Below is an excerpt taken from a case study in reporting and portrayal of suicide in Australia's metropolitan press (a link to the full article is provided at the bottom of this blog).
The case study discusses media framing, with particular focus on mental health risk and a link between the acne drug Roaccutane and depression.
Various newspapers have been exampled within the case study, focusing on how each paper framed and published relevant teen suicides, allegedly resulting from the use of Roaccutane.
I have also included two points from the conclusion of the case study, which provide information on how journalists should relay/frame mental health issues, and how the stories should provide a balanced view.
That is one area which is of personal interest to me.
I really don't like reading news stories which are obviously one-sided/biased. I understand it's all about politics and business, but it's also very transparent - readers can see straight through a biased article.
Anyway, that's getting a bit off track.
I just found this article to be quite interesting and very relevant given the recent lectures on reporting mental health in the media.
I also used Roaccutane myself, another reason I found this case study interesting.
Hope you enjoy it as much as I did.
Excerpt from case study:Risk and News Values
Kitzinger (1999) identifies key factors that may impact the way in which risk is constructed in the news media. She says the nature of the risk, the size and time scale, novelty and ‘human face’ of the risk, news values and the internal dynamics of media organisations are all factors that determine what risks the media report. For example, risks that impact a large number of people at one time are more likely to be reported by the media than risks with a cumulative effect. Similarly, unusual risks have been found more attractive to the media than common risks; personal accounts are often favoured over official denials of risk; risk stories tend to be event rather than issue oriented, and positive findings of risk are more newsworthy than no evidence of risk (Kitzinger, 1999, p. 62). Horlick-Jones (2004, p. 112) also suggests that popular news media accounts of failures such as BSE tend to convey to the audience ‘a sense of intimate familiarity with those who have suffered from the tragedy but often without providing a clear sense of the scale of the risk to the wider community’.
The ‘logic’ of ‘risk news’ (Lupton, 1999b, p. 6) is intimately connected to news values, the professional and institutional routines that characterise media organizations, and editors’ perceptions of their audiences. Price et al (1997) identify conflict, human interest and consequence as primary news values. Conflict and blame, in particular, are key criteria in the media’s attention to risk and influence risk reporting. For example, risks are likely to be deemed more newsworthy if they are associated with overt conflict between stakeholders, or if there is a perception of government vested interest or secrecy about the risk, or if there is the ability to blame someone. Journalists also tend to favour sources that have firm opinions, one way or the other, about a given risk (Kitzinger, 1999).
Other factors that impinge on ‘risk reporting’ include the cultural or geographical proximity of the threat to journalists and their perceived audiences and the journalists or editors personal identification with a risk. Institutional factors that may impinge on the media’s reporting of risk include the extent to which other news outlets are covering the risk, the extent to which a risk has already been covered and the potential for ‘story fatigue’ (Kitzinger, 1999). In addition to news values, Kitzinger (1999, p. 65) says it is important to consider ‘how sources operate and how journalists select and assess contributions to a story’. Given that interest group accounts, including experts, are rarely identical to the media coverage of an issue, as Terkildsen et al. (1998, p. 46) argue, ‘alterations in message structure, rhetoric, and source cues are made by the media somewhere along the way’. With so many available angles from which to approach risks, the theory of media framing posits that the media reduce complex information to easily accessible frames.
This paper focuses on the reporting and framing of a Sydney coroner’s court inquest into the suicide death of 14-year-old Vivian Crane in the metropolitan press in Sydney, Melbourne and Brisbane in October 2004. The paper investigates the interaction between news values and news frames in the reporting and portrayal of the coroner’s findings and identifies some of the ways in which news outlets privileged certain news frames over others and, therefore, presented certain risks to the public at the expense of others.
Roaccutane & Teenage Suicide – an exemplar:
In January 2003, American news – reported in Australia – signalled a possible link between the prescription drug Roaccutane, prescribed for severe cases of teenage acne, and depression and suicide. Sydney’s Daily Telegraph (13 January p 9) in a story headlined, ‘Suicide families blame acne drug: Warning labels ‘inadequate’’ reported that: ‘Families of young suicide victims have linked an acne “miracle” cure to depression’. It also ran another story (p 19) headlined, ‘Shadow over wonder drug’.
On the same day Brisbane’s Courier Mail in a front-page story (pp 1 & 2) headlined, ‘Suicides linked to acne drug’ more dramatically reported that: ‘A “miracle” anti-acne drug has been blamed for a wave of teenage suicides’. It also reported a story (p 2) headlined, ‘Mum says miracle treatment led to son’s death’, about a mother who blamed Roaccutane for her son’s suicide, and a Fact File on Roaccutane. Melbourne’s Herald Sun in a story (p 5) headlined, ‘”Miracle” drug’s darker side’ also reported that Roaccutane had been “blamed for a wave of teenage suicides” and an adjacent story headlined, ‘Son’s state tragic – dad’, about a father who blamed Roaccutane for destroying his son’s life.
All the stories were framed around differences in the labelling of Roaccutane between the US and Australia, and they all privileged the claims of former users of Roaccutane and their families who blame or link the drug to depression and suicide. However, there were some differences in emphasis in these otherwise identical News Limited newspaper stories. The Daily Telegraph did not report that Roaccutane had been blamed for a ‘wave of teenage suicides’ and was more balanced in its presentation of evidence disputing the link between Roaccutane and depression and suicide. In contrast, the Courier Mail story drew more heavily on the claims of former patients and families of people who blame Roaccutane for the suicides of their loved ones. Significantly, the Herald Sun devoted a separate nine-paragraph story to Australian Rules footballer Jason Akermanis’ experiences with the side effects of Roaccutane, along with two photographs of the footballer. In contrast, the Courier Mail and Daily Telegraph only devoted three and four paragraphs respectively to this news angle, which may reflect differences in editor’s perceptions of the news value of celebrity.
A noteworthy omission from all the initial reports linking Roaccutane to the risks of suicide and depression was information for readers about where they could seek mental health services. Also, with the exception of the Courier Mail report, none of the stories provided any factual information about Roaccutane and no positive treatment experiences with the drug were included in any reports.
It was also significant that this story was not covered in the Fairfax press.
More than 18 months later on 21 October 2004, the Sydney Morning Herald reported in a page 3 story on evidence given at the Glebe Coroner’s Court. The headline read: ‘Acne drug may have led to teenager’s depression and suicide, court told’ and the lead reported that:
A prescription drug a 14-year-old girl was taking for her severe acne might have made her depressed and led the above-average student to kill herself, an inquest has been told.
The story reported evidence presented to the coroner from the girl’s parents that she became withdrawn when taking Roaccutane and that they had not been warned of the risks of the drug. The third paragraph reported that US consumer warning labels state the drug ‘may cause depression’. But the fourth paragraph referred to court evidence from Roche Pharmaceuticals that there was no direct evidence linking the drug to depression. Halfway through the story readers learnt that the young girl had been taking the anti-depressant drug, Zoloft. But no mention was made in the story of the continuing controversy about prescribing this drug (and similar Selective Serotonin Reuptake Inhibitors or SSRIs) to children and adolescents – a story of major significance in the same paper in 2001-2002 (Blood et al, 2003) and throughout 2003-2004. Significantly, the Sydney Morning Herald story did contain a separate section on ‘Advice for doctors’ about the potential side effects of Roaccutane. But the story did not contain specific advice to readers about depression or where to seek help – something specifically mentioned in the Australian government’s guidelines, Reporting Suicide and Mental Illness (Commonwealth of Australia, 2002).
On the same day, Sydney’s Daily Telegraph covered the story on page 7 with the headline: ‘Acne drug may have killed teen’. The lead said:
A commonly used medication to treat acne may have caused a schoolgirl to take her own life, the Glebe Coroner’s Court heard yesterday.
The reference to Roaccutane as a commonly used medication exaggerated the magnitude of the risk when the drug is only prescribed for severe cases of acne. The second paragraph of this story gave explicit details of the method and scene of suicide – something the Australian government’s guidelines caution against (Commonwealth of Australia, 2002). The primary source of this report was the lawyer for Vivian Crane’s family, who implicated Roaccutane in her depression, suicidal ideas, self-mutilation and suicide. The story did not mention that the deceased young girl had also been prescribed the anti-depressant Zoloft and did not include any advice for readers about depression, or suicidal ideation, or where to seek advice.
In a clear shift from the cautionary tone of this article the Daily Telegraph carried another story on page 11 with the headline, ‘Why did she die – Parents blame acne drug for depression’. The lead reported that: ‘A 14-year-old girl committed suicide because she took a commonly used acne drug, her parents said last night’. The story was framed around the parent’s lack of awareness of the side effects of Roaccutane and their efforts to get help for Vivian are reported as being hampered ‘because they were not aware depression was a side effect of the drug’ (par 6). The story devoted only one paragraph to evidence disputing the link between Roaccutane and depression and suicide. It also failed to mention the psychological effects of acne itself or that Vivian Crane had also been prescribed Zoloft, as the Sydney Morning Herald story did. The exclusion of this information supported the news frame of a direct link between Roaccutane and suicide.
In contrast, the AAP story on the same day (October 21) carried the cautionary headline: ‘Parents should not fear acne drug’, which quoted a statement from Dr John Sullivan, chairman of Severe Cystic Acne Resource (SCAR), who emphasised the link between depression and acne itself. No metropolitan newspapers followed the AAP’s lead and sourced SCAR or the actual statistics of a recent study into the effects of Roaccutane. The following day the Sydney Morning Herald did publish in its Letters column a response from the chairman of SCAR (October 22 p 10), but his comments were not reported in news stories. He argued that media coverage about Roaccutane ‘is likely to be causing additional unnecessary concerns in patients and their families’ and urged people to seek medical advice. He quoted evidence from the US Food and Drug Administration disputing the link between the drug and depression. The dermatologist wrote:
There is evidence, however, that depression is common in young people and that acne itself can cause or increase the risk of depression.
This was one of the few items in newspapers that acknowledged the risks of depression for people with severe acne, over and above the depression and suicide risk of Roaccutane. The Courier Mail also carried a lengthy response from a child and adolescent psychiatrist, written in consultation with a dermatologist, which outlined the positive and negative aspects of using Roaccutane and Zoloft or similar medications.
A week later the coroner handed down her findings of the inquest into the suicide of Vivian Crane. In contrast to the news frames evident in early Coroner’s court stories, AAP reported on the coroner’s verdict on October 28 in a story with the headline:
Common drugs may have contributed to suicide.
Note the plural; it is two drugs, Roaccutane and Zoloft that are named by the Coroner. The lead to the story read:
Two commonly used medications may have aggravated a Sydney schoolgirl’s depression causing her to kill herself, an inquest found today.
The dominant frame posited both Roaccutane and Zoloft as contributors to the girl’s depression but was cautionary – ‘may have aggravated’ the depression leading to the subsequent suicide. The story also reported that the girl’s mother was ‘impressed with the job the coroner has done’. For the most part Australian metropolitan newspapers did not follow this frame set by AAP, nor did they – with one notable exception – discuss depression as a significant risk factor for suicide.
In a separate story, AAP reported (October 28): ‘Mother warns parents against drug that killed her daughter’. This report gave explicit details of the method of suicide. It reported the coroner’s finding that Roaccutane and Zoloft may have contributed to the girl’s depression. But the main theme of the story – supporting the dominant news frame – comprised comments from the girl’s mother outside the court warning other parents of the dangers of Roaccutane: ‘She was a bubbly, full of life, full of fun girl and she became a shutdown, hollowed-out shell of a person with no personality.’ The report downplayed the risk of Zoloft, which the coroner could not rule out as possibly aggravating the girl’s depression, in favour of the more topical Roaccutane. The story was re-issued later by AAP with a corrected headline: ‘Acne drug may have contributed to teen’s death: coroner’.
On the same day (28 October) AAP also reported: ‘Girl’s suicide no reason to stop taking medication: Dr’, which cautioned parents and patients about stopping prescribed medication and quoted a child and family psychiatrist as saying:
I have concerns that for every one of this sort of situation there’s going to be another 10 or 20 kids who suicide because they weren’t prescribed an anti-depressant.
This story was not reported in the metropolitan press.
On October 29 and subsequently the coroner’s verdict and details of this case, including interviews with the girl’s mother, were covered by metropolitan newspapers:
‘Acne drug in “bubbly” girl’s death spiral’ (The Australian, 2004, October 29, p. 2).‘Acne drug linked to teenager’s hanging’ (Courier Mail, 2004, October 29, p. 3).
‘Acne drug suicide link – coroner’ (Herald Sun, 2004, October 29, p. 26)
‘Diary of a little girl lost in her despair’ (Sydney Morning Herald, 2004, October 29, pp. 1-2)
‘The drug that comes with doctor’s health warning’ (Sydney Morning Herald, 2004, October 29, p. 2).
‘You did wrong by Vivian – Hospital criticised over acne girl’s suicide’ (Daily Telegraph, 2004, October 29, p. 7).
‘When a girl’s mum is the only one listening’ (Daily Telegraph, 2004, October 30, p. 21).
The Australian, the Courier Mail and the Herald Sun - three News Limited newspapers - adopted similar news frames. It was the acne drug that was explicitly linked – not may have contributed – to the girl’s depression and suicide.
Both the Courier Mail and Herald Sun reports, which were based on the AAP report, departed from the cautionary news frame set by AAP of two drugs, Roaccutane and Zoloft, which may have led to the depression and suicide. Both stories repeated the method and scene of suicide in the second paragraph – ‘hanging by a pair of stockings in her wardrobe’, which media reporting guidelines warn against (Commonwealth of Australia, 2002). The Courier Mail story was the only one to provide information to readers about where they could seek help.
The Australian’s report on the coroner’s verdict also implicated Roaccutane, ahead of depression, as the cause of the girl’s suicide, although it did so cautiously. It included a photograph of the distraught parents outside court with the caption: ‘No warning’. It was not until paragraph 7 of this 13-paragraph story that readers learnt of the Coroner’s comments about Zoloft and treatment the girl received at a Sydney Hospital, as possible factors in her depression and suicide. Although the story did not include details of the method of suicide, it also did not include advice for readers about where to find further information or how to access help.
The other News Limited newspaper, the Daily Telegraph, in line with its coverage of Sydney hospitals that month, re-framed the story to emphasise the coroner’s criticisms of Hornsby hospital. The headline read, ‘You did wrong by Vivian: Hospital criticised over acne girl’s suicide’ and the lead referred to the method of her suicide. This story insensitively referred to the schoolgirl, as she was described in earlier stories, as the “acne girl”. It included a photo of Vivian Crane with the caption ‘Sent home …’, to support the hospital ‘blame’ frame. Readers learnt in the third paragraph that an inquest had found that both Roaccutane and Zoloft were ‘contributing factors to the depression which triggered her suicide’. In paragraph 7 readers learnt that it was the ‘on-duty registrar’ at Hornsby hospital who had sent Vivian home after assurances from her that she would not harm herself. The Daily Telegraph made no attempts to contextualise the risks of Roaccutane, compared to the risks of Zoloft and depression itself, as the Sydney Morning Herald did. Instead, it opted for the simplistic hospital ‘blame’ frame, and provided no advice to readers about how to access dermatological or mental health services.
In contrast, the Sydney Morning Herald front-page report headlined, ‘Diary of a little girl lost in her despair’ quoted excerpts from Vivian Crane’s diary. Vivian Crane was not framed as the “acne girl” done wrong by Roaccutane or the Hornsby hospital but the ‘little girl lost in her despair’. This story was framed around her depression and took a cautious approach to the risks of Roaccutane, reporting in paragraph 7 that Vivian’s depression, ‘an inquest found yesterday, might have been caused by the acne drug Roaccutane’. The story reported that Vivian was turned away from Hornsby hospital, despite one doctor judging her to be at risk, and her parents instructed that she should be under 24-hour-supervision. The report said that a child psychiatrist, who had prescribed Vivian the anti-depressant Zoloft, ‘failed to warn Mrs Crane the drug might aggravate her depression, or could be dangerous if stopped suddenly (which Vivian had secretly done).’ The story also reported that Vivian’s dermatologist had taken her off Roaccutane when told of her depression. This story included recommendations for health professionals when prescribing both Roaccutane and SSRI anti-depressants such as Zoloft.
The Sydney Morning Herald also carried another story written by the paper’s medical editor headlined, ‘The drug that comes with doctors’ health warning’, which provided factual information about Roaccutane; the rate of its prescription in Australia, its potential to cause severe birth defects, that it can only be prescribed by dermatologists and immunologists, the possibility of depression as a side effect, and the possibility of a rise in blood pressure. Significantly, this story reported that evidence more conclusively implicated Zoloft in triggering suicidal thoughts in teenagers than Roaccutane. However, no advice was given to readers in either of these stories about where they could seek advice or further information.
The following day (October 30) the AAP ran a story headlined, ‘SSRIs not a cure-all for kids: Professor’, which reported the warnings of a leading expert in suicide prevention about the risks and uncertainties surrounding the prescription of SSRIs to children. It reported that, ‘His warning comes only days after NSW deputy state coroner Dorelle Pinch said the acne treatment Roaccutane, and the anti-depressant Zoloft, may have aggravated 15-year-old Vivian Crane’s depression, which caused her to commit suicide’. It reported that the coroner ‘told the court Zoloft had never been indicated for children or adolescents, and Roaccutane had documented adverse side-effects including depression’.
Rather than pick up this story, the Daily Telegraph followed up the previous day’s story with an interview with the girls’ mother: ‘When a girl’s mum is the only one listening’. This feature-length story was accompanied by a poem by Vivian Crane, next to a large school photograph of her below which is a smaller photograph of her parents outside court. It appealed to the ‘human face’ of risk or ‘human interest’ news value. The primary source was Vivian Crane’s mother and the story was framed around her grief about not knowing the extent of her daughter’s depression while she was alive, as reflected in her poetry. The story pitted a mother’s attempts to help her daughter against the coroner’s criticisms of Hornsby hospital. The blame for Vivian Crane’s death was shifted in this story from the inadequate labelling of the side effects of Roaccutane to flaws in the hospital system itself, but the ‘blame’ frame remained dominant. Professor Ian Hickie, clinical adviser from the national depression initiative Beyondblue, was quoted towards the end of the article as saying this suicide is one example, among many, of “disjunctive care”. But the story did not report any comment from Hickie, or other mental health professionals, about the risks of prescribing Zoloft to children and adolescents, which was a glaring omission in light of the coroner’s comments about Zoloft and AAP reports on the same day warning of these risks.
Conclusion- Two of the journalistic standards outlined in the MEAA Code of Ethics are to strive for accuracy and to not give distorting emphasis. In this case study the most problematic news framing involved the reframing of the coroner’s findings so as to accentuate the risks of one drug, Roaccutane, over another, Zoloft. Despite the Coroner finding, as cautiously reported by AAP, that both Roaccutane and Zoloft ‘may have’ contributed to the girl’s depression and suicide, News Limited newspapers departed from this frame. This distorted the coroner’s findings, particularly her comments about the risks of prescribing the anti-depressant Zoloft to children, and simplified the complex factors that may have played a role in Vivian Crane’s depression and ultimate suicide.
- It is significant that in reporting the coroner’s findings into this suicide only one news story provided contact information for where people ‘at risk’ are able to seek advice and assistance, despite the fact that many referred to suicide in the headline and reported the method. The provision of such information is one of the recommendations of the Australian government’s guidelines, Reporting Suicide and Mental Illness (Commonwealth of Australia, 2002). Information about the benefits of Roaccutane was also absent from news stories, as was information about alternative non-medical treatments for severe acne and depression. For journalists and editors the exclusion of this information may be of little consequence. But what of readers who were taking Roaccutane or Zoloft? What about readers who were depressed about their acne? What about people who were depressed or feeling suicidal?
LINK:
http://live-wirez.gu.edu.au/jea.papers/Holland,%20Blood,%20Pirkis%20and%20Martin.rtf