Authors' reply

Regarding the questionnaires discussed by Drs Jha & Kumar, we want to clarify some statements regarding some of the measures of our study. As they correctly pointed out, the Erlanger Depression Scale ¹ consists of 9 items, but only 8 of these items are used to calculate the score for depression, and the first item of the scale is a ‘warm-up’ item used for introduction to the scale. Further, the 48-item scale by Linehan and colleagues ² is commonly referred to as the Reasons for Living Inventory, ^3-5 even though earlier versions of this scale may exist.

We agree that factors other than the outcome of the suicidal crisis portrayed in the films (e.g. camera positioning, audio quality, lighting, special effects) might have determined the impact of the movies on the audiences, and this was discussed in our paper. Further studies are necessary to determine the effect of movies that do not differ with regard to characteristics other than the crisis outcome.

Regarding the screening process, ethical considerations and the safety of participants are of course a main priority. Therefore, we excluded individuals with high depression or suicidality scores from participation in the study and offered psychological counselling to them and to all participants after the screening, to help them cope with any distress they may have experienced due to exposure to the films or answering questions on suicidality. The screening process was approved by the Ethics Committee of the Medical University of Vienna and the Vienna General Hospital (study protocol 942/2011, date 24/11/2011). Of note, there is no evidence of general harmful effects of answering questions on suicidality among depressed patients ⁶ or the general population. Obtaining a detailed clinical history or examining the mental state with screening instruments such as the Composite International Diagnostic Interview, ⁷ as suggested by Jah & Kumar, would have further increased the participants' time spent on completing questionnaires, which may have resulted in negative consequences on participation. It is also important to note that suicidal ideation scores among study participants with baseline suicidality above the median who watched the suicide film were still considerably lower after the film screening than suicidal ideation scores of individuals with a history of suicidal ideation or parasuicide in previous studies (e.g. Linehan et al ² ). We also checked for incoherent responses during the screening process in order to identify potentially unreliable responses. There were no contradictory or inconsistent responses in the questionnaires, and there were no indicators of psychotic illnesses among the participants during briefing and debriefing of the study, which were both conducted by a psychologist (B.T.).