Can we consider the journalist an actor in suicide prevention?

INTRODUCTION: After more than 50 years of dedicated research, media coverage of suicide is now well known to have a significant influence on the suicide epidemiology. This influence is supposed to result from two opposite effects. The Werther effect (WE) refers to the robust increase of suicide rates following the publication of a suicide story. This specific kind of mass cluster implies a suggestion process, i.e. imitation of the depicted death by vulnerable persons. In contract, the preventive potential of medias has been labeled the "Papageno effect" (PE). Although more recently discovered and far less known, PE predicts that journalists can help prevent suicidal behaviors beyond a simple WE reduction. Because PE and WE directly bridge journalistic productions to suicidal events, several national and international health organisms (including the World Health Organization) started to see the media as new prevention opportunities. In this paper, we intend to assess the extent to which journalists can be considered as public health actors in the specific field of suicide prevention. METHODS: Based on a critical review of the so-called Media effect studies, we explore the opportunities, limits and constraints of collaborating with media professionals for public health actions. For that purpose, we focus on the main strategy employed so far, namely providing recommendations for more cautious coverage of suicide. An overview of the efficacy of these recommendations serves not only as a starting point for understanding how public health and journalistic perspectives can confront, but also how they can be combined in a fertile way. RESULTS: Numerous suicide prevention organisms developed strategies in order to assist journalists in reporting suicide stories in a safer way. As a formal support to these strategies, around 30 national or international guides have been produced around the word, with the shared aim of reducing WE and, eventually, promoting PE. The recommendations about articles' style and content that compose these guides were shown to be similar across the countries. They mostly meet public health concerns, rest on the available knowledge about the two effects' determinants and thus advocate for a less quantitatively and qualitatively prominent coverage. However, the way the guides were produced and implemented shows considerable variations. While most countries solely edited and/or distributed the recommendations with no complementary measures, several organisms associated their publication with promotion actions towards the journalists and general public. Evidence for the impact of the guides' publication on suicide rates, although encouraging, are seriously limited by methodological considerations. As a consequence, their efficacy is more often assessed in terms of media compliance to the recommendations. The extent to which media items respect the guidelines depends considerably on the way journalists are invited - or not - to resort to them. While the strategy seems inefficient when limited to a simple publication, the quality of suicide portrayal significantly improves when the guides are part of a whole prevention campaign dealing with suicide coverage. Moreover the journalist's implication at each step of the process seems a crucial point for its success. DISCUSSION: Media professionals are submitted to their own codes, constraints and missions which do not necessarily fit with public health concerns. If considered as prescriptions to reduce the suicide rates, journalists might see recommendations for a more cautious coverage to be a threat to their independence, thus accounting for their non-compliance. On the other hand, a real collaborative approach based on shared skills and knowledge could help sensitize journalists to a responsibility that PE and WE inevitably give them. Under these conditions, recommendations can become a precious resource to help media professional when facing a sensitive issue and finally contribute to fight against suicide