Determining the Effects of Protective Suicide Content in the Print Media in India

Aims
Suicide rates in India are among the highest in the world, resulting in over 200,000 deaths annually. One suicide prevention intervention that has received considerable attention elsewhere is improving media handling of suicide content. In India, the newspaper industry is truly colossal and growing annually, providing content for hundreds of millions of people. Research led by the principal investigator found that newspapers in India offer readers a daily diet of explicit and simplistic reports of suicides and suicide attempts, which contravene World Health Organization (WHO) guidelines and carries risks for the population. The public health perspective on the prevention of suicide is a more recent phenomenon in the Indian media and is under-developed, with an almost non-existent use of lived experience narratives of people who have ‘mastered a suicide crisis’ by drawing on internal and external resources to avoid progressing to a suicide attempt. In response to this, we are proposing a multiple group randomised controlled trial (RCT) complemented by qualitative inquiry to test the potential for generating protective effects through exposure to WHO guideline-based educative suicide prevention messaging in print media articles in India. Additionally, we include a novel built-in test of whether incorporating the added component of lived experiences stories of individuals who have mastered a suicide crisis will produce added benefits. Our aim is to build the evidence base to inform media-based suicide prevention interventions.

Methods
The proposed project is comprised of a multiple-group randomised controlled trial (RCT) laboratory study that seeks to measure the effects of varying suicide content in print media, complemented by semi-structured qualitative interviews with a sub-group of RCT participants. For the RCT, a sample of 240 participants will be randomised into three groups to allow us to investigate the protective effects of reading educative suicide prevention messaging in newspaper articles, with and without a lived experience story of someone who ‘mastered a suicide crisis’. We will investigate the effects of exposure to these articles on beliefs about refraining from suicide (primary outcome), suicide prevention knowledge, reasons for living, intended help-seeking behavior, stigmatising attitudes towards suicide and attitudes towards the preventability of suicide. Measures validated for use in India will be administered using a self-complete questionnaire at three time points; before the exposure (T0), immediately after the exposure (T1), and 2 weeks after the exposure (T2). Linear mixed models will be used to compare the 3 groups on post-test scores, adjusting for pre-test scores. Semi-structured qualitative interviews will be undertaken with a selection of 20 RCT participants to examine their perceptions of the attitudinal, behavioural and emotional impacts on themselves and their peers of the suicide prevention messaging and lived experience stories in the exposure articles.

Expected outcomes
This research will allow us to expand the knowledge base on the effects of media portrayals of suicide. The findings have important implications for the development of media-based suicide prevention strategies in India and elsewhere in Southeast Asia.