Discussion

To our knowledge, this is the first study to compare suicide reporting quality among different major US cable television networks across the ideological spectrum. In line with some previous research across media internationally, we found only limited adherence to responsible media guidelines overall; approximately half of all segments included a suicide method, more than 40% used stigmatising language and most putatively protective characteristics appeared in 10% or less of segments. ^{Reference McTernan, Spillane, Cully, Cusack, O’Reilly and Arensman19,Reference Pirkis, Dare, Blood, Rankin, Williamson and Burgess20,Reference Wu, Lee, Liao, Chan and Chen22,Reference Sinyor, Williams, Zaheer, Loureiro, Pirkis and Heisel25} A previous study specifically examining US newspaper reports following publication of responsible media recommendations found modest adherence and little putatively helpful content. ^{Reference Tatum, Canetto and Slater26}

Arguably, the most consequential finding of our study is that there were only 15 news segments focused on a story of survival from suicide across all 3 networks and 11 years of data. This means that, on average, a person regularly viewing one network might come across an example of a suicide-related segment focused on a story of survival every 2 years. Furthermore, only one segment focused on a narrative of survival on prime-time (on CNN) during the entire epoch. Contrast that finding with the 399 segments with narratives focused on suicide deaths and/or attempts, suggesting that a regular viewer of one channel would, on average, see one such story every month. These findings are disappointing when considered in the context of evidence that media narratives of survival tend to be followed by fewer suicides. ^{Reference Niederkrotenthaler, Kirchner, Till, Sinyor, Tran and Pirkis2,Reference Hawley, Niederkrotenthaler, Zaheer, Schaffer, Redelmeier and Levitt24,Reference Niederkrotenthaler, Till, Kirchner, Sinyor, Braun and Pirkis27} Dissemination of responsible reporting guidelines and engagement with journalists can have a positive impact in changing reporting coverage, and potentially in saving lives. ^{Reference Flego, Reifels, Mihalopoulos, Bandara, Page and Fox28–Reference Sinyor, Ekstein, Prabaharan, Fiksenbaum, Vandermeer and Schaffer30} There is a clear need for experts to liaise with major US cable news providers to discuss what steps may be taken, within the scope of the current media environment, to improve reporting quality and mitigate risks. Such efforts might emphasise that, when presented effectively, stories of survival can be highly compelling for viewers. ^{Reference Niederkrotenthaler, Tran, Gould, Sinyor, Sumner and Strauss31,Reference Sinyor, Stack and Niederkrotenthaler32} Given the unfortunate ubiquity of lived experience of suicide across large groups of people (and therefore large organisations), it may also be useful to identify journalists and other key stakeholders in the cable news sphere who feel a personal stake in improving content and who may be able to help champion this message to their colleagues.

Although we observed many statistical differences in content and gestalt narratives between segments across networks, most of these were of only small to medium magnitude, and there were no obvious trends indicating a difference in the global quality of reporting among networks. The much higher proportion of segments on Fox News that reported statistical information and included interviews with non-mental health specialists compared with other networks appears notable but somewhat difficult to interpret without a deeper investigation of, for example, what those statistics were and their accuracy. Fox News’ greater focus on the unsupported ^{Reference Pirkis, Gunnell, Shin, Del Pozo-Banos, Arya and Aguilar33} notion that suicides increased due to the COVID-19 pandemic and/or were related to lockdowns may be the finding most suggestive of political ideology influencing coverage; here, too, further exploration of this point is needed. Our results regarding celebrity-related reporting are likewise mixed. We must be concerned about the emphasis on suicidal behaviour/death in this group, potentially more sensational reporting and the inclusion of methods, especially on Fox News, given that such reports may be particularly likely to influence imitative behaviour. ^{Reference Niederkrotenthaler, Braun, Pirkis, Till, Stack and Sinyor1} Nevertheless, the fact that such reports were less likely to use stigmatising language (on CNN) and more likely to provide information about warning signs (on CNN and Fox News) is somewhat encouraging.

The fact that neither the word ’suicide’ nor any suicide method ever appeared in a MSNBC headline appears noteworthy, and could be evidence of a journalistic policy not to include such details. MSNBC also more commonly aired segments with narratives focused on ’suicide response’ (i.e. efforts to prevent suicide) as well as other positive messages; nevertheless, the absolute number of stories on prevention was very small (four segments). In contrast, MSNBC segments were less likely than those of the other networks to discuss warning signs of suicide or include reference to the national lifeline. Our findings also appear to indicate that MSNBC coverage had a somewhat greater focus on policies, legal issues and veteran suicide, with less focus on celebrity suicide.

The reduction in putatively harmful elements in coverage on CNN and MSNBC over time is somewhat encouraging. CNN had fewer instances of mentioning a suicide method, stigmatising language and discussing celebrity death over time, which led to a significant reduction in harmful elements. MSNBC also had a reduction in instances mentioning a suicide method or employing stigmatising language over time; this, too, led to a significant reduction in harmful elements. In contrast, there was an increasing trend of putatively harmful elements over time in Fox News segments. We speculate that these findings may reflect an increasing polarisation between the content presented by the networks. ^{Reference Till, Braun, Gahbauer, Reisinger, Schwenzner and Niederkrotenthaler34} Notably, there was no substantial difference in the number of putatively protective elements in segments across the networks over time.

Approximately one third of all segments across networks reported on suicide in public ‘villains’ (e.g. the suicide of Jeffrey Epstein). Such reporting may be less likely to produce a Werther effect and may even be followed by fewer suicides. ^{Reference Sinyor, Schaffer, Nishikawa, Redelmeier, Niederkrotenthaler and Sareen10,Reference Sinyor, Williams, Zaheer, Loureiro, Pirkis and Heisel25,Reference Niederkrotenthaler, Till, Herberth, Voracek, Kapusta and Etzersdorfer35,Reference Stack36} Those exposed to these stories may be less apt to identify with the person portrayed and imitate their behaviour. ^{Reference Niederkrotenthaler, Till, Herberth, Voracek, Kapusta and Etzersdorfer35} However, the impact of such portrayals may be complex and problematic in that they may stigmatise individuals who contemplate suicide and, worse, may contribute to a culture that normalises suicide as a way of coping with certain kinds of personal circumstances, such as being charged with a crime. ^{Reference Sinyor, Stack and Niederkrotenthaler32}

This study had a number of limitations. It was restricted to three major news networks in the USA, and a single epoch. Whether results would be the same in a different location, for other networks and during a different time period is unknown. Transcripts also did not capture inserted video clips or imagery aired during segments. Likewise, our focus on transcripts obviated investigation of details such as facial expressions and hand gestures, which may have influenced audience perception. Researchers are encouraged to consider approaches that might capture this information. Future studies would also benefit from attention to more granular details regarding certain variables, such as which statistics were quoted and their accuracy, as well as the stance presented on issues such as gun violence and assisted suicide. This was all outside the scope of our planned study. On the one hand, our focus on cable news is an innovation; on the other, there is a question of the degree to which these findings may be generalisable to other formats. Television news is a fast-paced medium, with many segments often focusing on exciting ‘breaking’ news that may be particularly susceptible to stories that may violate media guidelines. We may speculate that other formats, such as longer-form journalism, might better adhere to media guidelines; this speculation warrants confirmation. Last, our study did not measure the impact of news segments or their characteristics and narratives on people who may have been exposed to them, nor did it assess associations with subsequent suicide rates. Future analyses of such exposures may be complex in an age where multiple social media and streaming platforms mean that people consume news content at different times and in different formats (e.g. a person watching a CNN segment on YouTube weeks after it aired).

To our knowledge, this is the first study to examine the quality of suicide-related reporting comparing major 24-h news networks in the USA across the political ideological spectrum. We found limited adherence to responsible media reporting guidelines across networks, with most stories focusing on suicide deaths and very few communicating narratives of survival. Despite specific differences among these, there was no consistent pattern of reporting indicating higher-quality reporting by any network. These results point to the need for greater engagement with all major US networks about safe practices in reporting on suicide.