Anda di halaman 1dari 9

Journal of Affective Disorders 134 (2011) 488496

Contents lists available at ScienceDirect

Journal of Affective Disorders

j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / j a d

Preliminary communication

The Werther effect reconsidered in light of psychological vulnerabilities:

Results of a pilot study
Louise Pouliot , Brian L. Mishara, Ral labelle
Center for Research and Intervention on Suicide and Euthanasia, Department of Psychology, Universit du Qubec Montral, Qubec, Canada

a r t i c l e i n f o a b s t r a c t

Article history: Background: Findings from three decades of epidemiological studies suggest that media
Received 12 January 2011 diffusion of stories about suicide is related to increases in suicidal behaviours in the population
Accepted 27 April 2011 exposed to the media reports. However, we still know little about the psychological processes
Available online 31 May 2011 and personal vulnerabilities that prompt some people to engage in suicidal behaviours after
exposure to media presentations of suicides. This cross-sectional study explored the possible
Keywords: impact of exposure to film suicide in normal young people.
Media Methods: Undergraduates from a university (mean age 23 years) completed a questionnaire on
Suicide exposure to suicide portrayal in ctional lms, in which assessment of negative emotional and
cognitive reactions resulting from exposure, as well as emotional reactivity, dissociation,
thought suppression, and suicidal tendencies were made.
Werther effect Results: Of the 101 participants, 70% reported being distressed by the portrayal of a suicide in a
fictional film. Among those, 33% stated they felt distressed about the portrayal for several days
to several weeks. The majority of the affected participants (71%) indicated having been
mentally preoccupied for some time by the portrayal and experienced intrusive memories
(68%). Emotional reactivity and dissociation tendencies were significant predictors of the
negative reactions to the suicide film they viewed. Participants who reported that the idea had
crossed their mind to imitate the suicidal protagonist in the film were 3.45 times more likely to
be suicidal and tended to present higher dissociation and thought suppression propensities
compared to those who did not report these thoughts.
Limitations: The results showing possible influences of suicide portrayal in fictional film on
suicide related cognitions were based on a survey methodology.
Conclusion: Results suggest that fictional suicide portrayals in the media may have a deleterious
impact on viewers, and such impacts do not appear to be limited to people having a clinical
profile of mental disorders, as previously assumed by researchers in the field.
2011 Elsevier B.V. All rights reserved.

1. Introduction

This study examined in a direct manner the affective and

cognitive inuences of media portrayals of suicides in lms
and television on audiences as well as the role of psycho-
This paper is based upon an oral presentation at the 13th European logical vulnerabilities in the impact of exposure to suicide in
Symposium on Suicide and Suicidal Behaviour held in Rome in 2010. these media. A search using the web based Internet Movie
Corresponding author at: Center for Research and Intervention on
Suicide and Euthanasia, Universit du Qubec Montral, C.P. 8888, Succ.
Data base (IMDb, 2010) with the key word suicide
Centre-Ville, Montral (Qubec), Canada, H3C 3P8. appearing in the synopsis of lms and television series
E-mail address: (L. Pouliot). identied more than 4000 results. Therefore, audience

0165-0327/$ see front matter 2011 Elsevier B.V. All rights reserved.
L. Pouliot et al. / Journal of Affective Disorders 134 (2011) 488496 489

members in the general population often nd themselves suicidal behaviour following their exposure to a suicide story in
exposed to a suicide story diffused by electronic mass media. the media (Chen et al., 2010; Cheng et al., 2007a; Fekete and
Over the past three decades, numerous studies have Schmidtke, 1996; Martin, 1996; Zahl and Hawton, 2004).
reported an association between mass media diffusion of Studies have consistently found that gender is an important
suicides and a subsequent increase in the number of predictor of suicidal behaviour. Results from studies conducted
suicides in the general population (Berman, 1988; Bollen in North America and most of the world, suggest that females
and Phillips, 1982; Etzersdorfer et al., 2004; Fekete and are more likely to attempt suicide and report suicidal ideation,
Macsai, 1990; Frei et al., 2003; Gould et al., 1988; Gould and but are less likely to die of a suicide than males (Canetto, 2008;
Shaffer, 1986; Hassan, 1995; Jonas, 1992; Niederkrotentha- Mishara and Tousignant, 2004). Given that suicidal behaviour
ler et al., 2010; Niederkrotenthaler et al., 2009; Phillips, patterns are gender related, this has been examined in the
1974; Phillips and Carstensen, 1986; Platt, 1987; Romer et realm of the Werther phenomenon. Pirkis et al's. (2006)
al., 2006; Schmidtke and Hfner, 1988; Schmidtke and research, where the relationships between 4635 media
Schaller, 1998; Stack, 1996; Tousignant et al., 2005). The portrayals of suicide and subsequent suicidal behaviours in
association is more frequently observed in the context of both genders were analysed, revealed that 39% of media items
studies examining press media reporting of real suicide were followed by an increase in male suicides and 31% by an
cases than with other types of media or ctitious cases increase in female suicides. They also found that media
(Pirkis and Blood, 2001a, Pirkis and Blood, 2001b; Stack, portrayals broadcast on television were as likely to be
2003; Westerlund et al., 2009). associated with an increase in male as in female suicides.
Phillips (1974), who was among the rst researchers to Explicit reference in the media item content to a particular
document the phenomenon, used the term, Werther effect suicide method was not related to an increase in frequencies in
to describe this relationship, in reference to Goethe's (1774 both female and male suicides.
1968) novel telling the story of the young man Werther, who Findings from Stack's (2005) review, based upon 55 studies,
ended his life after an unhappy love affair. Goethe's novel had suggest that females are more susceptible than males to the
been banned in Europe on the grounds of its putative link Werther effect. Namely, research studies on the suicide rates of
with a series of suicides (Thorson and berg, 2003). women were almost 5 times more likely than others to report a
Currently, few studies provide proof that individuals de- signicant increase in completed suicides after media de-
ceased by suicide after media diffusion of the suicide story pictions of suicides. In the light of the current state of knowledge
had actually been exposed to the stimulus (for discussion of about the effect of gender in the relationship between suicide
this see Hawton and Williams, 2001; Pirkis and Blood, 2001a, portrayals in the media and the gender differences in real
2001b; Pouliot and Tousignant, 2010). Only a restricted suicides, there is an evident need to further explore the role of
number of studies have offered such a proof (i.e. Cheng et al., sex differences in media effect.
2007a, 2007b; Tousignant et al., 2005; Yip et al., 2006). In As demonstrated in many studies, media content has the
addition, these studies, because of their epidemiological potential to elicit emotional reactions in audience members
ecological approach, have been unable to increase our (Bandura, 1977; Giles, 2003). Studies, examining the impact
understanding of the underlying psychological mechanisms of visual media content on emotional reactions, have shown
involved in the inuence of mass media on suicide (Pouliot gender differences. In three studies where pictures or lms
and Tousignant, 2010). One may assume that the exploration were presented to subjects, female subjects tended to report
of proximal psychological experiences provoked by suicide more intense emotions than their male counterparts, as
stories presented in media could help in our understanding of assessed using a self-administered questionnaire (e.g. Gross
the psychological processes involved in this phenomenon. and Levenson, 1995; Huston et al., 1995; Lang et al., 1993).
Results showing a positive association between suicide Research in other domains may help us better understand
portrayals in the media and increased rates of suicide in the the mechanisms underlying the effect of media presentations
population are commonly interpreted, on a post-hoc basis, as a of suicide on suicidal behaviours by individuals. One variable
process of imitation. It is further assumed that the persons who that has been investigated is emotional reactivity. Mehrabian
are affected by media depictions of suicide are already (1995), considered emotional reactivity to be a psychological
vulnerable and at risk. Many researchers who evoke the vulnerability, which he dened as the propensity in some
imitation hypothesis use Bandura's Social Learning Theory to individuals to be more emotional, to experience intense
explain the effect. Bandura (1977, 1986) postulates that under emotions more easily, to emotionally react to events in a
certain circumstances a perceiver observing the behaviour of an more intense manner and to stay in a state of arousal for a
individual may be prone to imitate or engage in a similar longer period. In particular, according to a series of studies
behaviour. Researchers, who hypothesise that individuals with conducted by Mehrabian (1995), it appears that those who
personal vulnerabilities to suicide are those who are likely to be have high emotional reactivity have better memories of
at greater risk to suicide after exposure to media suicides, emotional events, and tend to be more impulsive, more
propose this hypothesis with empirical substantiation (Chen anxious and more suicidal. A more recent study conducted by
et al., 2010; Chiu et al., 2007; Doron et al., 1998; Fekete and Nock et al. (2008) with 87 adolescents and young adults
Schmidtke, 1996; Zahl and Hawton, 2004). The current state of under clinical treatment indicated that emotional reactivity
knowledge about the role of personal vulnerabilities in media played a mediator role in the association between psychopa-
related suicides is limited and results are divergent (Gould, thology and suicidal ideations.
2001). However, results from a restricted number of studies A third psychological vulnerability that may be associated
indicate that individuals with a history of suicide attempts or with cognitive reactions to exposure to media portrayals of
suicidal ideation appear to be more vulnerable to engaging in suicide is the tendency for dissociation. In the DSM-IV
490 L. Pouliot et al. / Journal of Affective Disorders 134 (2011) 488496

(American Psychiatric Association, 1994), dissociation is physiological arousal after viewing compared to the other
dened as a disruption of the usually integrated functions groups.
of consciousness, memory, identity or perception of the Using a qualitative methodology, Zahl and Hawton (2004)
environment. Research on dissociation tendency has found interviewed 12 patients, aged between 17 and 25, who had
that following exposure to traumatic events, those who have engaged recently in a self-harming behaviour. Participants
such tendencies tend to be more vulnerable to intrusive were asked to indicate whether they had been exposed to a
memories (Holmes et al., 2004; Murray et al., 2002; Punamki suicide story on television or at the cinema and if so to
et al., 2005). In a laboratory experiment, Murray (1997) describe the inuence that this story had had on them.
examined the potential association between dissociation, as Among the 12 patients interviewed, ten reported that a
measured with a self-reported questionnaire, and reactions to a suicide story they saw had inuenced them. The inuence
lm depicting a series of car accidents. He found that those reported by those patients varied greatly, with reactions
participants having a high score on dissociation reported more including: believing that suicide is an acceptable option,
intrusive memories associated with the lm content. rejecting the option of suicide, considering other methods of
Fourth, the personal tendency to suppress or divert from the suicide, conding to someone close to them about their
stream of consciousness aversive emotional thoughts (Wegner suicide attempts and prompting them to engage in the same
and Zanakos, 1994) may also be an important psychological suicidal behaviour as the one depicted in the lm or television
vulnerability to consider. Multiple pieces of evidence converge suicide story they had seen.
to show that this factor is involved in the development and More recently, Till et al. (2010), building upon Biblarz et al.
maintenance of many psychological disorders and is associated (1991) methodology, studied the inuence of ve lms, with
with suicidal behaviours (Chawla and Ostan, 2007; Lynch et and without a suicide content, on non suicidal adult subjects'
al., 2004; Najmi et al., 2007; Pettit et al., 2009). A series of three mood, arousal, inner tension, self-esteem, life satisfaction,
independent studies conducted by Pettit et al. (2009), with depression, suicidality, and attitudes toward suicide. Their
clinical and non clinical samples of participants between age 15 results did not indicate any signicant differences on the
and 22 years, indicated a positive and signicant association dependant variables between viewing conditions. However,
between the tendency to suppress unwanted thoughts and the all lm stimuli led to adverse consequences on participants'
intensity of suicidal ideation. mood, inner tension and depression, whilst being associated
Only a small number of studies have examined in a direct with positive effects on their self-esteem, life-satisfaction and
manner the cognitive and affective inuences of media suicidal tendencies.
portrayals of suicide in lms. In fact, it is difcult to compare The above body of ndings produced by research on the
results between these studies because of striking differences Werther Effect indicates that little is still known about the
in their methodology, participants' proles and the depen- mechanisms underlying the association between media and
dent variables measured. Martin (1996) investigated the suicide. With that in mind, this study was designed to explore
predictive power of the frequency of exposures to suicide on the emotional and cognitive reactions to suicide stories in
television for suicidal ideation, suicide attempts, and depres- lms and in television programmes as self-reported by a
sion using a self-reported questionnaire with 357 high school group of respondents and to examine the associations of
students. The frequency of exposures to suicide on television participants' reactions with several indicators of psycholog-
did predict suicide attempts, but it was not a signicant ical vulnerability.
predictor of either depression or suicidal ideation. Six research questions guided the development of our
Doron et al. (1998) presented to three groups of study and the analyses: (i) How prevalent and long-lasting
participants under psychiatric care a 20 minute lm excerpt are suicide story-induced emotional and cognitive reactions
showing the suicide by suffocation of two adolescents by in in a sample of young adults? (ii) What is the nature and range
reaction to their conicting relationships with their parents. of negative affective and cognitive reactions reported? (iii)
The rst group of participants was composed of suicide How prevalent is the reporting by young adults of suicidal
attempters, the second group presented suicidal ideation and thoughts induced by a suicide lm? (iv) Which of the
the third group was not suicidal. Measures of physiological psychological vulnerabilities are related to suicide-story
reactions, anxiety and psychomotor agitation were taken induced affective and cognitive reactions? (v) Which of the
before and after the stimulus presentation. In general, the psychological vulnerabilities of suicidal ideation, emotional
suicide attempters had less intense reactions to the lms, reactivity, dissociation, and thought suppression tendencies
compared to the other groups. The group with suicidal predict the intensity of negative affective and cognitive
ideation had intermediate values on the same measures of reactions? and (vi) Which of the psychological vulnerabilities
reactions, when compared to the other two groups. factors predict suicidal thoughts induced by suicide lms?
Biblarz et al. (1991) studied the impacts of lms depicting
either a suicide scene, a violent scene or a neutral content 2. Method
scene on attitudes toward suicide. Their study was conducted
with the participation of non suicidal university students who 2.1. Participants
were assigned to one of the three viewing conditions.
Participants' attitudes toward suicide and level of physiolog- The study sample consisted of 101 undergraduate stu-
ical arousal were measured before and after the lm dents from the province of Quebec, Canada. All participants'
presentation. Results failed to show a signicant difference rst spoken language was French. Their average age was
between groups in their attitudes toward suicide. However, 23 years old (SD = 4.27). Twenty nine (29) were male and
participants who viewed the suicide scene manifested greater seventy one (71) were female. The gender for one participant
L. Pouliot et al. / Journal of Affective Disorders 134 (2011) 488496 491

was not available. At the recruitment phase of the study, 34 items: Mehrabian, 1994) served as the measure of
described in further details in the procedure section, 305 participants' emotional reactivity ( Cronbach = .89). Finally,
students consented to participate in the study. In a later Wegner and Zanakos' 15 item White Bear Thought Suppression
phone contact to arrange with them an appointment to either Inventory was used for the psychometric assessment of
one of three group sessions, 204 students desisted from participants' tendencies to thought suppression (WBSI:
participating. Wegner and Zanakos, 1994) ( Cronbach = .91). Since no
version of the TAS, TDS, and WBSI validated and translated in
2.2. Instrument French existed at the time the study was conducted, these
scales were translated by our research team using the backward
A 127 item questionnaire, divided into three sections, was translation technique (Vallerand, 1989). The reliability of the
used in the study. In the rst section, socio-demographic adapted or French translated version of the scales used in the
information about participants' age, gender and level of study generally compared favourably to the English versions.
formal education were collected with 4 items. The second
section entailed 32 items asking respondents about their 2.3. Procedure
exposure to suicide stories, seen on television, in music
videos, in lms broadcast on television or seen at the cinema. Participants were recruited during class time in a college
Following an afrmative response about exposure, they were and a university located in Montreal. They were informed that
invited to give the title of the lm they viewed and to a study on the perception of violence in the media would be
describe its content in a few lines. Then, on a scale of six held at the university and that they were being approached to
categorical choices, respondents were invited to indicate the take part in the study. Students who manifested their interest
duration of their distress, if any, induced by the lm they to participate where invited to write down their full name
viewed (ex.: I have been distressed 1 For a few hours (less and phone number on a list in order to later be contacted by
than a day) to 6 For many months). Also, the negative the experimenter or her research assistant. A few days later,
affective and cognitive reactions induced by a lm, as they were contacted by telephone and invited to attend one
remembered and reported by the respondents, were ex- of three group sessions held at the university. Participants
plored with a 22 item scale, inspired and adapted from Weiss gave their informed consent at the outset of the group
and Mamar's Impact of Event Scale-Revised (IES-R: Weiss sessions. They then completed the questionnaire used in the
and Mamar, 1997) ( Cronbach = .89). For this study, the study. Approximately 45 min were necessary to complete the
version validated in French by Brunet et al. (2003) served as a questionnaire.
template in the construction of the items. The original Ethical approval from the institutional research ethics
version of the instrument is designed to assess stress review committee of the university was received before the
responses to real life events. In the context of our study, it study was conducted. Since suicidal tendencies in partici-
was necessary to adjust items' wordings to the fact that pants were measured in this study, participants' score on the
respondents would be asked to report on their cognitive and Suicidal Probability Scale was computed in the two days
emotional responses evoked by a suicide scene viewed in a following the completion of the questionnaire. In accordance
lm. Therefore, original items' scale where the word event with the SPS administration manual, individuals who present
appeared was removed and replaced by the word scene. On a score equal or higher to 53 are of clinical consideration.
a further series of items, participants were solicited to Using this cut-off criterion, 44 participants in our sample
estimate retrospectively the intensity of their emotional were contacted and scheduled for a 15 minute clinical
reaction to four types of emotions (fright, horror, anger, and interview with a member of our research team with
powerlessness) likely to have been evoked by the stimulus experience in suicide risk assessment at the university within
viewed on a ve point scale (1 not at all to 5 extremely). seven (7) days after completion of the questionnaire. At the
This section also included two items asking participants to end of the interview, these participants were given a list of
indicate to what extent the media presentation they viewed mental health resources. Following these interviews, none of
made them fear they would engage in the same suicidal the participants were considered at a current risk to commit
gesture as the protagonist in the scene, and to what extent suicide, whether low, moderate or high. This procedure was
they had the idea to do the same thing as the protagonist in undertaken to ensure the well-being and referrals of our
the scene. Answers to these items were collected on a ve- participants, if needed.
point scale (1 not at all to 5 extremely).
The third section of the questionnaire consisted of scales on 3. Results
the four psychological vulnerabilities under study (i.e. emo-
tional reactivity, tendency to commit suicide, dissociation 3.1. Prevalence and duration of suicide story-induced emotional
tendency, and thought suppression tendency). The eight item and cognitive reactions
subscale of the Suicide Probability Scale, measuring suicidal
ideation, was used as a proximal indicator of the propensity of The rst research question asked how prevalent and long-
respondents to commit suicide (SPS: Cull and Gill, 1982/1988). lasting suicide story-induced emotional and cognitive re-
For this study, the version validated in French by Labelle et al. actions would be in our sample. Consistent with past media
(1998) of the SPS was used ( Cronbach = .71). The tendency studies showing gender differences in emotional reactions,
towards dissociation was assessed with the 38 item Trait gender specic results are presented. On the rst set of
Dissociation Questionnaire (TDQ: Murray et al., 2002) ( questionnaire items, 70% of the participants indicated having
Cronbach = .93). The Mehrabian Trait Arousability Scale (TAS, memories of a scene of suicide depicted on screen and having
492 L. Pouliot et al. / Journal of Affective Disorders 134 (2011) 488496

been distressed by the scene. When looking at gender vs. females: M = 37.33, SD = 11.21). Over 71% of the sample
differences, 55% of the males endorsed having been distressed reported at least one stress reaction. Typically, stress re-
compared to 76% of females. From this sub-group, 33% overall actions were of an intrusive nature (71%), such as being
mentioned that their distress lasted from a few days to less mentally preoccupied by what they had seen in the scene. In
than a month. However, males were proportionally less 7% of the participants, this mental preoccupation was
numerous in claiming that their distress lasted over the rst extreme. Furthermore, nine participants (13%) said that
day of their exposure to the suicide scene (13%) compared to they experienced recurrent thoughts for many days to
females (39%). Each participant completed the questionnaire many weeks following the viewing. Most participants also
using as referent a lm they viewed in the past outside the reported having sustained waves of strong feelings about the
study context. The lms listed by participants, following scene (68%), and that any reminder of the scene brought back
verication by our research team, were classied, by the emotions related to it (61%).
Quebec Film Review Board, as being adequate for mature
audiences, available in most local video stores for rentals, and 3.3. Prevalence of suicide-related thoughts induced
all had been featured in movie theatres during the last by the suicide scene
decade. Therefore, the media stimuli they reported on were in
the limits of what most adult spectators may view or be The third research question asked how prevalent suicide-
exposed to on a day to day basis. On a subsequent item of the related thoughts would be in our sample. We found that 13%
questionnaire asking participants to indicate the emotions said that they feared that they would engage in the same
provoked by the suicide stimulus they viewed, the majority suicidal gesture as the protagonist in the scene. Furthermore,
(60%) reported that the stimulus viewed had induced a 13% reported that the idea crossed their mind to do the same
feeling of powerlessness. They were also numerous (51.4%) to thing as the protagonist in the scene. No signicant gender
indicate having felt horried by what they had viewed. In differences were found for any of the items pertaining to the
comparison, they were less likely to indicate having been suicide ideas elicited by the suicide scene they viewed. In
frightened (34.2%) and reporting that the scene induced a other words, both females and males endorsed in the same
feeling of anger (42%). As shown in Table 1, for a good proportions both items.
proportion of the participants, the intensity of these scene-
induced emotions was quite strong, ranging from moderate
3.4. Associations between psychological vulnerabilities and suicide
to extreme. Table 1 shows that females across all items
story-induced negative emotional and psychological reactions
covered in the questionnaire reported stronger emotional
reaction than males.
The fourth research question was to determine which
psychological vulnerabilities considered in the study would
3.2. Range and types of stress reactions (affective and emotions be associated with the suicide-scene induced stress reactions
reactions) reported and suicidal related thoughts. As shown in Table 2, correlation
analyses revealed that scores on the two indices of scene-
The second research question concerns the range of stress induced suicide related thoughts were both signicantly
reactions that were reported in our sample following their associated with participant's history of past suicide ideation,
viewing of a media presentation of a suicide. On the total (r(70) = .44, p b .001, and r(69) = .38, p b .01). The gender
mean scores derived from the scene-induced cognitive and variable was signicantly related to two out of the seven (7)
emotional stress scale non signicant gender differences variables under study. Males tended to show stronger
were found, (t (64) = .37, n.s.; males: M = 36.13, SD = 9.93 dissociation tendencies than females (r (69) = .27,

Table 1
Distribution of participants' answers on type and intensity of experienced emotions about the suicide scene they viewed (n = 70).

Item Not at all To some extent Moderately Quite a lot Extremely

I felt frightened
Total sample 37.1* 28.6 21.4 11.4 1.4
Male 43.8 25.0 25.0 0 6.3
Female 35.2 29.6 20.4 14.8 0
I felt horried
Total sample 21.4 27.1 27.1 11.4 12.9
Male 31.3 31.3 12.5 18.8 6.3
Female 18.5 25.9 31.5 9.3 14.8
I felt angry
Total sample 28.6 30.0 24.3 14.3 2.9
Male 25.0 50.0 18.8 6.3 0
Female 29.6 24.1 25.9 16.7 3.7
I felt powerless
Total sample 18.6 21.4 18.6 20.0 21.4
Male 43.8 12.5 12.5 31.3 0
Female 11.1 24.1 20.4 16.7 27.8

Note. *Percentage of participants endorsing the answer.

L. Pouliot et al. / Journal of Affective Disorders 134 (2011) 488496 493

Table 2
Intercorrelations between measured variables (n a).

Gender Reactivity Dissociation Suppression Ideation Stress Imitation 1 Imitation 2

Gender .33 .27 .11 .20 .05 .04 .03

Reactivity .30 .60 .23 .47 .20 .16
Dissociation .61 .37** .40 .15 .03
Suppression .24* .40 .12 .10
Ideation .14 .44 .38
Stress .19 .07
Imitation 1 .71
Imitation 2

Notes: Reactivity = emotional reactivity; dissociation = dissociation tendency; suppression = thought suppression tendency; ideation: suicide ideation;
imitation 1 = I have feared that I would engage in the same suicidal gesture as the protagonist in the scene; imitation 2 = The idea crossed my mind to do the
same thing as the protagonist in the scene.
n varies from 65 to 70 according to availability of data on the variable.

p b .05). On the other hand, females tended to report higher logistic regression analyses were performed using each of the
emotional reactivity than males (r (69) = .33, p b .01). A vulnerability factors, severity of stress reaction index and
strong and positive correlation was observed between interaction cross product terms as the independent factors to
emotional reactivity and the overall score on the suicide predict scene-induced suicidal ideations.
scene impact scale measuring scene induced stress reactions The rst logistic regression showed that having antecedents
(r (65) = .47, p b .001). There was a signicant positive of suicidal ideation positively predicted fear of imitating the
association between tendencies toward thought suppression suicidal gesture of the protagonist in the scene (M= 14.78 vs.
and stress reactions, (r (65) = .40, p = .001). The relationship M = 10.08; OR= 1.62, 95% CI = 1.01 to 25.27; 2 = 17.51,
between the propensity towards dissociation and stress p b .05). However, none of the interaction terms was signicant.
reactions was also signicant, (r (65) = .40, p = . 001). The The second regression analysis showed that participants who
association between the severity of stress reactions and reported that the idea crossed their mind to imitate the suicidal
suicide ideation was not signicant. Finally, analyses indicat- protagonist in the scene were more suicidal (M= 15.56 vs.
ed that the severity of scene-induced stress reactions, thought M = 9.93; OR = 3.45, 95% CI = 1.18 to 836.97), presented
suppression, emotional reactivity, and dissociation propensi- higher dissociation (M= 50.56 vs. M = 39.95; OR= 2.42,
ties were not signicantly correlated to stimulus-induced 95% CI = .01 to 1.13) and thought suppression tendencies
suicidal ideation. Since gender appeared as a non signicant (M= 52.44 vs. 47.03; OR = 2.34, 95% CI = .76 to 140.15),
correlate of the independent variables under study, this factor (2 = 23.64, p b .01). Again, none of the interaction terms
was not included in further analysis. were signicant.

3.5. Predictor analysis for stress reaction outcomes induced 4. Discussion

by a suicide scene
This study is among the rst of its kind to explore
The fth research question asked which psychological empirically the emotional and cognitive reactions induced by
vulnerability factors would predict the severity of stress ctional portrayals of suicide presented in movies and
reactions. The independent contribution of the psychological television series with a non clinical sample of young adults.
vulnerability factors in the prediction of the severity of stress It went beyond previous research in attempting to identify
reactions induced by the suicide scene was determined by a psychological vulnerabilities likely to predict emotional and
standard multiple regression analysis. The propensities cognitive reactions induced by suicide portrayals in mass
towards dissociation (partial = .22) and emotional reactivity media.
(partial = .35) were signicantly associated with the severity In our sample, reactions of distress that are reported to
of stress reactions, (F (4, 60) = 6.29, p b .001), and explained have been caused by exposure to a suicide scene on screen
54% of the variance in stress reactions. In contrast, the appear to be quite prevalent, with 71% of our sample
thought suppression factor and suicidal ideation antecedent reporting distress after media exposure to a suicide. In this
did not contribute signicantly to the prediction of the stress regard, it is worth mentioning that all lms or television
effect of the suicide scene (for further details see Table 3). series mentioned by participants are within everyone's reach
from local video stores or the internet. For the majority, the
3.6. Predictor/Moderator analysis for scene-induced suicidal distress induced had a short duration (limited to a few hours).
ideations However, more than one third of participants indicated that
their distress lasted for several weeks. This nding contrasts
The sixth and most important question concerns the with Bollen and Phillips' (1982) conclusion, derived from
predictive power of the psychological vulnerability factors their study on the effects of broadcast television news on
used in this study on scene-induced suicidal ideation and was suicides. The authors then concluded that the effects on the
addressed by conducting logistic regression analyses. Two audience were limited within seven days of the broadcast.
494 L. Pouliot et al. / Journal of Affective Disorders 134 (2011) 488496

Table 3 the media presentation and contemplate that they might

Standard multiple regression of vulnerability factors on severity of suicide- replicate the protagonist's suicidal behaviour. In our sample,
scene-induced stress reactions.
nine participants reported such an inuence. This should be
of major concern since our convenience sample was drawn
Predictor B SE (B) t p from a non-clinical sample.
Suicidal ideation antecedents .06 .13 .05 .47 .64 Results of this study also reveal that propensities towards
Emotional reactivity .39 .14 .40 2.90 .01 emotional reactivity and dissociation are signicant psycho-
Dissociation tendency .33 .16 .29 2.04 .05 logical vulnerabilities accounting for variations in the severity
Thought suppression .01 .17 .00 .00 .99
of stress reactions induced by media depictions of suicide.
These ndings are in line with previous research on the
relationships between these psychological vulnerabilities and
Our ndings suggest that ctional portrayals of suicides, by cognitive and emotional reactions to aversive events in
their graphic nature, may have a more signicant and longer general (Holmes et al., 2004; Mehrabian, 1995; Murray,
lasting impact than newscasts about suicides. 1997; Murray et al., 2002; Punamki et al., 2005).
Our results also show that ctional portrayals of suicide in Concerning the Werther Effect, it may be argued that
electronic mass media seem to provoke stress reactions, psychological vulnerabilities could partially account for the
which in most instances take the form of a mental suicidogenic effect of suicide portrayals in electronic media
preoccupation, recurrent and obsessive thoughts and waves on the population. Some media portrayals of suicide, as
of strong feelings about the suicide portrayal they viewed. We demonstrated in this study, induce emotional and psycho-
found that for 10% of participants, the stress reactions were logical stress reactions mostly modulated by propensities to
acutely experienced for a long time. These suicide scenes emotional reactivity. The risk that these stress reactions result
were reported as having evoked feelings of powerlessness in suicidal ideation depends upon antecedents of suicidal
and horror in most of our participants. For 13% of the thoughts, thought suppression and dissociations tendencies.
participants, their exposure to a suicide portrayal was Together these psychological vulnerability factors are signs of
accompanied by a fear of engaging in the same suicidal maladaptive cognitive and emotional processing strategies to
gesture that was depicted and thoughts about doing the same cope with stressful events in general, and as might be also the
as the suicidal protagonist in the scene. These observations case with exposure to depiction of suicide in media.
are consistent with previous research showing that viewers Prospective and experimental studies are necessary to
are not all equally affected by media portrayals of suicide determine whether or not emotional reactivity does indeed
(Biblarz et al., 1991; Till et al., 2010). However, as proposed lead to or predispose one to increased stress reactions to
by some researchers, some viewers may be more at risk of media portrayals of suicide, and that suicidal, thought
being negatively affected by media portrayals of suicide suppression and dissociation tendencies act as mediator
because of psychological vulnerabilities (Chen et al., 2010; variables.
Cheng et al., 2007a; Chiu et al., 2007; Doron et al., 1998; Due to the relatively small sample size, the absence of, or
Fekete and Schmidtke, 1996; Zahl and Hawton, 2004). marginally signicant results for some psychological vulner-
Despite the observation in our study that females reported ability variables should be viewed cautiously. Additional
overall stronger emotional reactions, this does not seem to studies, with a higher statistical power are needed in order to
translate to greater susceptibility to suicide-scene induced verify if those psychological vulnerabilities are independent
cognitive and emotional stress reactions for them compared to predictors, moderators or uninvolved in the Werther effect.
their male counterparts. Many clinical studies have demon-
strated that females report more symptoms of mood distur-
bance and depression than do males (for a review see Zender 5. Limitations
and Olshansky, 2009). Notwithstanding this fact, the aetiology
of this difference and its' impact on stress responses are still The ndings should be interpreted with caution since
unknown (Young and Korszun, 2010). As it is the case in the they are based upon reports on exposure to variety of
majority of clinical studies and studies in the eld of different media portrayals of suicide which are probably not
psychology, females outnumbered males in our sample. It comparable in terms of their content and cinematographic
follows that a replicated study with a balanced number of characteristics. Furthermore, the results are based upon a
females and males participants may offer a more conclusive survey methodology. Survey methodologies cannot estab-
answer about gender issues in the Werther Effect. Our results lish causal relationships nor determine the causal direction
concur, to some extent with Pirkis et al.'s (2006) ndings that between the variables under study. In light of such
for both, men and women, dissemination of suicide portrayals limitations, future research might consider using an exper-
in electronic media are as likely to be associated with suicidal imental approach where participants are exposed to media
behaviour. depictions of suicide where the attributes of the media
Congruent with prior research, our results show that presentations are controlled, and their reactions are
suicidal antecedents increase the odds that ones' thoughts assessed, thus allowing for a better test of causality. Also,
about suicide would be affected by a portrayal of suicide in the emotional and cognitive inuences documented here
the media (e.g. Chen et al., 2010; Cheng et al., 2007a). People may not fully generalise to the young adult population since
with prior suicidal ideation and/or suicide attempts appear to our sample was composed of undergraduate students. We
be particularly affected by suicide scenes. They are more suggest that future research use a more heterogeneous
likely to fear that they will commit suicide like the victim in sample of participants.
L. Pouliot et al. / Journal of Affective Disorders 134 (2011) 488496 495

In spite of these limitations, this study suggests many new Cull, J.G., Gill, W.S., 1982/1988. Suicide Probability Scale (SPS): Manual.
Western Psychological Services, Los Angeles.
paths of inquiry on the interplay between electronic media Doron, A., Stein, D., Levine, Y., Abramovitch, Y., Eilat, E., Neuman, M., 1998.
portrayals of suicide, psychological vulnerabilities, and cogni- Physiological reactions to a suicide lm: suicide attempters, suicide
tive and emotional reactions. ideators, and non suicidal patients. Suicide Life Threat. Behav. 28,
Etzersdorfer, E., Voracek, M., Sonneck, G., 2004. A dose-response relationship
6. Conclusion between imitational suicides and newspaper distribution. Arch. Suicide
Res. 8, 137145.
Fekete, S., Macsai, E., 1990. Hungarian suicidal models: past and present. In:
This study contests several previously held assumptions Ferrari, G., Bellini, M., Crepet, P. (Eds.), Suicidal behavior and risk factors.
about the Werther effect, many of which are included in media Monduzzi Editore, Bologna, Italy, pp. 149156.
guidelines for reporting on suicides. It shows that ctional Fekete, S., Schmidtke, A., 1996. Suicidal models their frequency and role in
suicide attempters, non suicidal psychiatric patients and normal
depictions of suicide are as potent, and possibly more control case: a comparative GermanHungarian study. Omega 33,
inuential, in provoking suicidal reactions as news stories 233241.
about real suicide cases. Furthermore, their negative impacts Frei, A., Schenker, T., Finzen, A., Dittman, V., Kraeuch, K., Hoffmann-Richter,
U., 2003. The Werther effect and assisted suicide. Suicide Life Threat.
seem to not be limited to people with a strong clinical prole.
Behav. 33, 192200.
Stress reactions to ctional suicides may extend well beyond Giles, D., 2003. Media psychology. Erlbaum, Mahwa, NJ.
seven days after exposure. There is a need to replicate our Goethe, J.W., 17741968. Les souffrances du jeune Werther. Prsentation et
ndings with larger and more varied samples and to conduct traduction par Joseph-Franois Angelloz. Flammarion, Paris.
Gould, M.S., 2001. Suicide and the media. Ann. N. Y. Acad. Sci. 932, 200224.
experimental investigations to explore more fully the factors Gould, M.S., Shaffer, D., 1986. The impact of suicide in televisionmovies. New
which inuence the impact of ctional depictions of suicides in Engl. J. Med. 315, 690694.
the media. However, given our ndings, it is reasonable to Gould, M.S., Shaffer, D., Kleinman, M., 1988. The impact of suicide in
television movies: replication and commentary. Suicide Life Threat.
recommend that broadcasting companies and lmmaking Behav. 18, 9099.
agencies should be aware of the potential negative impact on Gross, J.J., Levenson, R.W., 1995. Emotion elicitation using lms. Cogn.
viewers in the diffusion of suicide portrayals on screen. Emotion 9, 87108.
Hassan, R., 1995. Effects of newspaper stories in the incidence of suicide in
Australia: a research note. Aust. NZJ Psychiatry 29, 480483.
Role of the funding source Hawton, K., Williams, K., 2001. The connection between media and suicidal
This research was not supported by any grant from funding sources. behaviour warrants serious attention. Crisis 22, 137140.
Holmes, E.A., Brewin, C.R., Hennessy, R.G., 2004. Trauma lms, information
Conict of interest processing, and intrusive memory development. J. Exp. Psychol. Gen.
The authors declare that they have no competing interests. 133, 322.
Huston, A.C., Wright, J.C., Alvarez, M., Truglio, R., Fitch, M., Piemyat, S., 1995.
Perceived television reality and children's emotional and cognitive
Acknowledgements responses to its social content. J. Appl. Dev. Psychol. 16, 231251.
At the stage of its design, this study has beneted from many useful IMDb, 2010. Available [On-line].
comments of afliated researchers and community partners of our research Jonas, K., 1992. Modeling and suicide: a test of the Werther effect. Br. J. Soc.
center. We would like to thank Eveline Pilon, for her assistance in the literature Psychol. 31, 295306.
searches, and Prscilla Labelle for her collaboration in data collection and entry. Labelle, R., Daigle, M.S., Pronovost, J., Marcotte, D., 1998. tude psychom-
trique d'une version franaise du Suicide Probability Scale auprs de
trois populations distinctes. Psychol. Psychomtrie 19, 427.
References Lang, P.J., Greenwald, M., Bradley, M.M., Hamm, A.O., 1993. Looking at
pictures: evaluative, facial, visceral, and behavioural responses. Psycho-
American Psychiatric Association, 1994. Diagnostic and statistical manual of physiology 30, 261273.
mental disorders, 4th ed. Author, Washington, DC. (DSM-IV). Lynch, T.T., Cheavens, J.S., Morse, J.Q., Rosenthal, M.Z., 2004. A model
Bandura, A., 1977. Social learning theory. General Learning Press, New York, predicting suicidal ideation and hopelessness in depressed older adults:
NY. the impact of emotion inhibition and affect intensity. Aging Ment. Health
Bandura, A., 1986. Social Foundations of Thought and Action: A social 8, 486497.
Cognitive Theory. Prentice Hall, Englewood Cliffs, NJ. Martin, G., 1996. The inuence of television suicide in a normal adolescent
Berman, A.L., 1988. Fictional depiction of suicide in television lms and population. Arch. Suicide Res. 2, 103117.
imitation effects. Am. J. Psychiatry 145, 982986. Mehrabian, A., 1994. Manual for the revised Trait Arousability (converse of
Biblarz, A., Brown, R., Biblarz, D., Pilgrim, M., Baldree, B., 1991. Media the Stimulus Screening) Scale. (Available from Albert Mehrabian, 1130
inuences on attitudes toward suicide. Suicide Life Threat. Behav. 21, Alta Mesa Road, Monterey, CA, USA 93940).
374384. Mehrabian, A., 1995. Theory and evidence bearing on a scale of Trait
Bollen, K.A., Phillips, D.P., 1982. Imitative suicides: a national study of the Arousability. Curr. Psychol. 14, 328.
effects of television news stories. Am. Sociol. Rev. 47, 802809. Mishara, B.L., Tousignant, M., 2004. Comprendre le suicide. Presse de
Brunet, A., St-Hilaire, A., Jehel, L., King, S., 2003. Validation of a French version l'Universit de Montral, Montral.
of the Impact of Event Scale-Revised. Can. J. Psychiatry 48, 5661. Murray, J., 1997. The role of dissociation in the development and
Canetto, S.S., 2008. Women and suicidal behaviour: a cultural analysis. Am. J. maintenance of post-traumatic stress disorder. Unpublished doctoral
Orthopsychiatry 78, 259266. dissertation, Oxford University, Oxford, England.
Chawla, N., Ostan, B., 2007. Experiential avoidance as a functional Murray, J., Ehlers, A., Mayou, R.A., 2002. Dissociation and post-traumatic
dimensional approach to psychopathology: an empirical review. J. Clin. stress disorder: two prospective studies of road trafc accident
Psychol. 63, 871890. survivors. Br. J. Psychiatry 180, 363368.
Chen, Y.-Y., Tsai, P.-C., Chen, P.-H., Fan, C.-C., Hung, G.C.-L., Cheng, A.T.A., Najmi, S., Wegner, D.M., Nock, M.K., 2007. Thought suppression and self-
2010. Effect of media reporting of the suicide of a singer in Taiwan: the injurious thoughts and behaviours. Behav. Res. Ther. 45, 19571965.
case of Ivy Li. Soc. Psychiatry Psychiatr. Epidemiol. 45, 363369. Niederkrotenthaler, T., Voracek, M., Herberth, A., Till, B., Strauss, M.,
Cheng, T.A., Hawton, K., Chen, T.H.H., Yen, A.M.F., Chen, C.-Y., Chen, L.-C., et Etzersdorfer, E., Eisenwort, B., Sonneck, G., 2010. Role of media reports
al., 2007a. The inuence of media coverage of a celebrity suicide on in completed and prevented suicide:Werther v. Papageno effects. Br. J.
subsequent suicide attempts. J. Clin. Psychiatry 68, 862866. Psychiatry 197, 234243.
Cheng, T.A., Hawton, K., Lee, C., Chen, T.H.H., 2007b. The inuence of media Niederkrotenthaler, T., Till, B., Kapusta, N., Voracek, M., Dervic, K., Sonneck,
reporting of the suicide of a celebrity on suicide rates: a population- G., 2009. Copycat effects after media reports on suicide: a population-
based study. Int. J. Epidemiol. 36, 12291234. based ecologic study. Soc. Sci. Med. 69, 10851090.
Chiu, S.-H., Ko, H.C., Wu, J.Y.W., 2007. Depression moderated the effect of Nock, M.K., Wedig, M.M., Holmberg, E.B., Hooley, J.M., 2008. The Emotion
exposure to suicide news on suicidality among college students in Reactivity Scale: development, evaluation, and relation to self-injurious
Taiwan. Suicide Life Threat. Behav. 37, 585592. thoughts and behaviours. Behav. Ther. 39, 107116.
496 L. Pouliot et al. / Journal of Affective Disorders 134 (2011) 488496

Pettit, J.W., Temple, S.R., Norton, P.J., Yaroslavsky, I., Grover, K.E., Morgan, S.T., Stack, S., 2003. Media coverage as a risk factor in suicide. J. Epidemiol.
Schatte, D.J., 2009. Thought suppression and suicidal ideation: prelim- Community Health 57, 238240.
inary evidence in support of a robust association. Depress. Anxiety 26, Stack, S., 2005. Suicide in the media: a quantitative review of studies based
758763. on nonctional stories. Suicide Life Threat. Behav. 35, 121133.
Phillips, D.P., 1974. The inuence of suggestion on suicide: substantive and Thorson, J., berg, P.-A., 2003. Was there a suicide epidemic after Goethe's
theoretical implications of the Werther effect. Am. Sociol. Rev. 39, Werther? Arch. Suicide Res. 7, 6972.
340354. Till, B., Niederkrotenthaler, T., Herberth, A., Vitouch, P., Sonneck, G., 2010.
Phillips, D.P., Carstensen, M.S., 1986. Clustering of teenage suicides after Suicide in lms: the impact of suicide portrayals on nonsuicidal viewers'
television news stories about suicide. N. Engl. J. Med. 315, 685689. well-being and the effectiveness of censorship. Suicide Life Threat.
Pirkis, J., Blood, R.W., 2001a. Suicide and the media. Part I: reportage in Behav. 40, 319327.
nonctional media. Crisis 22, 146154. Tousignant, M., Mishara, B.L., Caillaud, A., Fortin, V., St-Laurent, D., 2005. The
Pirkis, J., Blood, R.W., 2001b. Suicide and the media. Part II: portrayal in impact of media coverage of the suicide of a well-known Quebec
ctional media. Crisis 22, 155162. reporter: the case of Gatan Girouard. Soc. Sci. Med. 60, 19191926.
Pirkis, J., Burgess, P.M., Francis, C., Blood, W., Jolley, D.J., 2006. The Vallerand, R.J., 1989. Toward a methodology for the trans-cultural validation
relationship between media reporting of suicide and actual suicide in of psychological questionnaires: implications for research in the French
Australia. Soc. Sci. Med. 62, 28742886. language. Can. Psychol. 30, 662680.
Platt, S., 1987. The aftermath of Angie's overdose: is soap (opera) damaging Wegner, D.M., Zanakos, S., 1994. Chronic thought suppression. J. Pers. 62, 615641.
to your health? BMJ 294, 954957. Weiss, D.S., Mamar, C.R., 1997. The impact of Event Scale-Revised. In: Wilson,
Pouliot, L., Tousignant, M., 2010. Les grappes de suicide: un phenomene J.P., Keane, T.M. (Eds.), Assessing Psychological Trauma and Ptsd: A
psychosocial reel ou une aberration statistique? Can. Psychol. 51, Practitioner's Handbook. Guilford, New York, pp. 399411.
120132. Westerlund, M., Schaller, S., Schmidtke, A., 2009. The role of mass-media in
Punamki, R.-L., Komproe, I.H., Qouta, S., Elmasri, M., de Jong, J.T.V.M., 2005. suicide prevention. In: Wasserman, D., Wasserman, C. (Eds.), Oxford
The role of peritraumatic dissociation and gender in the association textbook of suicidology and suicide prevention: a global perspective.
between trauma and mental health on a Palestinian community sample. Oxford University Press, NY, pp. 515523.
Am. J. Psychiatry 162, 545551. Yip, P.S., Fu, K.W., Yang, K.C., Ip, B.Y.T., Chan, C.L.W., Chen, E.Y.H., et al., 2006.
Romer, D., Jamieson, P.E., Jamieson, K.H., 2006. Are news reports of suicide The effects of a celebrity suicide on suicide rates in Hong Kong. J. Affect.
contagious? A stringent test in six U.S. cities. JoC 56, 253270. Disord. 93, 245252.
Schmidtke, A., Hfner, H., 1988. The Werther effect after television lms: new Young, E., Korszun, A., 2010. Sex, trauma, stress hormones and depression.
evidence for an old hypothesis. Psychol. Med. 18, 665676. Mol. Psychiatry 15, 2328.
Schmidtke, A., Schaller, S., 1998. What do we know about media effects on Zahl, D.L., Hawton, K., 2004. Media inuences on suicidal behaviour: an
imitation of suicidal behaviour: state of the art. In: De Leo, D., Diekstra, interview study of young people. Behav. Cogn. Psychother. 32, 189198.
R.F.W. (Eds.), Suicide prevention: a holistic approach. Kluwer Academic Zender, R., Olshansky, E., 2009. Women's mental health: depression and
Publishers, Netherlands, pp. 121137. anxiety. Nurs. Clin. North Am. 44, 355364.
Stack, S., 1996. The effect of the media on suicide: evidence from Japan,
19551985. Suicide Life Threat. Behav. 26, 132142.