Suicide Prevention Public Service Announcements

Article in review: Wiglesworth, A., Abate, J.P, & Klimes-Dougan, K. (2021). Suicide Prevention Public Service Announcements – Recall Biases Associated With Increased Risk for Suicide, Crisis. https://doi.org/10.1027/0227-5910/a000744

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Summary

Public Service Announcements work by communicating messages and providing a call to action on a certain behaviour or belief. For PSAs about suicide prevention to be effective, a person must be able to recall the message before or during a suicidal episode. The purpose of this study was to better understand recall of suicide prevention PSA amongst young people at “high” risk and “low” risk for suicide. (We have our own opinions on such classifications… but for the purpose of this review, we are reflective of their language and methodology). The study found that young people considered at high risk of suicide were less likely to recall key prevention messages than those not considered at risk of suicide.

Public Service Announcements and Suicide Prevention

Public service announcements (PSAs) have become a popular strategy for raising awareness of suicide and suicide prevention. There is evidence to suggest that PSAs have a positive impact overall, by assisting to increase awareness and literacy and alter attitudes about suicide. However further research is needed to determine how effective suicide prevention campaigns may be and how messages are perceived by those experiencing suicidality.

Modern audiences are constantly being presented with messages across all media channels – online, through TV and radio, printed materials and billboards. One way of assessing the effectiveness of public service announcements is to study recall, which is how audiences recall language, graphics and other features of PSAs.

PSAs related to suicide prevention must be carefully constructed. While some messages are designed using provocative messaging there are “critical limits” on messages related to suicide that can be publicly presented. Language must be considered in PSAs about suicide; for the risk of inadvertently communicating harmful messages. For example, the language “committed suicide” may communicate beliefs about immorality, or narratives depicting suicide may be taken to indicate perceptions of the reasonableness of this as a solution, to a suicidal person. Young people in particular may be especially prone to misinterpreting messages which seem to sensationalise suicide or facilitate affiliation with characters depicted as having died by suicide.

The value of Public Service Announcements in Suicide Prevention

There is research to suggest the value of PSAs to promote suicide prevention. People who are at risk of suicide may be:
• Primed to better remember PSA information through cognitive and affective biases
• More likely to encode, attend to and commit negative information to memory, possibly leaning to enhanced reception of PSAs related to suicide prevention
• Retain better information they believe to be personally significant or self-referent

However, when suicidal, people may also experience neuropsychological impairments that undermine prevention messages. People with depression have been noted to display deficits in attention and memory while those experiencing suicidal thoughts often have deficits in autobiographical memory. Individuals are also more likely to recall messages that are congruent and in line with their emotional state – so those in compromised emotional states may not be able to recognise or recall help-seeking suggestions in suicide prevention PSAs. This corresponds with the research that has found that help seeing messages in PSAs do not effectively prompt help-seeking behaviours.

This study has sought to determine the extent to which young adults could recall information about suicide prevention messages. The first was to understand recall of a billboard PSA featuring suicide prevention messages, help-seeking information and other features. The second aim was to determine if there was a difference in recall between young people at “low” or “high” risk of suicide.

Participants and method

The study involved 140 young adults aged between 18 and 28 (mean 21.3 years, 78.57% female, 72.86% white). Participants completed a questionnaire related to demographics and questions and adapted a depression screening tool to assess suicide risk (where we flag the methodological flaws of the study with respect to risk categorisation based on a depression screener), with 44 participants (31.43%) determined to be at high risk (reporting depressive symptoms or suicide attempt).
Participants were then shown a simulated billboard for five seconds. The billboard had a main message of “Prevent Suicide. Treat Depression”, and a help-seeking message- “See your doctor”. Participants were asked questions related to their recall of a PSA they viewed and were asked to describe in as much detail what they saw.

Finding

A code was developed to classify the content of responses to the question about the PSA. The main message was coded as complete if the respondent could provide the word for word message, or a complete paraphrased message. Other responses included:
• Aspects of seeking help
• General references to getting help
• Presence of a website
• Symbols, fonts and colours
• Features of the person depicted

The percentage of participants who reported:
• All critical aspects of the main suicide prevention message -48.57%
• help-seeking content – 40.71%
• At least one graphic feature of the PSA – 62.14%

The most commonly recalled features of the person represented were “male” (46.43%) and the mood of the person being “sad” (29.29%). The study found no significant difference in the report of the main suicide prevention methods between the low-risk suicide and high-risk suicide groups, however:
• The “high” risk group was significantly less likely to recall the help-seeking message than the low-risk group
• The highest risk group who had sought help for depressive ad suicidal behaviours were significantly more likely than those who had never sought help to recall the main message of the billboard
• There was also no difference between the groups regarding the graphic elements of the PSA.

This study has reinforced the idea that those at risk of suicide (experiencing depression) are less likely to recall messages about seeking help in a time of crisis and suicide risk, consistent with other research that the sound those with depresses are more likely to ignore help-seeking material. Individuals with depressive symptoms or who have attempted suicide are less likely to recall the message that help is available.
Authors argue that these findings may explain why media-based suicide prevention efforts have not been as successful at encouraging those at risk to see the help.

Future research in this area could include:
• Audience recall across different forms of media
• Nuances of specific prevention SPAs
• Provision of different types of exposure and exposure to different types of messages

The extent to which PSAs can actually encourage those at risk to seek help is thought to be somewhat limited, and understanding why these messages may be lost or forgotten at a critical point is the necessary next step for research.