Newspaper reporting of suicide in Nepal: Quality assessment against World Health Organization media guidelines

Abstract Background Sensible media reporting of suicide is a population‐based suicide prevention strategy. However, the quality of media reporting of suicide has not been assessed in Nepal. Objectives We aimed to assess the newspaper reporting status of suicide in Nepal with reference to World Health Organization (WHO) media guidelines for suicide reporting. Method We retrospectively searched eight major newspapers in Nepal between January 2020 and May 2021 and assessed 167 news reports against WHO suicide reporting guidelines. Results Potentially harmful characteristics were found to be reported in both the title and main text of the reports. About half of them mentioned sex (48.5%) and 38.3% mentioned the location of suicide in the title. Of the 167 reports, 74.3%, 95.2%, 34.7%, 92.2%, 98.8%, and 52.7% mentioned the name, sex, occupation, method of suicide, the location of suicide, and life events, respectively, in their main content. On the other hand, only 6% and 2.4% of reports mentioned linkage of suicides with mental illness and substance abuse, respectively. While lesser than 1% of reports narrated educative information regarding suicide prevention, none mentioned contact information for help‐seeking for the vulnerable. Conclusion Newspaper reporting of suicide in Nepal poorly adheres to WHO guidelines, substantiated by the high presence of potentially harmful characteristics and negligible presence of potentially helpful characteristics.


| INTRODUCTION
An estimate of 703,000 people died by suicide in 2019 accounting for 1.3% of all deaths worldwide. 1 Among the suicides, 77% happened in low-and middle-income countries in 2019 where prevention of suicide is under-prioritized. 1 The agestandardized suicide rate was 10.2 per 100,000 in South-East Asia, and 9.8 per 100,000 in Nepal in 2019 which was higher than the global average (9 per 100,000). 1 Media plays a bidirectional role in the suicidal behavior of the general population, which is well-known by the "Werther effect" and "Papageno effect." [2][3][4][5][6] Media reports can have potentially positive effects in suicidal prevention by disseminating the potentially helpful characteristics of media reporting, which has been circulated by World Health Organization (WHO). 5 On the other hand, it can be harmful when it provides a simple, monocausal explanation, suggesting it as a solution to immediate triggers and, failing to explain the correlation with various proximal and distal risk factors. 7,8 Publishing of detailed descriptions of suicide methods can consequently result in imitation by the vulnerable people. 2,9,10 Therefore, sensible media reporting of suicide is a population-based suicide prevention strategy. 4,5 To minimize the inappropriate suicide reporting and promotion of sensible reporting, a guideline for media reporting of suicide has been developed by WHO and the International Association for Suicide Prevention (IASP). 5 However, one recent review revealed that media rarely report the linkage of suicide with mental health, drug-related issues, and usually do not include experts' opinions and factual statistics in South-East Asian countires. 11 Very little is known about the proper utilization of these recommended guidelines in Nepal. No report regarding assessment of the quality of media reporting on suicide in Nepal has been identified. 11,12 Hence, we aimed to explore the newspaper reporting status in Nepal against the WHO suicide reporting guidelines, which would be considered as a baseline study regarding quality analysis of media reporting on suicides in Nepal.

| Data collection
We searched the major printed national newspapers and major read online news portals in Nepal to identify the suicide news reports. The search was conducted by the first four authors. The newspapers and online news portals were selected based on daily nationwide circulation coverage and maximum hits of accessing the online sites, respectively. A retrospective search was done in six Nepali newspapers (two national printed and four online news portals) and two national English newspapers via their available online version. The two purposively selected English language newspapers were The Himalayan Times and My Republica and Nepali language newspapers and news portals were Kantipur and Naya Patrika, and Onlinekhabar, Ratopati, Setopati, and Khabarhub.
News reports published between January 2020 and May 2021 were included in this analysis. We searched in Google using the term "suicide," "Nepal," names of the newspapers, "self-harm," "hanging self," and "poisoning" in different combinations. The first author assessed the data quality by cross-checking the reports and an acceptable level of inter-rater reliability (Cohen's κ was above 0.90) was revealed.

| Inclusion criteria
We included news of those specifically reported suicide in Nepal.

| Exclusion criteria
We excluded news related to suicidal ideation, suicidal attempts, suicide bombing, opinion pieces on suicide, editor's view, and undecided suicide from the study. We did not include news published in languages other than English and Nepali and those published in local and regional newspapers.

| Instrument, data extraction, and outcome variables
We identified and contrasted the variables against the WHO guidelines to assess adherence. 5 We checked both potentially harmful and helpful characteristics as per the WHO guidelines. The instrument has already been used in various studies in different countries like Bangladesh, India, Indonesia, Myanmar, and Thailand. [13][14][15][16][17] Potentially harmful characteristics include name, age, sex of the deceased, place, mode, attributed cause, pictorial presentation of suicide, life event related to suicide, and a suicide note. Whereas potentially helpful information targeting the prevention like help-seeking behavior and services were extracted as outcome variables. We scrutinized the news reports and noted the outcome variables in MS Excel 2010 sheet on a "yes" and "no" basis. We also noted the basic details of news sources, including the name and language of the news outlet, link, and publication date for the online news reports. We presented the quality assessment of the news reports under three headings-content in the title, content in the body, and reporting education and information to the readers.

| Statistical analysis
The Micro Soft Excel 2010 version and the Statistical Package for the Social Sciences (SPSS) were used for data analysis. We used frequency and percentage to describe the characteristics of media reports and performed χ 2 test and Fischer's exact test to determine the association between the type of media and quality of news reports and language of media and quality of news reports.

| Ethical considerations
As the study analyzed publicly available information from online newspaper reports, no formal ethical clearance was sought for conducting the study.

| Background characteristics of the suicide reports
Among the 167 suicide reports, 43.8% of the reports were from printed national newspapers and the rest 56.2% were from online national news portals (Table 1). Similarly, 87.4% of the suicide reports were from news media published in the national language (Nepali), and the remaining 12.6% were published in English (Table 1).

| Potentially harmful and helpful characteristics of Nepali media according to WHO suicide reporting guidelines
The potentially harmful characteristics were reported in both the title and main text of the suicide reports ( 3.3 | Comparison of adherence with WHO suicide reporting guidelines between online news media and printed newspaper While it was found that both forms of newspapers (online and printed) reported both harmful and helpful characteristics of suicide, no significant variation was noted between the forms of newspaper and quality of suicidal reports to conclude whether any of them had lesser or more harmful or helpful characteristics than its counterpart (Table 3).

| Comparison of adherence with WHO suicide reporting guidelines between online local language newspaper and English newspaper
While it was found that news media in both languages (English and Nepali) reported both harmful and helpful characteristics of suicide, there was no significant association between the language of news and quality of suicidal reports to conclude whether any of them had lesser or more harmful or helpful characteristics than its counterpart (Table 4).

| DISCUSSION
Although responsible media reporting is one of the effective population-based suicide prevention strategies, it has not been explored previously in Nepal. [4][5][6]11,12 We aimed to assess the quality of newspaper reports against WHO media guidelines for suicide reporting. We assessed 167 reports from eight prominent newspapers of Nepal between January 2020 and May 2021. Our study showed that media reporting suicide is usually nonadherent to WHO suicide reporting guidelines. The explicit mentioning of potentially harmful characteristics in both the title and main text of the reports was common practice, whereas reporting of potentially helpful characteristics was minimal. The narration of name, age, gender, method, and location of suicide in the main content is in more than one-third of the suicidal reports. Educational information on suicide prevention was rarely mentioned and no information for help-seeking behavior with suicidal thoughts was reported.
The findings of this study correspond to the reviews that assessed the quality of media reporting of suicide in South-East Asia. 11,12 The low adherence to WHO guidelines and sensational presentation of suicides have been consistently found in other Asian counties also. 7,15-26 One of the studies in India reported gender as the most common identity reported by the newspaper both in the title and main text. 24 The minute reporting of cause and steps of suicide is found to be reported in this study, which can be potentially harmful to readers. 22 Adherence to WHO suicide media reporting guidelines was also not practiced properly while reporting suicide reports in the newspaper and online media sources in China. 25 These types of insensible practices can provoke suicidal behavior and can be imitated by vulnerable people; hence, controlling such practices is important. [27][28][29] In contrast to potentially harmful characteristics, potentially helpful characteristics like providing hope to readers were less focused, which is comparable to the study findings from India, Bangladesh, Indonesia, Bhutan, Myanmar, and Thailand. 12,[15][16][17]30,31 Apart from rarely mentioning educative information on suicide prevention, suicide linkage with mental illness, substance abuse, warning signs, and other potentially helpful reporting characteristics encouraged in the WHO guideline were not identified. Nothing was mentioned about supportive helpline/hotline information for the people with suicidal thoughts, which is similar to the study findings from Bangladesh. 13 These can be due to the lack of awareness about media guidelines among the media personnel. 13 The newspapers in India are also more focused on sensationalism and fail to incorporate educative materials on suicide prevention. 32 This can be on account of lack of collaboration of media with mental health experts, poor mental health literacy, and absence of media monitoring. 22 Hence, there is a dire need for collaboration of mental health professionals with media personnel for guidelines' implementation to prevent suicides. 18,25,32 However, inadequacy in the number of mental health professionals in Nepal hinders such practices; thus, it is implausible as these professionals cannot contribute ample time to share their expertise with media professionals regularly. 22 The WHO/IASP guideline further recommends using population-level data, suicide research findings, mentioning a suicide hotline number, and supportive programs on suicide prevention; however, lack of population-level data, few preventive and supportive programs, and paucity in research on suicide make the effective implementation of the guideline in Nepal a challenging task. 5 Therefore, it is important to consider the re-

commendations of WHO/IASP guidelines in suicide reporting in
Nepal.
This study reported no significant association between the forms of newspaper (online and printed) and quality of reports, which suggests that both forms of newspapers follow the same reporting pattern. Likewise, no significant association was found between the languages (English and Nepali) of news and the quality of reports. It is the same in the reports from Pakistan, where reporting was inappropriate in both Urdu and English language. 26 However, other studies found that potentially helpful characteristics were reported more in English language newspapers compared to vernaculars. 30,33 One of the studies in India also reported the quality of suicide reporting in English newspapers, which focused on preventive aspects with lesser breaching in reporting compared to the regional language. 34

| Strengths
This is one of the first studies conducted in Nepal to assess the quality of newspaper reporting suicide and can serve as a baseline study. This study can be helpful to media professionals to understand the current state and can encourage them in sensible media reporting, which can consequently help prevent suicide.

| Limitations
There were some limitations in our study and the results should be generalized cautiously. This is a cross-sectional study that included only eight printed and online news portals. Moreover, they were searched purposively and retrospectively. The information from newspapers may be insufficient, untrustworthy, and biased. 36 We did not include other mass media, such as television and social media, which are the important source of news. We included only those articles which covered suicide deaths and excluded suicide attempts and reports discussing suicide topics.

| CONCLUSION
Newspaper reporting was poor in adherence to WHO suicide reporting guidelines in Nepal. A detailed description of suicide cases was done frequently. Reporting of potentially harmful characteristics was common, while reporting of the helpful characteristics was minimal. There was negligible information about the supportive helpline for suicidal people. Awareness is needed and media professionals should be sensitized and engaged in appropriate and sensible media reporting of suicide. Strategic collaboration with media professionals, stakeholders, and mental health professionals should be designed to facilitate media professionals for their effective contribution to suicide prevention.

CONFLICTS OF INTEREST
The authors declare no conflicts of interest.

DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.