The effects of celebrity suicide on copycat suicide attempt: a multi-center observational study

Background The effect of celebrity suicides on copycat suicide attempts is not well known. Our objective was to determine the association between celebrity suicide and copycat suicide attempts. Methods We conducted a retrospective multicenter observational time series analysis. Celebrity suicides were selected by an operational definition via three nationwide television news internet sites from January 2005 to December 2008. The reference week was defined as the week preceding date of suicide notification to the public. Then two pre-event weeks and four post-event weeks were analyzed for suicide attempts. We derived a prediction model for suicide attempt visits for each ED for these seven observational weeks using a General Additive Model with data from the National Emergency Department Information System (NEDIS) database. We calculated the mean excess visit (EV = observed visit - expected visit) and mean excess visit ratio (EVR = EV/expected visit). We tested the mean EV and EVR between reference weeks versus the observational weeks using independent t test and repeated measures ANOVA. Results Five celebrity suicides occurred during the study period. Total number of ED visits was 5,453,441 in the 85 EDs over the 4-year period, and suicide attempt or selfinjury occurred in 27,605. The mean excess visit for each observational interval per ED was less than 0.1 during pre-event periods but increased to 0.695 in the second post-event week. EVs were significantly higher in the first to the third post-event weeks (p = 0.02, p\0.01, p = 0.03, respectively) compared to reference week. The mean EVRs were significantly higher (=0.215) in the second post-week intervals compared with the reference week (p = 0.03). Mean EVs and mean EVRs showed significant increase in the post event period compared with the observational period (p = 0.001 in EV, p = 0.021 in EVR). Conclusion From a prediction model using a 4-year nationwide ED database, ED visits for suicide attempts or self injury increased following the announcements of celebrity suicides.