It’s not very often that you hear about a rap song related to the field of psychiatry, but in 2017 American hip hop artist Logic released his song “1-800-273-8255,” which promoted the US National Suicide Prevention Lifeline phone number.
A study was recently published which assessed the daily call volumes to the lifeline when wide scale public attention was paid to the song which peaked at number 3 on the US Billboard Hot 100 and received nominations for “Song of the Year” and “Best Music Video” at the 60th Annual Grammy Awards. During those times, calls to the lifeline increased and there were fewer suicides, according to findings from a time series analysis published in BMJ.1
The study references the Papageno effect, which refers to a character in Mozart’s 18th century opera, The Magic Flute. When Papageno loses the love of his life, he feels that the only way to subdue his pain is suicide. Before he ends his life, 3 other characters show him that there are other ways to solve his problems.2 According to information from the National Suicide Prevention Hotline, the Papageno effect is the influence that mass media can have by responsibly reporting on suicide and presenting nonsuicide alternatives to crises.
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Research regarding the utility of the Papageno effect has been limited to experimental designs and suicidal thoughts, but Logic’s song, which depicts an individual calling the lifeline while contemplating suicide and then choosing to live, has been streamed more than 1 billion times on Spotify, said one of the study’s authors, Thomas Niederkrotenthaler, PhD, MMSC, an associate professor and head of the unit of Suicide Research & Mental Health Promotion at the Medical University of Vienna, Austria. He is also vice president of the International Association for Suicide Prevention and chairman of the Wiener Werkstaette for Suicide Research in Vienna.
“Logic’s song likely represents the broadest and most sustained suicide prevention messaging directly connected to a story of hope and recovery in any location to date and is thus a serendipitous event for research,” Dr Niederkrotenthaler said.
Using Brandwatch, the researchers retrieved tweets in the US from March 2017 through April 2018 that contained “Logic” and “1-800-273-8255” and identified peaks in tweeting behavior. They assessed the duration of the peaks and differences between visual inspection and quantitative assessment of change points in the time series data.
The lifeline provided the total number of calls it received each day from 2010 through 2018. The US Centers for Disease Control and the Prevention’s National Center for Health Statistics provided national suicide data, identified as the X60-X84, Y87.0 and U03 ICD-10 codes as daily aggregates for 2010 through 2018. The investigators included dummy variables to account for possible confounding by the release of 13 Reasons Why (a Netflix series which contains the suicide of a teen), the suicides of celebrities, and World Suicide Prevention Day.
Daily tweets about Logic’s song peaked around the song’s release in April 2017 (1,151 tweets per day for 3 days), the MTV Video Music Awards in August 2017 (the highest peak: 1324 daily tweets over a 28-day period), and the Grammy Awards in January 2018 (1883 tweets a day for 3 days), with smaller peaks around the time of the song’s video release on August 17, 2017, and media reports of increased calls to the lifeline associated with the song on October 10, 2017.
The researchers found a statistically significant association between calls to the lifeline and the 34-day periods related to the 3 main events. Observed calls exceeded forecasted calls for the song’s release (5.3% 95% CI 0.53%-10%), the performance at the MTV Video Music Awards (8.5% 95% CI 5.1%-11.9%), and the performance at the Grammy Awards (6.5% 95% CI 1.7%-11.2%). In combined analysis, the researchers found that there were 9915 additional calls, across the 34 days, an increase of 6.9% (P <.001).
In combined analysis, the researchers found that observed suicides were 245 fewer than model forecasts with discrete pulse in the combined 34 day period after the three main events relating to the song, a 5.5% reduction (P =.02) in the 34-day period.
The study authors found similar results when they examined only unique lifeline calls and when they utilized a pre-intervention cut-off date of April 27, 2017. When Logic-related media events were combined into a single model, they maintained association with lifeline calls but not with suicides.
“These findings emphasize the potential population health benefits of working creatively and innovatively with other sectors, such as the music and entertainment industries, to promote new impactful stories of help seeking that resonate with broad audiences, leave a visible footprint on social media, and are safe in terms of not featuring potentially lethal actions but rather coping and mastery of crises,” Dr Niederkrotenthaler said.
On the hip hop/rap website Genius, Logic talks about the inspiration and the video for his song featuring Alessia Cara and Khalid. The video tells a compelling story of a young gay adolescent who encounters discrimination and rejection from his family and other teens at school.
“So the first hook and verse is from the perspective of someone who is calling the hotline and they want to commit suicide. They want to kill themselves. They want to end their life. When I jumped on a tour bus that started in Los Angeles, California and I ended in New York City and did a fan tour where I went to fans’ houses and shared meals with them, hung out with them, played them my album before it came out. Then along with other people on tour, just fans that I met randomly, they’ve said things like, ‘Your music has saved my life. You’ve saved my life.’ And I was always like, ‘Aw, so nice of you. Thanks.’ And I give them a hug and [expletive] but in my mind, I’m like, ‘What the [expletive]?’ And they’re really serious. And they tat[too] [expletive] on their arms and get [expletive] like lyrics that save their life and in my mind, I was like, ‘Man I wasn’t even trying to save nobody’s life.’ And then it hit me, the power that I have as an artist with a voice. I wasn’t even trying to save your life. Now what can happen if I actually did?”3
We reached out to Dr Niederkrotenthaler for additional insights about this study.
What made you decide to study the effects of a rap song?
Dr Niederkrotenthaler: We have done a few experimental studies about different narratives for suicide prevention. For example, how they impact individuals with some degree of vulnerability to suicide. Those were all experimental studies, so they were randomized controlled trials. In a study, the participants would read a story about someone coping with suicidal thoughts or they’re assigned to a control group. We found in these experimental settings that there was some evidence of a decrease in suicidal thoughts and feelings among those who read a story or watched or visited a website with a theme of hope and recovery.
There was some evidence from these experimental studies but a major problem for us in suicide prevention has been that these types of stories rarely get a sufficiently large audience over a longer period of time. So it’s very hard to measure if there are real behavioral impacts of such stories.
It actually kicked off when the research team here at the Medical University of Vienna entered into a cooperation with the National Suicide Prevention Lifeline and they told me about the Logic song. We thought that’s definitely something we need to study and make a formal assessment of how this song relates to seeking help from the lifeline and how it relates to suicide.
Regarding research, what is special or unique about Logic’s song?
Dr Niederkrotenthaler: This song really caught our attention because of its narrative. It was really unique to us in suicide prevention in 2 important ways. First of all, it was a song. Normally, the prevention message typically features experts speaking about the problem and then how to potentially solve the problem. It’s really rare to see these issues come across in a song.
And the other novelty was that it had a real clear focus on coping and recovery. It’s a suicide prevention song, but it was not even about suicide. It’s about a young man struggling with discrimination for being gay and he then considers suicide. After this occurs in the music video he then grabs the phone and calls the crisis line. And this actually marks the point of improvement for him. So, it’s really a story that has a very clear narrative of hope and recovery.
I think on a broader level what we can learn here is that it’s definitely important for suicide prevention to work with the creative arts, including pop culture of course, and also with the entertainment industry in order to develop narratives that really resonate with diverse audiences.
What is your advice for other clinicians working in suicide prevention?
Dr Niederkrotenthaler: For clinicians working with suicidal clients it’s really important to know how patients are affected by a specific media portrayal. For example, the Netflix series 13 Reasons Why, in which a girl died by suicide, seemed to affect a lot of youth in the US and Europe. In Austria we provided resources to the public to help guide clinicians and teachers in order to assist them in addressing questions that were coming up with their patients and with their students.
In the US, the Suicide Awareness Voices of Education in Minnesota took the same approach. So it’s really important for clinicians to be aware that the media can have a strong impact. For example, asking a patient what kind of conversations does he or she have in social media? How does he or she feel about it? This might strengthen the therapeutic relationship and the clinician might learn more about the suicidal state of the specific individual.
Can you explain further about the resources created specifically for 13 Reasons Why?
Dr Niederkrotenthaler: When the first season of 13 Reasons Why was released in 2017 there was immediate concern from my colleagues in the US as well as from my European colleagues. Here was a show that might have a negative effect on young people who are in a suicidal crisis. And the problem was that you don’t want to promote a portrayal of suicide which is potentially harmful.
But then in Austria, teachers approached myself and other colleagues in the area of suicide prevention telling us that their students are in their classrooms discussing 13 Reasons Why. They said that they don’t know how they should deal with this because they didn’t want to promote the series. The teachers thought that it might be harmful to talk about it, but on the other hand, the students are all talking about it anyway so what should they do?
So, we drafted a resource for teachers which gave them suggestions for questions to discuss within the classroom. For example, have you seen the show? How did you feel about the characters portrayed? What was done well in the program? What might be improved? How do you feel about the Hannah Baker’s situation? [Hannah is the main character in the show who had killed herself.] Do you think it’s a realistic portrayal of suicidal ideation and thoughts? What problems is she actually facing? How would this translate to our school? Where can you get help in our school setting? Who can you approach if you are depressed or have suicidal thoughts?
From these efforts we received a lot of positive feedback from teachers and also from clinicians. In the US a very similar approach was done by several organizations who provided similar resources not only for teachers but for parents who were concerned about how their children might cope with the series. Resources were also provided in the US for clinicians to become aware of the series and the impact of the series in their offices.
.In July 2022 the number for the US National Suicide Prevention Lifeline will be changed to 988.
Editor’s Note: the article was slightly modified to suit the audience.
Disclosure: Some study authors have been employees or received financial support from Vibrant Emotional Health, the non-profit organization that administers the National Suicide Prevention Lifeline.
Reference
1. Niederkrotenthaler T, Tran US, Gould M, et al. Association of Logic’s hip hop song “1-800-273-8255” with lifeline calls and suicides in the United States: interrupted time series analysis. BMJ. Published online December 13, 2021. doi:10.1136/bmj-2021-067726
2. The Papageno Effect. National Suicide Prevention Hotline. Accessed February 2, 2022. https://suicidepreventionlifeline.org/wp-content/uploads/2021/04/Lifeline-Papageno-Effect.pdf
3. Mench C. Logic’s “1-800-273-8255” inspired thousands of call to the Suicide Prevention Hotline. Genius. Published July 13, 2017. Accessed February 2, 2022. https://genius.com/a/logic-s-1-800-273-8255-inspired-thousands-of-calls-to-the-suicide-prevention-lifeline.
This article originally appeared on Psychiatry Advisor
