The New York Times might have increased suicide deaths. Here’s what it can do to fix it.

• Kimberly A. Van Orden, Ph.D., Associate Professor, Center for the Study & Prevention of Suicide, University of Rochester Medical Center, Rochester, NY USA
• Jonathan B. Singer, Ph.D., LCSW, Associate Professor, Loyola University Chicago School of Social Work
• April R. Smith, Ph.D., Assistant Professor, Auburn University; Research on Eating Disorders and Suicidality Laboratory, Director
• Ian Cero, Ph.D., Senior Instructor, Center for the Study & Prevention of Suicide, University of Rochester Medical Center, Rochester, NY USA

Note to readers: On December 9, 2021 Gabriel J. X. Dance and Megan Twohey published the results of a year-long investigation into a pro-suicide website. The article was the subject of much discussion in the field of suicidology. The four of us decided to write an op-ed and send it to the New York Times. The New York Times declined to publish it. Here’s a timeline of what happened after:

• On December 21, 2021, April posted the text to Dropbox and tweeted out the link.
• One of the authors, Megan Twohey, responded to the tweet and asked to see the letter. April sent it to her. She asked to speak with us.
• On January 3, 2022 the four of us spoke with Megan. We learned that the website mentioned in the article was now a members-only site. We learned more about the process that Megan and Gabriel went through with the NYTimes before publishing the piece​, including discussions they had with numerous experts in the field of suicide prevention and many discussions with editors on ethical considerations and strategies to prevent harms and maximize benefits from their reporting. We hope to continue that productive discussion.

Here is our letter:

There is a long-standing myth about suicide: If someone really wants to kill themselves, there’s nothing we can do to stop them. Decades of suicide prevention research has disproved that myth; public health approaches to suicide prevention that include multiple components prevent suicide deaths (for a review, see Fazel et al., 2020). Examples include the Garrett Lee Smith Youth Suicide Prevention Program for youth (Garraza et al., 2019) and the Air Force Suicide Prevention Program (Knox et al., 2020) for adults. Other approaches show promise, such as psychotherapies focused on reducing suicide risk (e.g., Erlangsen et al., 2015). Another approach with strong evidence is restricting access to lethal means, which is considered a best practice. Decades of research have also shown that when news and entertainment media share information about suicide method and location, there is a short-term increase in suicide deaths (e.g., Niederkrotenthaler et al., 2021; Sinyor et al., 2018). In an effort to reduce unnecessary deaths, suicidologists have partnered with journalists to develop suicide reporting recommendations.

All suicides require that two necessary conditions to be met. Specifically, a person must have both a desire to die and the capacity to bring about their own death (see, for example, Klonsky et al., 2018 and Van Orden et al., 2010). Although suicidal desire (sometimes called “ideation”) is relatively common, most of the people who desire to die lack the capacity to bring about their own death — at least in a way that they consider workable. On December 9, 2021, the New York Times published the results of a year-long investigation into a pro-suicide website by Megan Twohey and Gabriel J.X. Dance, “Where the Despairing Log On and Learn Ways to Die.” This website provides users with the tools needed to increase their capability to die by suicide, including detailed information on lethal means, discussions about what it is like to engage in suicidal behavior that may allow users to habituate to the fear, and support from others to continue engaging in lethal behavior despite fear and pain. In short, this website can facilitate suicide deaths that otherwise would not occur. This website is one of several that perpetuates the myth that we can’t stop people who are suicidal.

As suicidologists we were horrified to learn about this website and the novel method people were using to kill themselves. We applaud the Times for this in-depth investigative reporting that uncovered the identities of the men who run the site, as this could support future efforts to regulate or dismantle such sites and save lives. In addition, the data the Times gathered documenting the rate of web traffic to the sites and the number of adults in the U.S. who died after using the site is an invaluable source of information for suicide prevention researchers in better understanding this phenomenon so that we can develop public health strategies to mitigate risks associated with such sites.

While we were grateful that this investigation could lead to the website and the novel method being shut down, we were equally concerned that disregarding the suicide reporting recommendations could result in more suicide deaths. Understanding whether this is the case is important; thus, we recommend the following:

1. We urge the Times to continue their investigative work on this site for the next 12 months so that they can empirically examine whether traffic to the site increased after the publication of this article (compared to the year before publication), and if increased site visits are associated with an increased rate of deaths linked to visiting the site. It will be imperative that the Times publish the results of this continued investigation, even if they show the Times article is linked to increases in suicides.
2. We also implore the Times to investigate whether suicides by the particular lethal means mentioned in the article (which again, was in direct violation of responsible media guidelines) increases as well. This would allow the Times to empirically examine the potential harms, or benefits, of such an investigative piece, which would provide valuable information to both those in suicide prevention and those in journalism to guide decision-making on expected benefits and harms from reporting on suicide. Again, the results of this investigation must be published in order to inform future practices, as well as appropriate national and local responses to the website and its continued investigation.

We appreciate the ethical dilemmas that the journalists and editors at the New York Times had to grapple with. We appreciate the greater attention and discussion that suicide prevention is receiving in the media and in everyday conversations. This is especially important given the huge public health impact of suicide and the personal impact suicide has on those experiencing the pain of suicidal thoughts and those who lose loved ones to suicide. However, we hope that the attention to suicide prevention can be given in a thoughtful manner, and one that follows best practices and responsible media guidelines. If the journalists and editors believe that publishing this piece was in the service of saving lives, then it is imperative for them to follow through in the ways outlined above. If you, or someone you know, are experiencing suicidal thoughts, there are resources and help available. The National Suicide Prevention Lifeline is available 24/7 at 1–800–273-TALK and online at crisistextline.org.

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Expertise or relationship to this topic:

All authors conduct research in suicide prevention and are also trained clinicians who provide care to suicidal people.

The lead author, Dr. Van Orden, is a clinical psychologist and Associate Professor in the Department of Psychiatry at the University of Rochester Medical Center. She is a co-director of the Center for the Study and Prevention of Suicide at the University of Rochester and co-directs a postdoctoral fellowship in suicide prevention. She is the Principal Investigator of the HOPE Lab (Helping Older People Engage) and Co-Director of the Rochester Roybal Center for Social Ties and Aging. Her lab conducts randomized trials of suicide prevention interventions to promote social engagement and healthy aging. Her research has been funded by the National Institute of Mental Health, the National Institute on Aging, and the Centers for Disease Control and Prevention. She mentors students and fellows, and maintains an active clinical practice providing evidence-based psychotherapy. She has gained international recognition for expertise in suicide prevention and in the Interpersonal Theory of Suicide, which she helped develop, refine, and test (Van Orden et al., 2010). Methodologies she has successfully applied over time include epidemiology, cohort and case control approaches, and development and testing of psychosocial interventions in clinical trials. Her strong record of engaging in collaborative suicide prevention science with colleagues around the world and across disciplines was recently recognized by the American Association of Suicidology with the Edwin S. Shneidman Award for outstanding contributions in research in the field of suicidology.

Dr. Jonathan B. Singer, LCSW is Associate Professor of Social Work at Loyola University Chicago, founder and host of the award-winning Social Work Podcast, Past-President of the American Association of Suicidology and coauthor of the best selling 2015 Routledge text, Suicide in Schools: A Practitioner’s Guide to Multi-level Prevention, Assessment, Intervention, and Postvention. He is the author of over 75 publications and his research has been featured in national and international media outlets like NPR, BBC, Fox, Time Magazine, and The Guardian. His co-authored article with Arielle Sheftall and John Ackerman about the news media’s reporting on the suicide deaths of Kate Spade and Anthony Bourdain won the prestigious 2019 SDX prize for research on journalism. He is an NASW Expert, Healio Psychiatry Peer Perspective Board member, and on several national youth advisory boards including Sandy Hook Promise, JED Foundation, Suicide Prevention Resource Center, and the National Suicide Prevention Lifeline.

Dr. April Smith is the director of the Research on Eating Disorders and Suicidality (REDS) Laboratory at Auburn University. Dr. Smith received her Ph.D. from Florida State University’s Clinical Psychology Program in 2012 and completed her clinical residency at the University of California, San Diego.Dr. Smith was an associate professor at Miami University before starting at Auburn in 2021. Dr. Smith was named a 2016 Rising Star by the Association for Psychological Science. Dr. Smith has published over 100 articles and received over $2 million in funding from the Department of Defense and NIMH to support her work.

Dr. Ian Cero is a clinical psychologist and statistician. He is a senior Instructor in the Department of Psychiatry at the University of Rochester Medical Center and a member of the interdisciplinary Center for the Study and Prevention of Suicide. He is also a founding member of the Department of Psychiatry’s Quantitative Core. Dr. Cero’s research and clinical work focus on both upstream and acute social network interventions to prevent suicide.

Twitter links: @kimvanorden; @socworkpodcast; @REDSLabAuburn; @IanCero