Media and suicide prevention in Southeast Asia: challenges and directions

Globally, suicide is a preventable public health issue.1 The Southeast Asia region is the most populated region of the world, comprised of 11 low- and middle-income countries (LMICs) accounting for 26% of the world’s population with the highest regional suicide rate of 17.7 per 100 000.1,2 Suicide in this region differs from the West, in several aspects; these include the lack of a bonafide mental illness in a significant proportion of those who take their own life, the lower male-to-female gender ratio and the greater elderly to non-elderly suicide ratio.3 Major drivers of suicide in these nations include socioeconomic factors such as social inequities, gender disparities, financial strife and family conflicts.4 While these multitudes of factors imply that suicide prevention efforts in Asia are challenging and unlikely to yield results solely by improving availability and accessibility to mental health services, they also offer some unique opportunities for suicide prevention. There are certain challenges to implement media reporting guidelines for suicide in LMIC countries. Majority of countries in the region have no central suicide database as well as national suicide prevention plans or policies. Most countries have little population base statistics on suicide. Some countries, like India, have crime and suicide-related statistics published by the National Crime Records Bureau (NCRB) every year (https://ncrb.gov.in/accidental-deaths-suicides-india-2018). However, these documentations are the reflection of registered cases by police, which is unlikely to be a true reflection of the overall community picture. Not all cases of suicide that are registered by police get media attention. Further, there are several sources of bias in media reporting in LMIC countries. Media reporting of suicide in LMICs are mostly based on the information gathered from family members, neighbors and workmates of the deceased or from police personnel. Hence, the report gets colored by sociocultural, personal and legal perspectives rather than psychological information. Regular collaboration of media personnel with mental health professionals could be difficult in LMICs due to a lack of motivation, policy and scarcity of mental health professionals. Poor health literacy among the general population is a common phenomenon in the countries, which is compounded by inadequate sensitization of media personnel regarding the mental health issues. Lack of adequate legislation and political will to implement media reporting guidelines as a routine practice is another barrier. Media can play a vital role in suicide prevention in the LMICs in several possible ways. There are differences in methods of suicide between Asia and the West. For instance, pesticide ingestion is a common method of suicide in Asia,5–7 unlike firearms, which are common in developed nations.8 As such, media reporting of the method of suicide may potentially be much more harmful in Asia, because it popularizes the method and leads to increased adoption of the same.9 Easy availability and perceived accessibility have been shown to influence the choice of suicide method.10 Therefore, the media needs to exercise extra caution in reporting the methods of suicide in Asia. Given the socioeconomic determinants of suicide in Asia, the media should focus adequately on the social factors that drove the person to commit suicide. This will also move suicide away from the realm of mental illness to more of a ‘social illness’ and may destigmatize help-seeking. Next, suicide being a more impulsive phenomenon in Asia,10 media could highlight the link between substance use, trait impulsivity and suicide. This may dissuade at least a few from using alcohol as a coping mechanism to deal with stress and, particularly, among impulsive users, it may reduce the risk of impulsive suicides due to poor judgment. At the same time, the media can emphasize the use of alternate, healthier coping strategies to deal with stress. Finally, the media also needs to focus on the role of locally relevant protective factors that operate to reduce the risk of suicide. For instance, religious affiliation is an important protective factor, particularly in Muslim countries where suicide is proscribed by religion. Countries with a robust religious identity generally report lower suicide rates.11 However, there are contradictory findings too.12 This is why the media must stay abreast of locally relevant research findings in suicide and educate the public about what may work in their setting. Suicide is a highly sensitive social and public health issue. Media reporting of suicide, without exercising due diligence, caution and sensitivity, may have detrimental effect on the society. Media needs to see the suicide-related events more holistically, rather than attributing them to a single cause without adequate verification. The authors declare no conflicts of interest with respect to contents of the manuscript.