Background Imitative (‘copycat’) suicide occurs when a media representation of suicide precipitates a suicide attempt. Several organisations have guidelines for responsible suicide reporting, designed to minimise risk of precipitating imitative suicide. Observational studies have explored the evidence for imitative suicide, showing that a large amount of suicide coverage in the news is followed by higher incidence of deaths from suicide. Those imitating a suicide tend to share characteristics such as gender and age with the person whose death was portrayed. The effect of sharing transgender status has not yet been explored. Suicide attempts are common in the transgender population: 40% have attempted suicide at least once. This systematic review will evaluate to what extent UK newspapers adhere to guidelines when reporting suicides of transgender people.

Methods We searched the newspaper database Nexis for UK newspaper articles published September 2007–2017 which reported the suicide of a transgender person. One reviewer screened results and applied inclusion and exclusion criteria. A checklist tool of ten criteria was adapted from the suicide reporting guidelines of three organisations. Two reviewers independently applied the checklist to each article, noting any breaches. Disagreements were resolved by discussion. A measure of inter-rater reliability was calculated. Analyses were conducted in SPSS.

Results The search found 996 articles, 187 of which were screened in full. The 79 articles which met inclusion criteria concerned 22 individuals’ deaths, and came from 19 newspapers.

Every article had ≥1 checklist breach, with a mean of 3.9/10 breaches (95% CIs 3.5 to 4.3). The majority of articles (63.3%) had 3–5/10 breaches. Percentage prevalence of breaches varied between checklist items, with the most commonly breached features being inappropriate headlines, failure to signpost readers to sources of support, and inappropriate descriptions of death/suicide method.

The measure of overall inter-rater reliability showed nearly perfect agreement between reviewers (Cohen’s kappa=0.86).

Discussion Breaching responsible reporting guidelines is very common in UK newspapers when covering suicide deaths of transgender people, although a key limitation is that results cannot be extrapolated to internet news sources or social media.

Because breaching guidelines has the potential to cause harm-- perhaps more so in transgender than cisgender individuals-- journalists should be aware of imitative suicide and try to minimise risk of harm. Although sometimes breaching guidelines may be justified, the priorities of public health and of journalism should be weighed against each other.