Whenever someone famous commits suicide, experts worry that media coverage might be the spark that sends others to try to solve a temporary problem with an all too permanent, and tragic, solution.
There were more calls than usual Tuesday to the National Suicide Prevention Lifeline, and Lisa Furst of the Geriatric Mental Health Alliance of New York told NBC that Robin Williams' death was one reason why.
There is precedent for the concern. The best example is Marilyn Monroe's suicide in 1962, says Dr. Alex Crosby, a medical epidemiologist in the division of violence prevention at the Centers for Disease Control and Prevention.
"If you recall the demographics," Crosby says, "Marilyn Monroe was in her 30s. Researchers found a statistically significant increase in suicides across the nation in white females in their 30s and early 40s in the year after she died."
There was a similar, though limited, uptick after Kurt Cobain died in 1994.
"While they were not able to demonstrate it nationally as in Marilyn Monroe's case, they were able to show that suicides rose in certain populations — primarily in the region of Washington where he lived," Crosby says.
There's no doubt that there is a "contagion effect," says Dr. J. Raymond DePaulo, Jr., Henry Phipps Professor and director of the department of psychiatry & behavioral sciences at the Johns Hopkins University School of Medicine. "And I believe it also accounts for things like these mass shootings. Almost anything you see, there can be copycats and a contagion."
One very important thing to keep in mind is that a good 75 percent of clinically depressed people don't get diagnosed or treated for it, DePaulo says.
"And most don't come for care because they don't think of themselves as having something they need to go to the doctor for. They figure we all have good days and bad days," he adds. "So there is this reservoir of people out there who are clinically depressed and also having bad days on top of that and sometimes they see a suicide and it will have an effect."
Crosby and other experts believe that the way the media reports on suicides can make an impact, for good or bad.
First and foremost, suicides shouldn't be glamorized, he says. Instead, coverage might focus, for example, on the consequences of suicide, what happens to the family afterward.
You don't want the story "to prompt vulnerable individuals, or those who might identify with the celebrity, to think that this is the way to deal with their problems and their pain," says Dr. Lanny Berman, senior advisor to the American Association of Suicidology. "When someone is suffering from a nonspecific loss of hope, they may think, 'My god, if Robin Williams couldn't hack it given all his fame and fortune and adoration, what hope do I have?"
The best response, experts say, is to use the tragic event as an opportunity to teach the public to recognize the warning signs of suicide so they can try to help loved ones before it's too late.
Berman says those warning signs include:
- Expressions of suicidal thinking: in words, poems, diaries, etc.
- Increased use of drugs or alcohol
- Little sense of meaning or purpose
- Struggles with anxiety, agitation and insomnia
- Expressions of feeling trapped, feeling like being between rock and hard place
- Feelings of hopelessness, that things will never change for the better
- Moving away from anything that represents a reason to live: people that matter, work, school hobbies
- Showing excessive anger or rage
- Increase in recklessness and/or risk taking behavior.
- Dramatic mood changes, such as shifts from being OK to being depressed or being depressed to being OK
If you see any of those signs, you need to encourage the person to seek the help of a mental health professional, Berman says. Help can be found at 1-800-273-TALK (8255) or on this list of crisis helpline services.
Sometimes depressed people need help in reaching out. It may be enough to get the person connected with a specific mental health provider, says Emanuel Maidenberg, director of cognitive behavioral therapy in the department of psychiatry at the University of California, Los Angeles.
"People in a depressed mood often do not have the energy to look for help," Maidenberg explains. "They may have the idea but not the energy to find help."
It's important for people to recognize that most depressed people don't end up killing themselves. "Longitudinal cohort studies have shown that less than 10 percent of people with clinical depression die as a result of suicide," Maidenberg says. "That means that 90 percent die from something else."
But if your loved one is resistant to getting help, "you need to firmly, but gently, remind the person that as bad as it may feel at a given time, depression tends to pass. Suicidal thoughts always pass. They may return, but you have to have the courage to wait till they go away."
NBC Senior Medical Producer Ami Schmitz contributed to this report.