Introduction

Suicide is a major health issue in all countries[1]. According to the Korean National Statistics Office, suicide-caused death has increased by 119.90% during the last decade. In 2011, 43.6 people died by suicide daily in Korea[2]. The suicide rate of 31.7 per 100,000 people is about 2.6 times higher than the OECD average; thus, suicide is a serious social issue in Korea[2]. The suicide rate is particularly high among elderly people, reflecting the rapid aging of Korean society and the suicide rate in males outnumbers females as in most other parts of the world[2-4].

Celebrity suicides have frequently been reported in the media over the last decade in Korea. A celebrity suicide event is likely to receive public attention through extensive media exposure, and this event may induce imitative suicides[5-7]. The surge in the incidence of suicide and suicide attempts following incidents of celebrity suicide is particularly salient when those celebrity suicide cases are widely publicised in the media[8-12]. This general imitative effect of an increase in the number of suicides triggered by extensive media reporting on suicide cases is described as the ‘‘Werther effect’’, which describes the widespread imitative suicide copying Werther (the hero in Goethe’s novel)[12]. Since the term Werther effect was used to describe the phenomenon of the increasing suicides after a publicized suicide in a 1974 article, it has been widely discussed in terms of the impact and mechanisms of publicized report on suicide behaviour[12-15]. Previous studies have suggested that age, gender and identification of the method of suicide following a celebrity suicide are relevant to imitative suicide[8-10,12,16,17]. This imitative suicide is more prominent among young people and among the same gender as the celebrity[5,9,11,17-19].

Since the Werther effect was reported in Taiwan[10,11,18], further research estimated the elevated suicide risk after celebrity suicides in non-western countries[8,9,17,20]. Regarding Korea where the suicide rate is increasing rapidly, one study reported an increased suicide risk in Korea after the suicide death of a famous actress in 2005[17]. Since then, subsequent suicide deaths of celebrities have occurred in Korea. A recent study examined a pattern of increasing suicide rates in Korea and found that three of 11 suicides of celebrities significantly influenced the suicide risk in the country[20]. While media effects about celebrities’ suicide and imitative suicides are linked, given their renown[21], the Werther effect after the suicide of other types of celebrity, rather than an entertainment celebrity, has rarely been examined. In a milestone study investigating on the celebrity suicide effects based on the theoretical taxonomy of celebrities, only entertainers and political celebrities were found to be related to significant Werther effect among several types of celebrity[21].

During the last decade, two dramatic examples of celebrity suicide in Korea were the deaths of actress Jin-Sil Choi and the former President Moo-hyun Roh of the Republic of Korea. A popular 40-year-old movie actress, Jin-Sil Choi, killed herself by hanging in her house on October 2, 2008. The next year, the 63-year-old sixteenth Korean President, Moo-hyun Roh, killed himself by jumping off a mountain on May 23, 2009. Ms. Choi was a major star who overcame childhood poverty and difficulties. Giving hope to the public, she was popularly called ‘the nation’s female actor’. Former President Roh, who used to represent politically disadvantaged people as a civil-rights lawyer in South Korea, was elected as the sixteenth Korean President (February 25, 2003-February 24, 2008). He received extensive support, particularly from the younger population. Before their suicides, these two celebrities were living in a state of considerable distress. The distress and suffering of Ms. Choi had been continuously reported following her divorce from her husband, due to his infidelity, approximately 3 years before her suicide. Sympathy for her tragedy went hand-in-hand with reproach of her former husband immediately after her suicide, which was amplified by a number of imitative suicides. Towards the end of his tenure, President Roh suffered from depression and was under pressure from the opposing party, who brought about a regime change, regarding evidence of his political corruption, which constituted a fatal blow to his image as an ‘ordinary person’ who differed from the public perception of typical politicians[22]. The disappointment of the general population in President Roh may have weakened the Werther effect following his death, as compared to that of Ms. Choi.

News of the suicides appeared immediately in the headlines of TV networks, newspapers, and Internet broadcast. The methods of the suicides were detailed and pictures of the suicide scenes were aired for several weeks.

In this study, we further examined the effect of politician celebrity and entertainment celebrity suicide news on the suicide rate across age, gender, and suicide method. We also investigated the duration of the Werther effect in terms of the age, sex and suicide method of suicides that may have resulted from the media reporting of the suicides of an entertainment celebrity and a political celebrity.

Materials and Methods

Results

Suicide rates after the celebrity suicides

The suicide incidence rate before and after each celebrity suicide on a weekly basis is depicted in Figure 1. Immediately after both suicides, the suicide rate rose. However, the increase in the suicide rate appeared steeper during the first week after the suicide relative to the week before in Ms. Choi’s case (515 vs. 283 suicides; 1.82 times) as compared to the increase after that of President Roh (442 vs. 331 suicides; 1.34 times). Subsequently, suicides gradually decreased. During the second and third weeks after Ms. Choi’s suicide, there were 451 and 449 suicides. Comparing the incidence of suicide in the 3-week periods before and after the suicide of the celebrity, there were increases of 162.3% and 104.8% following Ms. Choi’s and President Roh’s suicides, respectively (Table 1).

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Figure 1. Weekly number of suicides before and after the celebrity suicides.

https://doi.org/10.1371/journal.pone.0084876.g001

	Three weeks before the suicide	Three weeks after the suicide	% change of increase	P-value
Actress Choi (2008)
All	872	1415	62.27%	<.0001
Male	588	795	35.20%	<.0001
Female	284	620	118.30%	<.0001
<50 years	431	799	85.38%	<.0001
By hanging	588	775	31.80%	<.0001
Ex-President Roh (2009)
All	1179	1236	4.83%	0.4025
Male	776	800	3.09%	0.6516
Female	403	436	8.19%	0.2929
>=50 years	605	645	6.61%	0.3485
By jumping	112	180	60.71%	0.0003

Table 1. Number of suicides in the 3-week period prior to, and after, the suicide of actress Choi and former President Roh in South Korea.

P-value is associated with t-test.

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While suicide rates rose significantly for both males and females during the 3 weeks after Ms. Choi’s death, the female suicide rate more than doubled (118.3% vs. 35.2%) (Table 1). The increased rates of the male and female groups were not statistically significant in President Roh’s case (Figure 1, Table 1). Suicides by subjects < 50 years of age increased significantly by 85.38% during the 3 weeks immediately after Ms. Choi’s suicide (p < 0.0001), whereas immediately after former President Roh’s suicide the increase was only 6.61% for subjects over 50 years of age (Table 1).

Hanging suicides, which was the method used by Ms. Choi, increased significantly (60.71% increase; p < 0.0001). The number of suicides by jumping, which was the suicide method used by President Roh, also increased markedly to 180 (60.71%) from 112 (p = 0.0003).

Discussion

We have provided data about imitative behaviours in terms of the Werther effect following two celebrity suicides, one a popular actress and one a former President, over 3 years. These suicides were highly sensational and shocking incidents in Korea, where suicide is a major public health problem. A recently published study on the entertainer celebrity suicides in Korea showed that only three incidents among 11 were significant in terms of the impact on the suicide risk and Ms. Choi’s suicide case resulted in the strongest immediate impact on suicide deaths[20].

Although entertainers and politicians are very different types of celebrity, we found that both celebrities had a profound impact on suicide risk in terms of the Werther effect following their suicides. While the lives of both Ms. Choi and the former President influenced the public’s emotion, our research showed that the Werther effect band was a bit longer following the suicide of Ms. Choi (6 weeks) than after that of President Roh (4 weeks). Possible reasons for this discrepancy might be that the emotional connection of the public may be greater for an entertainer than for a politician, that President Roh’s suicide had less effect because it was less widely reported, and that the differences in the news frame used in relation to these two celebrity suicides may have affected the duration of the Werther effect band. Considering the longer period of Werther effect band for Ms. Choi’s incident could be explained by the fact of greater media coverage for Ms. Choi’s suicide in terms of the counts of newspaper columns for 3 weeks (n = 905) compared to former President Roh (n = 360). Stack’s work supports our results as that it proved that the greater the media coverage measured in column inches, the greater the suicide risk and this imitative suicide was triggered only for entertainer and politician celebrity subtypes[21].

Conflicting news frames in newspaper articles on the suicide of President Roh indicate a potentially weakened empathy toward him. In addition, the media reporting on the suicide of former President Roh may have been more limited by social norms and, hence, his suicide was less of a shock to the public. According to differential identification theory, negative definitions of suicide through negative frame of media coverage weakened the imitative suicide behaviours[27].

While previous findings have shown that young people are more susceptible to the influence of celebrity suicides[6], and that being middle-aged is a protective factor against media influence[28], our findings reveal a significantly higher suicide risk among all age groups during the Werther effect band for both Ms. Choi and President Roh.

While the Werther effect was significant for both males and females after President Roh’s suicide as well as Ms. Choi’s, the impact of imitative effect was stronger for females after Ms. Choi’s suicide incident. This is because imitative suicide is characterised by the same gender as the celebrity[8,9,17]. In addition, females are more prone to have suicidal ideation than males in a similar distressed situation[29]. Furthermore, the incident had a big impact on depressed females in distress in Korea because of the symbolic power of the actress, along with her efforts to be a strong independent mother. For example, as soon as the relevant laws were revised, she became the first woman in Korea to change her children’s family name to that of her maiden family and the media story focusing on the positive aspects of the victim, actress Ms. Choi, could develop positive definitions of her suicide and facilitate suicidal behaviour of females[27].

The prominent increase in suicide deaths by the same suicide method during the Werther effect band strongly suggests the important role of media reporting in facilitating imitative suicides[8]. Our study showed that the method-specific suicide rate was not observed during the adjacent years of the suicide incident for both entertainment and politician celebrities. Indeed, the suicide methods of the two celebrities were reported without censorship, in the most prominent places in newspapers; this appears to have explicitly infringed on the guidelines for responsible reporting by media professionals that were devised with a view to preventing imitative suicide behaviours[30]. According to the guidelines, providing detailed information about the site and explicit description of the suicide method is to be avoided. Additionally, repetition of news reporting, particularly headlines, should be restricted; these rules should be considered especially in the reporting of celebrity suicides.

The news articles examined in our study came from the three major newspapers in Korea, all of which mediate conservative views. However, if cable TV and Internet media are considered, the news on celebrity suicides is significantly magnified in Korea. In particular, the Internet is extensively prevalent, as Korea has the highest Internet access rate in the world[31]. In this regard, studies have reported that the stress and depression caused by reckless media reporting, including malicious comments in the mass media such as in newspapers and Internet news, have propelled celebrities to commit suicide in Korea[32,33]. The information technology infrastructure allows people to log on to the Internet or access media more or less anywhere and at any time[34]. Therefore, the general public can easily learn about the private lives of celebrities, and media reporting about celebrity suicide may now have an even greater diffusive effect on potential suicide among the general population with suicidal ideation or those who admire celebrities.

At present, media-press guidelines have been developed by several countries to improve the quality of reporting, besides the World Health Organization (WHO) guideline[14,35]. Although suicide-related press guidelines exist in Korea, they are not enforceable. Thus, it appears an urgent matter to develop authoritative regulation to restrict indiscreet mass media reporting of suicides in Korea. For example, as suicide methods vary with age, it might be helpful to establish a suicide policy distinguished by age criteria, restricting access to harmful suicide methods and mass media such as Internet news as well as regulating media reporting on suicide-related news[17,36]. Furthermore, the task of educating the public about the suicide problem should be given to the mass media in close cooperation with public health workers to establish a more promising strategy, as recommended by the WHO[14,30,36,37].

Several limitations should be addressed in the interpretation of our findings. First, it is difficult to determine whether those who committed suicide following the recognised celebrity suicides had actually been exposed to the news. Second, although we controlled for various environmental factors in our analytical model, such as season, day of the week, average temperature, humidity, and unemployment rate, and the risks related to these factors seemed consistent with previous research, other factors might have influenced the suicide pattern, which could not be ruled out in this study[38,39]. Third, many celebrities have committed suicide over the past decade, as well as after the two suicide incidents considered in this study, but the cumulative effect of celebrity suicide on the imitative suicide risk has not been measured. Indeed, the ex-husband of Ms. Choi, who suffered from widespread reproach in the mass media, committed suicide in 2012. The cumulative and diffusive suicide risk as a result of celebrity suicides in Korea should be examined in future research.

Conclusions

The Werther effect was significantly apparent in Korea for 6 weeks and 4 weeks, respectively, after the suicides of entertainment celebrity Ms. Choi and former President Roh. The longer Werther effect band of entertainment celebrity could be explained by greater and positive frames of media coverage about her suicide. During the Werther effect periods following the death of both Ms. Choi and former President Roh, there was a significantly increased risk of suicide for all age groups, both genders, and the use of the same suicide method. This notably elevated suicide risk such as using specific suicide method during the same period of Werther effect band was not found for each of adjacent years of celebrities’ suicides. Considering the substantial impact of media coverage on both entertainment and politician celebrities, regulations and guidelines for the mass media should be urgently developed along with public efforts to enhance public mental health in Korea.