The global impact of celebrity suicides: implications for prevention

and used the average for our analyses.To investigate whether weekly search volumes had changed since the suicide of Sushant Singh Rajput, relative to the two preceding years, we conducted interrupted time series regression for each search term.The outcome was the relative weekly search volume for the search term, which is generated in Google Trends as an index ranging between 0 and 100 4 , and analyses were repeated using binary predictor variables representing each of the three weeks since the suicide.Models were fit using a generalized linear model from the Poisson family, with a loglink function and a scale parameter to account for overdispersion.Models controlled for long-term trends (entered as a fractional polynomial to account for nonlinearity) and short-term seasonality trends (entered as Fourier terms).At week 1, we observed large relative risk (RR) increases for "suicide" (RR=11.53,95% CI: 10.01-13.27),"commit suicide" (RR=16.46,95% CI: 14.20-19.07),"how to suicide" (RR=10.15,95% CI: 7.38-13.97),"hanging" (RR=2.08,95% CI: 1.65-2.62),"how to hang" (RR=10.80,95% CI: 6.33-18.44),"suicide hanging" (RR=2.53,95% CI: 2.00-3.19),"aatmahatya" (RR=2.70,95% CI: 1.76-4.14)and "khudkushi" (RR=7.56,95% CI: 5.02-11.38).Significant increases persisted at week 2 for the search terms "suicide" (RR=3.11,95% CI: 2.55-3.80),"commit suicide" (RR=2.96,95% CI: 2.39-3.67),"how to suicide" (RR=6.50,95% CI: 4.58-9.22),"hanging" (RR=1.43,95% CI: 1.09-1.88),"how to hang" (RR=4.00,95% CI: 1.95-8.17),and "suicide hanging" (RR=1.67,95% CI: 1.27-2.20),and at week 3 for the search terms "suicide" (RR=1.61,95% CI: 1.25-2.08),"commit suicide" (RR=1.48,95% CI: 1.13-1.95),"how to suicide" (RR=3.05,95% CI: 1.98-4.69)and "suicide hanging" (RR=1.82,95% CI: 1.39-2.37).At week 1, we also observed large increases for the putatively protective search terms "suicide prevention" (RR=12.64,95% CI: 5.01-31.89),"suicide helpline" (RR=5.63,95% CI: 4.57-6.94),"depression" (RR=6.40,95% CI: 5.93-6.92),"depression doctor" (RR=4.99,95% CI: 3.10-8.03),"psychiatrist" (RR=1.86,95% CI: 1.65-2.10),"antidepressants" (RR=1.47,95% CI: 1.19-1.81)and "avsaad" (RR=5.79,95% CI: 3.22-10.39).Significant increases persisted at week 2 for the search terms "suicide helpline" (RR=1.86,95% CI:1.36-2.54),"depression" (RR=1.79,95% CI: 1.59-2.02),and "psychiatrist" (RR=1.41,95% CI: 1.23-1.62),and at week 3 for "depression doctor" (RR=2.61,95% CI: 1.74-3.93)and "avsaad" (RR=2.87,95% CI: 1.16-7.13).The suicide of Sushant Singh Rajput and the subsequent widespread media coverage appears to have activated large increases in both harmful and protective Google search queries in India.This may have been exacerbated by the COVID-19 lockdown, with more time spent at home on online devices resulting in increased media exposure and greater opportunities to search online.Whether Sushant Singh Rajput's death and these search trends will be associated with an increase in suicides should be investigated when data become available.Regardless, the current analysis clearly shows that his suicide was associated with strong increases in suicide-related Internet search behaviours, highlighting the need to promote media recommendations 3 .Furthermore, the monitoring of Internet search queries after celebrity suicides and other large-scale media phenomena could inform suicide prevention.