Media influence on parasuicide. A study of the effects of a television drama portrayal of paracetamol self-poisoning S Simkin, K Hawton, L Whitehead, J Fagg and M Eagle The British Journal of Psychiatry 1995 167: 754-759 Access the most recent version at doi:10.1192/bjp.167.6.754
References
Reprints/ permissions You can respond to this article at Email alerting service Downloaded from
Article cited in: http://bjp.rcpsych.org/cgi/content/abstract/167/6/754#otherarticles To obtain reprints or permission to reproduce material from this paper, please write to
[email protected] http://bjp.rcpsych.org/cgi/eletter-submit/167/6/754 Receive free email alerts when new articles cite this article - sign up in the box at the top right corner of the article or click here bjp.rcpsych.org on July 12, 2011 Published by The Royal College of Psychiatrists
To subscribe to The British Journal of Psychiatry go to: http://bjp.rcpsych.org/subscriptions/
British Journal of Psychiatry (1995), 167, 754—759
Media Influence on Parasuicide A Study of the Effects of a Television Drama Portrayal of Paracetamol Self-Poisoning SUE SIMKIN, KEITHHAWTON, LINDAWHITEHEAD,JOAN FAGGand MATTHEW EAGLE Background.
Paracetamol self-poisoning,
which carries a significant
risk of fatal liver damage,
is increasingin the UK, especiallyamongadolescents.There is concernthat mediaportrayal of suicidalbehaviourmay influenceits occurrence.We have investigatedthe effects of two
broadcasts of a television drama showing a teenage girl's overdose of paracetamol. Method. Datafromthe OxfordMonitoringSystemfor AttemptedSuicidewere usedto examine changesinthe numberof overdosesandthe useof paracetamolinthe threeweek periodbefore and after both broadcasts.An analysisof log-linearmodelswas carriedout, usingadditional data from two previousyears, in orderto controlfor the effects of gender,age group, time period,season,yearanddrug.A questionnairewas usedto ascertainwhetherthe programme
had influencedpatients' decisionsto take an overdoseor their choiceof drug. Results.An increasein paracetamoloverdosesoccurredfollowingthe firstbroadcast,but when data from the two previousyearswere examinedand the log-linearanalysiswas usedthere was no evidenceof significanteffectsattributableto the broadcasts.The questionnairestudy revealed that very few people had seen either episode, and only two claimed that it had influenced
them (one in terms of getting help). Conclusions.It isimportantto usesoundmethodologyto avoidinterpretingchancefluctuations asa mediaeffect.Thepotentialpositivebenefitsof suchprogrammes shotMalsobe investigated.
Over the last 20 years there has been considerable interest in the influence of media representation of
suicidalbehaviour,both throughnewsreportsof actual suicides and fictional depictions of deliberate self harm, on rates of suicide and attempted suicide (for a review, see Schmidtke & Hafner, 1989). Schmidtke & Häfner(1988) found a significant increase in railway suicidesin Germany following a televisionseriescentred round the similar death of a young male student. Several methodological problems are associated with any investigation into mass media influence on suicidal phenomenon (Phillips, 1989; Platt, 1994). One of the most important is the epidemiological fallacy: that is, the assumption that a change in the number of cases following a broadcast or newspaper report reflects a causal media effect. It is crucial to determine whether those people engaging in suicidal behaviour actually had access to the implied stimulus. In order to assess the impact of a particular media item it is also vital to control for other variables known to be relevant to suicidal behaviour, such as age, gender and seasonal effects. It is even more difficult to investigate any positive impact, where people might be deterred from suicidal action or a particular method by media depictions of unpleasant consequences of such behaviour. Platt (1987) examined possible effects of a suicide attempt by a woman in her mid-30s in the soap-opera 754
EastEnders,
to investigate
the impact of fictional
media representations of parasuicide on the rates of this behaviour among audiences. He controlled for temporal trends and referred to viewing figures in order to assess the potential extent of the programme's influence. Platt concluded that any media effect was ‘¿not proven'. In the UK, paracetamol has become the most common substance for self-poisoning (Hawton & Fagg, 1992a), and its increased use has been most marked among adolescents (Hawton & Fagg, 1992b). Paracetamol liver damage accounts for at least 150 deaths per year in the UK (Spooner & Harvey, 1992). The Casualty series is a popular television hospital drama series which often includes material relevant to health education. In the episode on 9 January 1993 a teenage girl took an impulsive overdose of 50 paracetamol tablets in response to a background of parental marital conflict, pressure from her mother to achieve at school and inability to communicate her distress. She presentedat the casualty department 48 hours later with severe abdominal pain and by the end of the programme had been transferred to a specialist liver unit, with the implication that she would die. The episode was seen by 15.5 million viewers aged four and over (6.1 million men and 9.4 million women). It was repeated on 16 July 1993, when it reached an audience of 7.8 million (3 million
MEDIA
INFLUENCE
755
ON PARASUICIDE
men and 4.8 miffion women). After the first broadcast, Collins (1993) reported an increase in the number of overdoses, mostly involving paracetamol, by teenage girls presenting at a district general hospital. Waldron et al(1993) observed a significant increase in the numbers of women admitted to hospital in the South West Thames Region following paracetamol overdoses in the week after the first programme. However, when he used weekly figures from previous years he demonstrated that seasonal fluctuations explained this apparent effect. The present study used data routinely collected by the Oxford Monitoring System for Attempted Suicide to examine whether there was any evidence of a change in the number of overdoses or the use of paracetamol after the broadcasts. Care was taken to control for seasonal effects and to use appropriatemethodology in assessingthe results.The announcement of the repeat screening in July provided an opportunity to use a brief questionnaire to determine whether those taking overdoses had in fact seen either programme, and if so, if this had influenced their actions in any way.
between factors of interest. The independent categorical variables used were gender, age group, time (before and after the broadcast), season (January/July), year, and drug (paracetamol/non paracetamol). The dependent variable was the number of cases observed for each possible combination of these independent variables.
whether this had influenced either their decision to take an overdose or their choice of drug.
Method
Results
Questionnaire A questionnaire was devised for use by staff from the hospital psychiatric service during their clinical assessment of patients admitted to the hospital after self-poisoning in the three week period following the July episode of Casualty. Those who were not formally assessed by the team, for example patients in psychiatricday- or in-patientcare locally or people who took theirown discharge,wereexcluded. Details of age, sex, and previous suicidal behaviour were collected. Patients were asked if they had seen or
heard about either of the two episodes, and if so,
Information on overdoses
Effects of the broadcast
The Oxford Monitoring System for Attempted Suicide was established in 1976 in order to identify and provide clinical and research information on
The numbers of overdoses of paracetamol and of other substances during the three-week periods before and after the two broadcasts of the Casualty programme and during the corresponding periods in the two preceding years are shown in Table 1. While the raw numbers suggest an increase in paracetamol overdoses (from 18 to 30) after the January 1993 broadcast, analysis of all data by means of the log linear model provided no evidence of any significant effects attributable to the broadcasts. There were, however, statistically significant interactions arising from other factors. There was evidence of an age/sex interaction (@ change =11.2, d.f. = 2, P= 0.004), and an age/drug interaction (x2 change=28.4, d.f.=2, P
