This study assessed the characteristics and dynamics of SSRIs and suicidality coverage by scientific and medical journals in general and newspapers in NL and the UK from 2000 to 2010. Scientific journals published predominantly research articles about positive therapeutic outcomes with little mention of an association between SSRIs and suicidality, particularly in adults. Despite different ethnic backgrounds (eg, tabloid culture in the UK, among others) and language, newspaper reporting trends in NL and the UK were comparable and were overall negative regarding the therapeutic effect of SSRIs in paediatrics, while positive-effect reporting prevailed for adults.
The present study has several limitations. It covered 11% of the total population per country based on newspaper circulation figures. Nevertheless, the random sample is representative (n=789 newspaper articles) given the aim to ascertain differences (in terms of numbers, categories and timing) between negative and positive newspaper and journal articles on SSRIs and suicidality. The categories ‘effect’ and ‘type of article’ might be limited by our definition, and their interpretation could differ between readers. We attempted to avoid subjectivity by analysing the data independently by two researchers. We achieved >95% agreements during article categorisation (effect, type of article and age group categories). We did not, however, ascertain the context of the articles in terms of construction of the newspaper and opinion articles from its original source. Neither did we explore other forms of media coverage (television, radio, magazines or the internet). The content analysis method used in this study does not allow for these additional more complex queries.
Our results showing a positive publication tendency in scientific journals are consistent with the previous work, which demonstrated that antidepressant trials with a positive outcome were published more often than those with negative outcomes.23
This positive publication tendency continued even after the regulatory warnings and could potentially leave physicians with a biased view of the medications that they are prescribing to patients. Studies questioning these warnings and the possible disservice they did to public health (eg, the possible inverse association between SSRIs prescriptions and suicidality or the decline in treatment of depression in paediatrics) contributed to this post-warning positive-effect trend.16 17
On the other hand, this positive publication tendency in scientific journals does not seem to prevent the dissemination of bad news about medications. For instance, science journalism articles (newspapers) that presented a negative publication tendency regarding SSRIs (ratio=0.7) could not be related to the positive publication tendency found in scientific journals. These findings indicate that either newspaper journalists may selectively report scientific outcomes to the public, as also stated in the CHMP assessment report on antidepressants,24
or that controversial topics might be selected to increase readership.4 10 25 26
Such practices might generate confusion, since the translation of evidence-based medicine to the public is not uniform,2 5 12 27
and may have implications for patients compliance with medications, willingness to see physicians and trust in the doctor–patient relationship. However, scientific and medical journals might also do disfavour to the scientific community by favouring positive outcome studies, thus limiting the journalists' sources of accurate and critic information to communicate to the public new scientific and medical evidence.
The uncertainties regarding the SSRIs' benefit/risk balance, primarily in paediatrics, have led to the restriction of almost all SSRIs under 18-year-olds in 2003 and further restrictions for young adults (18–24-year-old) in 2007.13–15 28
In the same periods, our data revealed shifts towards negative-effect reporting trends in scientific and newspaper articles on paediatrics and opinion articles. The timing between the warnings and the observed increase in articles substantiate the possible influence of warnings on media publication trends. Moreover, this increment in the number of articles suggests that newspapers informed the public about this particular drug safety event in a timely fashion. Studies have underlined the relevance of informing the public about medical news within a suitable time frame.6 29
However, these studies only focused on a subset of scientific journals, whereas we did not discriminate among scientific journals. A balance between timely coverage, consistent and adequate information is fundamental when reporting on drug safety controversies. Ideally, this balance should be the result of an open dialogue between healthcare practitioners, academia, governmental agencies, the pharmaceutical industry, journalists and the public. However difficult, educating the public properly and on time about the benefits and the risks of medicines will help to maintain public trust during unsettling periods.30
Finally, the possible implications of the discovered tendencies in scientific journals and newspapers for patients and doctors have not been addressed in this paper. It has been shown that news media reports (on suicide or related to suicide) have an influence on suicidal behaviour and on drug usage.31 32
It might be valuable in this regard to determine the long-term influence of media coverage and the regulatory warnings on prescription patterns.