the videos were codeable. Conclusion: Videos do not fully represent gender identities and sexual orientations. Messaging on suicidality and professional help require strengthening to tailor them better for suicide prevention.

SummaryIn 2015, 119.2 t of active ingredients of antibiotics were used in Austria in human medicine (70.4 t; 59.1%), for food animals (48.8 t; 40.9%) and in plant production (0.002 t; < 0.1%). During the last five years, consumption of antibiotics increased in human medicine by 3. 8% (2011: 67.8 t; 2015: 70.4 t). In hospitals, it increased by 17.3%, from 19.7 t in 2011 to 23.1 t active ingredients in 2015. In the community, measured in kg active ingredient, it increased by 0.3% from 2011 to 2015. Consumption in defined daily dose (DDD) per 100,000 inhabitants per year decreased by 3.6%. Our numbers for the community (2015: 17.0 DDD) contradict AURES reports and a recent ECDC report, which claim a consumption of 14.0 DDD/1000 inhabitants per day in primary care in Austria, based on the social insurance company's sales data. Declining pharmacy sales prices due to an increase in market shares for cheap generic drugs as well as increase in deductibles for insured people falsely suggest low consumption. In food animals, the antibiotic consumption decreased by 8.7%, from 53.4 t to 48.8 t. In plant production, the annual usage fluctuated considerably and decreased by 95.3%, from 47.2 kg in 2010 to 2.2 kg in 2015.Keywords: antibiotic consumption, Austria, human medicine, food animals, plant production ZusammenfassungIm Jahr 2015 wurden in Österreich insgesamt 119,2 t antimikrobielle Wirkstoffe abgesetzt: In der Humanmedizin (70,4 t; 59,1 %), in der tierischen Lebensmittelproduktion (48,8 t; 40,9 %) und in der Pflanzenproduktion (0,002 t; < 0,1 %). In den letzten fünf Jahren ist der Gesamtverbrauch in der Humanmedizin um 3, 8 % angestiegen (2011: 67,8 t; 2015: 70,4 t), im stationären Bereich sogar um 17,3 % (von 19,7 t im Jahr 2011 auf 23,1 t im Jahr 2015). Im niedergelassenen Bereich stieg der Verbrauch (in kg Wirksubstanz) um 0,3 %. Der Verbrauch in definierter Tagesdosis (DDD) pro 100.000 Einwohner und Jahr sank um 3,6 %. Unsere Zahlen für den niedergelassenen Bereich (2015: 17,0 DDD pro 1000 Einwohner und Tag) stehen im Widerspruch zu AURES-Berichten und einem rezenten ECDC-Report, die -basierend auf österreichischen Sozialversicherungsdaten -für 2015 einen Antibiotikaverbrauch von 14,0 DDD postulieren. Aufgrund sinkender Abgabepreise (bedingt durch steigende Marktanteile von Generika) und steigender Selbstbehalte (Rezeptgebühren) spiegeln Sozialversicherungsausgaben den Verbrauch nicht korrekt wider. Der Verbrauch in der tierischen Lebensmittelproduktion ging um 8,7 % zurück, von 53,4 t im Jahr 2011 auf 48,8 t im Jahr 2015. Der jährliche Verbrauch von Antibiotika im Pflanzenschutz schwankte stark und sank in diesem Zeitraum um 95,3 %, von 47,2 kg im Jahr 2010 auf 2,2 kg im Jahr 2015.