Suicide is the third leading cause of mortality for young people ages 15 to 24 in the U. S. (Centers for Disease Control and Prevention, 2009) with the rate nearly tripling from 1960 to 1990 (Centers for Disease Control and Prevention, 1994). Many explanations have been suggested for this rise, including changes in demographics (Brenner, 1973; Brenner, 1979; Easterlin, 1980; Holinger, Offer, Barter et al., 1994) and increases in various forms of social disorganization (Stack, 2000). For example, the size of the baby boom generation may have increased strain on this demographic cohort (Holinger, Offer, Barter et al., 1994) and rising rates of divorce have been linked to youth suicide rates (Stack, 1990; Stack, 1981). Growing rates of major depression in adolescents and young adults may also have contributed to the rise in youth suicide (Wickramaratne & Weissman, 1996).
Aside from the above explanations, there also has been a steady increase in societal acceptance of suicide (Romer & Jamieson, 2003). Approval of suicide has increased for all age groups since the General Social Survey began tracking it in 1977 with young people ages 18 to 24 reporting more acceptance than those over the age of 50 (Romer & Jamieson, 2003). Furthermore, adolescent acceptance of suicide is related to reports of actually planning a suicide. In a recent study, young Americans were over 14 times more likely to have reported planning to kill themselves if they believed that suicide was an acceptable solution to life problems (Joe, Romer, & Jamieson, 2007).
Just as the decline in portrayal of tobacco use in movies paralleled reductions in cigarette consumption (Jamieson & Romer, 2010), a rise in movie suicidal behavior portrayal may reflect greater acceptance of suicide in the culture. Since adolescents are avid movie consumers and movie sales are large [worldwide box office was $29.9 billion in 2009 (MPAA, 2009)], this is cause for concern.
Media portrayal can influence the acceptance of and imitation of behavior. According to Bandura’s (2002) Social Cognitive Theory of Mass Communication (SCTMC), the more a behavior is shown as a potential solution to a personal problem, the more likely it is to be seen as normative. Indeed, repeated portrayal in the media of an otherwise proscribed behavior can cultivate beliefs about the acceptance of the behavior in the world (Bandura, 2002). The SCTMC also predicts that exposure to a novel behavior in the media creates representations in memory that make it more available for enactment. In particular, exposure to highly explicit suicidal behavior portrayal that dramatizes the attempted or completed taking of a character’s life can suggest novel and more lethal methods of suicide than might otherwise be contemplated (Fekete & Macsai, 1990).
Considerable research indicates that exposure to suicidal behavior portrayals can lead to suicide contagion (Kunrath, Baumert, & Ladwig, 2010; Insel & Gould, 2008; Phillips, Lesyna, & Paight, 1992). Adolescents are particularly susceptible to this form of media influence (Gould & Shaffer, 1986; Gould, 1990; Gould, Jamieson, & Romer 2003; Romer, Jamieson, & Jamieson, 2006). Adolescents with a variety of risk factors, such as psychiatric illness, family history of suicidal behavior, poor communication between child and parent, and stressful life events, may be especially vulnerable to media portrayals of suicide (Gould, Fisher, Parides et al., 1996; Gould, Greenberg, Velting et al., 2003).
Although there is stronger evidence for non-fictional than fictional portrayals influencing suicide (Centers for Disease Control and Prevention 2001; Gould, Jamieson, & Romer 2003; Pirkis & Blood, 2001), fictional portrayals also have been shown to produce contagion (Fowler, 1986; Gould & Shaffer, 1986; Gould, Shaffer, & Kleinman, 1988; Holding, 1974; Holding, 1975; Schmidtke & Hafner, 1988). For example, Hawton and colleagues (Hawton, Simkin, Deeks et al., 1999) reported a 17% increase in self-poisoning in the week following portrayal of such a method in a television drama. Indeed, reports from U.K. emergency rooms indicated 20% of patients who were interviewed reported they had seen the show and indicated it had influenced their choice of method.
Industry Efforts to Control Adolescent Exposure to Harmful Content
A major driver of suicidal behavior portrayal in U. S. films could have been the lifting of restrictions against such content when the “production code” was abandoned by the industry in 1968 (Nalkur, Jamieson, & Romer, 2010). The code prohibited explicit portrayal of a wide range of content including violence directed at others or the self. Beginning in 1968 however, the Motion Picture Association of America (MPAA) no longer restricted this content but instead provided parents with ratings information about its presence. To implement this system, the MPAA set up the Classification and Rating Administration (CARA) to rate all films distributed in the U. S. CARA employs a Board of unnamed parents who are charged with the general guideline to:
“…reflect what they believe would be the majority view of their fellow American parents in assigning a rating to a film. This gives the system a built-in mechanism to continually evolve with modern parental concerns. For instance, as society has grown increasingly concerned about drug use since the 1970s, the rating system, too, has reflected that growing parental concern.” (Classification and Rating Administration, 2010)
In implementing this charge, the Board originally assigned ratings using a three-tiered system: A general category (G) was distinguished from a parental guidance category (PG) to warn parents about films that might not be appropriate for all children. In addition, a restricted (R) rating was assigned to films that should not be seen by those under the age of 17 unless accompanied by a parent or other adult. In 1984, an additional rating category was added to differentiate among movies that had previously been rated as PG. This PG-13 rating was meant to warn parents that a movie might not be appropriate for a child under age 13.
Because this system of ratings could serve to reduce the effects on adolescents of exposure to highly explicit forms of suicidal behavior in films, it is important to examine trends in suicidal behavior content as a function of film ratings. This is especially critical because the fact that the CARA Board is sponsored and paid by funds from the movie industry, it is subject to an obvious conflict of interest in its assignment of ratings. Rather than rating films solely on the basis of potential adverse effects of movie content, the Board may also be sensitive to the economic expectations of the industry. Consistent with this concern, there has been a strong rise in explicit movie violence in general over this period of which explicit suicidal behavior portrayal may be a part. Furthermore, the rating system has been found to assign films with highly graphic violence that would have formerly been rated as R to the less restrictive PG-13 category (Nalkur, Jamieson, & Romer, 2010). Because the PG-13 category has the potential to draw a larger audience than an R-rated film, placing a film in the R category is likely to reduce its box office sales. While the assignment of the PG-13 rating to films containing highly explicit violence has been documented, it not clear whether a similar pattern has developed in regard to explicit forms of suicidal behavior.
The Current Study
In this study, we examine trends in explicit suicidal behavior portrayal in top-grossing movies since 1950 to determine whether portrayal of suicidal behavior has increased since the removal of the production code in 1968. Very little research has examined trends in suicidal behavior portrayal in popular films. Trewavas, Hasking, & McCallister 2010 examined a sample of 41 movies and found that non-suicidal self-injury was prominently featured. We have previously found that all forms of explicit violence have increased in popular films since the abandonment of the production code (Nalkur, Jamieson, & Romer, 2010). However, little is known about the effectiveness of the MPAA rating system for shielding children and adolescents from the explicit portrayal of suicidal behavior. If the CARA Board were sensitive to the potential effects on children and adolescents of exposure to explicit portrayals of suicidal behavior, it would assign films with this content to the R category.
We hypothesized that consistent with the rise in societal acceptance of suicide, popular films would increasingly display suicidal behavior and second, that just as with explicit violence in popular PG-13 and R rated movies from 1985 to 2006 (Nalkur, Jamieson, & Romer, 2010), adolescent accessible PG-13 movies would contain a large amount of explicit suicidal behavior content that would previously have been rated R. At the same time, we did not expect to see much change in the least restrictive G/PG categories.
We also recognized that not all portrayals of suicidal behavior might pose the same risk of contagion for young people. It might be expected that highly explicit portrayals that showed both the method and its use would be particularly susceptible to imitation (Insel & Gould, 2008; Fekete & Macsai, 1990). The age of the character committing the suicidal act may influence identification with the victim (Phillips, 1979; Schmidtke & Hafner, 1988). If trends in movie suicidal behavior portrayal involved primarily older adults (over age 40), it might pose less of a risk of contagion for a younger audience. Generalizing from the media violence literature, we also would not expect comedic suicidal portrayals to be as influential on an audience as more serious (non-comedic/dramatic) portrayals (King, 2000; Potter & Warren, 1998). Hence, we examined the ages of movie characters and the comedic context of the suicidal behavior portrayal.
We examined trends in suicidal behavior portrayal in top-grossing films from 1950 to 2006 and for highly explicit suicidal behavior content by movie rating since the introduction of the MPAA rating system in 1968 and also since the first full year of the PG-13 rating in 1985. In particular, we evaluated whether highly explicit portrayal of suicidal behavior has become more available to younger audiences since the introduction of the PG-13 category. We examined these questions using a database of 855 movies (15 per year) that had been content coded for portrayals of suicidal behavior among the top-30 grossing U.S. movies from 1950 to 2006.
The top-30 grossing movies per year from 1950 to 2006 were identified from Variety magazine’s annual lists. To identify trends in amount and explicitness of suicidal behavior, a representative half-sample of these movies was selected for content coding (N= 855). Every second movie rank was included in the sample with the starting rank (1st or 2nd) determined randomly. For the roughly 5% of cases in which movies were not available for purchase, the next ranking movie was substituted. Movie rating was identified from movie VHS tapes and DVD video boxes. The study did not involve human subjects, thus I.R.B. approval was not sought.
The Suicidal Behavior Explicitness Scale
Suicidal behavior was defined as actions in which a character had the “option of living but attempted or completed the taking of his/her life.” Verbal references to suicidal behavior were not coded as suicidal behavior portrayal. A 5-point suicide explicitness behavior scale adapted from Jamieson (2003, p.119) was used to measure explicit suicidal behavior portrayal (see Table 1). This scale was designed to be theoretically consistent with Bandura’s SCTMC (2002) in that higher levels of explicitness corresponded with more modeled suicidal behavior. Levels 1 and 2 on this scale represent two levels of implicit suicide behavior portrayal in which the act is implied but not shown. Levels 3 and 4 represent increasing levels of more explicit portrayal in which at least some of the act is shown.
Suicide Behavior Coding
The coding unit for movies was the five-minute segment. For example, a two-hour movie contained 24 segments. Suicidal behavior coding proceeded in two steps. In the first step, a pool of 23 undergraduate coders evaluated segments for the presence of suicidal behavior. To assess reliability, we used Krippendorff’s (2004) alpha formula, which controls for chance agreement between multiple coders and can handle both nominal and rating scale data such as was used in this study. By this formula, coders achieved a high level of reliability for identifying suicidal behavior content (Yes = 1; No =0; Ka = .77).
Coders identified 104 out of the 855 movies (12.2%) as having suicidal behavior content, not including references to suicidal behavior. Eight undergraduate coders were trained to evaluate explicit portrayal of suicidal behavior using 18 practice movies containing such portrayal. Each coder then viewed films across the entire study period to evaluate the explicitness of any suicidal behavior segments within those films. For each instance of suicide behavior portrayal, the explicitness of the portrayal was rated using the 1 to 4 scale in Table 1 (Ka = .84). If more than one occurrence of suicide behavior portrayal appeared in a 5-minute segment, the one with the highest explicitness rating was retained. We calculated the average suicidal behavior explicitness rating (0-4) over all 5-minute movie segments per film and then averaged these scores by year (N =57). As described below, we also evaluated trends over time by MPAA rating category for films released after 1968.
The age of up to 8 main characters in each film was coded using a scale with five categories (under age 10, 10-20, 21-40, 41-65, over age 65, Ka = .80). These ages were then linked to any main characters displaying suicidal behavior, approximately 71% of the portrayals that were identified. As we report below, although there were very few portrayals in the adolescent age range and none under age 10, most of the portrayals by main characters were under the age of 41. Hence, the age scale was recoded to reflect younger (1 = < age 41) versus older (0 = > age 40) suicidal behavior portrayals. Coders also rated each suicidal behavior for its comedic impact, which was defined as “the suicide takes on a comedic role (i.e., meant to get laughs), or is not a serious or realistic suicide attempt.” A parody of a suicide was also considered a comedic suicide. This measure was also highly reliable (Ka =.70).
Stata 11 (StataCorp, 2009) was used for all analyses. To identify trends for the 57-year study period, we regressed mean annual suicidal behavior portrayal scores on year using ordinary least squares. We tested linear, quadratic, and cubic trends as well as a trend that was stationary from 1950 to 1968 but linear thereafter. All tests of regression parameters used robust standard errors to protect against failures in assumptions of independence and heteroscedasticity in errors (Huber, 1967; White, 1982). We also tested but found no autocorrelation in the series. All tests were two tailed and 95% confidence intervals (CI) were reported.
To assess changes over time in overall as well as the most explicit portrayals of suicide behavior (categories 3 and 4 in Table 1), we examined trends in these portrayals in individual films grouped according to three eras in the study period: the pre-rating era from 1950 to 1967 (N=270), the initial ratings era from 1968 to 1984 (N=242), and the PG-13 era from 1985 to 2006 (N=327). To test the hypothesis that the PG-13 category would permit more explicit suicidal behavior portrayals to be shown to children under age 17 than was the case prior to its introduction, we examined the percentage of films with highly explicit suicidal behavior portrayals in each MPAA rating category across the three ratings eras (see Table 2 for the number of films in each rating category). We collapsed films with ratings of G and PG into one category because there were too few G-rated films to analyze separately. For this analysis, we could not identify a rating for 16 films released after 1968, and these films were treated as missing from the ratings analysis. We compared mean levels of suicidal behavior portrayal between rating categories within and across rating eras using paired and independent t tests. Logistic regression analyses were also conducted to compare films in different rating categories across the three ratings eras with a dependent variable that was coded 1 for films with highly explicit suicidal behavior portrayals (values of 3 or 4) versus 0 for films without highly explicit portrayals of suicidal behavior (values of 0, 1, or 2). Finally, we examined trends over time for the presence of comedic portrayals and for suicidal behavior portrayal by characters ages 10-40.
Trends in Suicidal Behavior Explicitness
The mean suicidal behavior portrayal score across the 57 years was .018 (inter quartile range .007-.027; SD = .016). The best fitting trend was linear with an r2 of .285 (b = .00051, CI = .00029, .00073, p < .001). As seen in Figure 1, this score more than tripled from .0037 in 1950 to .0324 in 2006.1 The rise in mean suicidal behavior portrayal, shown in Table 2, coincided with increases in the most explicit levels of portrayal in the films across the three eras, rising from 1.1% of all sampled films during 1950 to 1967, to 6.3% during the first ratings era, and then 8.8% after 1985, χ²(2) = 16.815, p < .001. Thus, the rise in portrayal cannot be solely attributed to an increase in implicit levels of portrayal.
Age of Main Character
There was a relatively small amount of suicidal behavior portrayal by main characters ages 10-20 (8.6%). However, the majority of suicidal behavior portrayal (60.7%) was by characters aged 10-40 years old. Because adolescent audience members that are at risk for suicide may identify more with suicide portrayals by younger characters, we examined the trend in suicidal behavior portrayal for younger main characters (those ages 40 and younger). Consistent with the overall increase in suicide behavior portrayal, the trend for 10-40 year-old main character portrayal also increased significantly from 1950-2006 (b=.00006, 95% CI=.00000, .00012, p=.037).
Comedic Suicidal Behavior Portrayal
Comedic suicidal behavior occurred in 19.4% of the portrayals. Controlling for the mean explicitness scores of films with such suicidal behavior did not change the upward trend in explicit portrayal from 1950-2006 (b = .00038, CI = .00015, .00062, p = .002). Thus, the overall rise in suicidal behavior portrayal could not be explained by an increase in comedic suicidal behavior portrayal.
Suicidal Behavior Portrayal by Movie Ratings
Table 2 also shows mean suicidal behavior explicitness scores by MPAA rating for each rating period. As noted above, suicidal behavior portrayal increased throughout the period since the MPAA rating system was put into place. However, from 1968 to 1984, the increase was primarily evident in films with an R rating. R rated films from 1968-1984 had mean suicidal behavior portrayal scores that were higher than all films during the pre-ratings era (mean difference = -.032, CI = -.055, -.009, p <.01); while G/PG films were not significantly higher than pre-ratings era films (mean difference= -.003, CI= -.010, .005, p =.476). With the introduction of the PG-13 category however, mean suicidal behavior portrayal was more than four times as high in PG-13 as it was in G/PG (mean difference = -.020, CI= -.038, -.002, p =.030), and there was no significant difference in overall suicidal behavior portrayal between R and PG-13 movies (mean difference = -.009, CI= -.027, -.009, p =.298). As in the earlier era, films with an R rating post 1985 were also greater than G/PG rated films (mean difference = -.029, CI = -.044, -.015, p<.001).
Highly Explicit Suicidal Behavior Portrayal by Movie Ratings
Differences in suicidal behavior portrayal at highly explicit levels further illustrate trends by rating over time. As seen in Figure 2, the proportion of PG-13 films with highly explicit portrayals was no different from R films in 1968-1984 (OR =.841, 95% CI = .361, 1.957, p = .688) or R films from 1985-2006 (OR=.770, 95% CI .449, 1.320 p=.342). PG-13 films contained greater proportions of highly explicit suicidal behavior portrayal compared to G/PG in 1985-2006 (OR = 2.023, 95% CI =1.465, 2.795, p <.001) as well as in 1968-1984 (OR = 4.875, 95% CI = 1.560, 15.234, p = .006). Furthermore, if one compares all the G/PG and PG-13 rated films in the post 1985 PG-13 era in our sample with the G/PG rated films in the first ratings era, the proportion of highly explicit portrayal in the later era is higher (OR=4.751, CI=1.071, 21.080, p =.04).
The primary purpose of this study was to measure the amount and explicitness of suicidal behavior portrayal in popular films since 1950 and by MPAA rating. We found that the average level of suicidal behavior portrayal in top-grossing movies has more than tripled since 1950. When comedic suicidal behavior was controlled, there was still a significant rise in suicidal behavior portrayal over time. This increase was not simply a result of increasing amounts of implicit suicidal behavior portrayals. Indeed, the percentage of films with highly explicit suicidal behavior portrayals increased by a factor of eight from the pre-ratings period to the more recent PG-13 ratings era. Furthermore, in the PG-13 era, highly explicit suicidal behavior portrayals are now as common in PG-13 films as in R-rated films. This trend indicates that explicit portrayals of suicide are increasingly accessible to adolescents under the age of 17.
The trend toward highly explicit portrayal in the PG-13 category suggests that although the PG-13 category was designed to warn parents of potential differences within the more general PG category, it has allowed content that would previously have been rated R to be seen in theatres by adolescents younger than 17. Increase in suicidal behavior portrayal following the lifting of the production code occurred primarily in R-rated films during the initial ratings era (1968-1984). If the PG-13 category truly functioned as a subclass of the larger PG category, we would expect PG and PG-13 films from 1985-2006 as a group to be roughly equivalent in suicidal behavior depictions to the PG category from 1968-1984. However, we found instead that highly explicit suicidal behavior was significantly greater in 1985-2006 PG and PG-13 movies than in PG movies from 1968-1984. This suggests that it is unlikely that the PG-13 category serves as a more explicit subcategory of the prior PG rating. Furthermore, highly explicit suicidal behavior depictions have not changed in the G/PG categories over time, while such depictions have increased dramatically in the PG-13 category.
As an illustration of this trend, it is worth considering a top grossing movie shown in 1956, Rose Tattoo, in which the protagonist’s daughter responds to her father’s death and her mother’s subsequent reclusion saying: “Next time I won’t cut my wrist but my throat.” While this was the most explicit suicidal behavior content in the movie, in the 2004 film The Grudge, a top grossing PG-13 movie, the opening scene depicts a man pushing himself over a high-rise balcony ledge and shows blood pooled next to his lifeless head. It is not surprising that such changes would coincide with a dramatic increase in acceptance of suicide in both adolescents and adults along with the increase in suicide rates that has occurred in young people ages 15 to 24 since 1960 (Romer & Jamieson, 2003).
It is also important to note that PG-13 movies have been increasing as a proportion of top selling films while the proportion in the R category has declined. Indeed, in recent years, 2001-2006, PG-13 films represented about half of the top 30 box office movies (Nalkur, Jamieson, & Romer, 2010). As a result, given our previous findings that the PG-13 category also contains increasing amounts of violence directed at others (Nalkur, Jamieson, & Romer, 2010), adolescents under the age of 17 are increasingly allowed to enter movies in theatres that portray violence directed toward both the self and others.
Effects of Movie Suicidal Behavior on Adolescents
As was observed for violence (Nalkur, Jamieson, & Romer, 2010), the CARA Board appears to regard highly explicit forms of violence to be acceptable for viewing by children as young as age 13. This is perhaps not surprising since it is funded by the film industry and may feel pressure not to restrict box office earnings by assigning R ratings to films. Nevertheless, permitting adolescent exposure to such content may have adverse effects. Bandura’s (2002) theory would predict that repeated exposure to suicidal behavior portrayals in films would increase acceptance of the behavior. This is troubling because adolescents who are experiencing symptoms of depression and who think that suicide is an acceptable solution to life problems are more than 14 times more likely to report considering suicide than those with less favorable views of suicide (Joe, Romer, Jamieson, 2007).
Adolescent suicide risk increases dramatically as adolescents enter the 15-19 year-old age range (CDC, 2009), and other risk factors during this period can enhance the risk. For example, male adolescents of divorced parents have been found to experience increased suicidal ideation even after controlling for multiple suicide risk factors including but not limited to mood and/or anxiety disorders (Fuller-Thomson & Dalton, 2011). Exposure to suicidal behavior in films may encourage the perception that persons who are suicidal cannot get the help they need from mental health practitioners. Indeed, young people ages 14 to 22 experiencing hopelessness or suicidal ideation who had repeatedly watched movies with mentally ill and suicidal characters also tended to believe they could not get help for their mental condition (Jamieson, Romer, & Jamieson, 2006). In addition, the modeling of suicide in the media (Insel & Gould, 2008) may provide suicidal adolescents with exposure to novel and more lethal methods than they would otherwise contemplate (Fekete & Macsai, 1990). Thus, vulnerable adolescents may be at risk from exposure to explicit movie suicide portrayal.
It is possible that the CARA Board’s assignment of movies with highly explicit suicidal behavior to the PG-13 rating has been influenced by the growing cultural acceptance of suicide. It is also possible that the increase in explicit portrayal of suicide in movies merely represents the increasing acceptance of violence in films. Indeed, the Board claims to represent the majority of American parental values. Nevertheless, while it often assigns the PG-13 rating to films with explicit violence, it also uses content descriptors to provide some warning to parents that such films have graphic scenes. However, we have not found ‘suicide’ as a content descriptor for films with explicit suicidal behavior portrayal. Even if the CARA board feels it is acceptable for adolescents under the age of 17 to view explicit suicide portrayals, it could warn parents about such content by including “suicidal behavior” as a movie content descriptor.
In the absence of controlled experiments with large representative samples including adolescents at risk for suicidal behavior, it is difficult to gauge the causal effects of the increase in suicidal behavior portrayals in movies. Such studies would present ethical dilemmas because of the risk of harming their human subjects. However, longitudinal studies similar to those done for tobacco exposure in films could show that such exposure has harmful effects on adolescents. More direct evidence of the adverse effects of exposure to suicidal behavior in films could encourage CARA to consider suicidal behavior content more heavily in its ratings. Indeed, as has been advocated for tobacco portrayal in movies (Polansky, Titus, & Glantz, 2008), assigning R ratings to movies with suicidal behavior enactments would be worthy of consideration as would showing suicide prevention and hotline information before films.
Although we find that suicidal behavior portrayal has increased in popular films, it also is the case that there is comparatively little suicidal behavior content overall in popular movies. Only about 12% of the movies in our sample 1950-2006 (104/855), and 15% in the last ten years of the study 1997-2006 (23/150) had implied or explicit suicidal behavior portrayals, while only about 3% of the movie five minute segments from the last 10 years of the study period had such portrayal. Nevertheless movies with even a small number of suicidal behavior scenes may powerfully affect audiences.
This is the largest and most reliable content analysis of trends in movie suicidal behavior conducted to date. However, the study has some limitations. For example, this study’s sample did not include movies less popular than the top 30 or cult movies that may be very important to young viewers. However, in the recent years of the study (2001-2006), the top-30 grossing movies represented 50% of total domestic box office gross sales (MPAA, 2009). Hence, the sample is likely to cover a significant portion of movie content with wide influence on audiences. Although there were not many examples of adolescent suicidal behavior in the movie sample, most of the suicidal behavior by main characters involved persons ages 10-40 with a significantly increasing trend for this age group. Younger audiences may identify more strongly with these characters, making their suicide portrayals more influential. We also controlled for trends in portrayal of comedic suicidal behavior, which may be less influential. However, we did not evaluate other contextual aspects of suicidal behavior that might affect its influence on audiences. Future studies should explore factors such as whether the suicidal behavior victim and act were glorified or romanticized, whether psychological problems of the victim were addressed, and how other characters’ responded to the suicidal behavior acts (CDC, 2001).
The rise in explicit suicidal behavior portrayal in films since 1950 and the lack of difference between highly explicit suicide portrayal in R and PG-13 rated films are causes for concern. Future research should expand the evidentiary link between movie suicidal behavior portrayal and effects on audiences to further inform discussion of the need to employ ‘suicidal behavior’ as a content descriptor in MPAA movie ratings and assigning movies containing highly explicit suicide an R rating.
Table 1. Coding of Suicidal Behavior Explicitness per 5-minute Segment
|Suicide Explicitness Scale Value||Definition|
No suicide related content or only verbal references to suicide
No visuals of act: A body (living or dead) may be shown, or the act is entirely implied. Auditory implications of suicide without visuals, e.g., a body in a tub or bloody water but no visuals of cutting wrists; gunshot heard behind a door.
Shows the intent, but not the act: Character prepares method (e.g., pointing gun at self, getting razor, tying rope), but no action of self-harm
Shows the act, but without completion (completion is unclear or unknown). Character explicitly engages in self-harm, but does not die (cutting, etc.)
Shows the act through completion (death): Character is seen or strongly implied to have been killed by self-injury (e.g., seen falling from a building, blood from wounds, or close-up of face or body.)
|Table 2. Mean Suicidal Behavior Explicitness in Movies by Rating Period and MPAA Rating|
Early Rating Period
PG-13 Rating Period
*16 films with unidentifiable ratings were treated as missing
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