Impact of Media Guidelines on Suicide-Related Reporting Quality and Suicides

<b></b> <i>Background:</i> Suicide-related media reporting can influence suicidal thoughts and behaviors. Stories describing suicide methods can increase suicides (Werther effect), whereas those highlighting coping with suicidal crises can prevent them (Papageno effect). <i>Aims:</i> To assess the impact of media guidelines for suicide reporting on reporting quality and suicides. <i>Method:</i> Following PRISMA guidelines, we searched PubMed, Scopus, Embase, PsycInfo, and Web of Science up to February 10, 2025, with an update on November 17, 2025. We included ecological pre-post studies assessing changes in reporting quality and time-series analyses assessing changes in suicides after guideline release. Random-effects meta-analyses estimated pooled risk ratios (RRs) for reporting quality and incidence rate ratios (IRRs) for suicides. <i>Results:</i> Fifteen studies from 11 countries (2003-2025) were included (14 on reporting quality, three on suicides, two measuring both). Following guideline release, reporting quality improved for "Do educate the public about the facts of suicide and suicide prevention based on accurate information" (k = 13, RR = 1.56, 95% CI = 1.30, -1.88), "Don't describe the method used" (k = 12, RR = 1.33, 95% CI = 1.15, -1.53), and "Don't oversimplify the reason for a suicide or reduce it to a single factor" (k = 0, RR = 1.16, 95% CI = 1.02, -1.33). For other recommendations, pooled estimates generally favored the guidelines but were often imprecise, and in some cases, had substantial heterogeneity. We could not draw firm conclusions on their impact on suicides as only three studies assessed this outcome. Contour-enhanced funnel plots and Egger's tests suggested possible small-study effects for some recommendations. <i>Limitations:</i> All included studies included ecological before-and-after designs. Implementation strength was inconsistently reported, preventing analysis of its influence. <i>Conclusions:</i> Media guidelines appear to improve several aspects of reporting quality. Although evidence for impact on suicides is limited, guidelines are unlikely to cause any harm and may confer benefits through improved reporting standards. Further research is urgently needed to quantify their impact on suicides.