Reading of the Week: Tweets for a Good Cause, But Suicide Prevention? Also, Racism in Mental Health (QT), and Rap & Awareness (JAMA Peds)

From the Editor

It’s an incredible campaign. With each passing year, Bell Let’s Talk Day gains more recognition, with many, including the Prime Minister, tweeting for a good cause.

But does the campaign affect suicide? In the first selection, we look at new paper from The Canadian Journal of Psychiatry. David Côté (of the University of Toronto) and his co-authors study the tweet contents of Bell Let’s Talk Day and suicide completions. “There was no associated change in suicide counts.” We mull the big campaign and the big paper.


In the second selection, we look at a new podcast that explores race and racism in mental health. In this Quick Takes episode, I’m joined by Drs. Amy Gajaria and Saadia Sediqzadah (both of the University of Toronto). “Racism exists and it exists in the lives of our patients.” The podcast covers some big topics – but it is also practical, with solid clinical advice.

And in the third selection, Alex Kresovich (of the University of North Carolina) and his co-authors wonder about the cultural discussion of mental health. To that end, they review popular rap songs in a JAMA Pediatrics paper. “The findings of this qualitative study suggest that mental health discourse has been increasing during the past 2 decades within the most popular rap music in the US.”



Selection 1: “Suicide-related Twitter Content in Response to a National Mental Health Awareness Campaign and the Association between the Campaign and Suicide Rates in Ontario”

David Côté, Marissa Williams, Rabia Zaheer, et al.

The Canadian Journal of Psychiatry, 10 February 2021  Online First


“Mental health awareness (MHA) campaigns have been shown to be successful in improving mental health literacy, decreasing stigma and generating public discussion. They may also result in improved health outcomes. For example, MHA campaigns have been associated with an increase in the use of inpatient and outpatient mental health services. However, despite the global proliferation of MHA campaigns, the effects on suicide of awareness campaigns that do not explicitly focus on safe suicide messaging and/or suicide prevention have not been characterized…

“Bell Let’s Talk is a Canadian organization that promotes mental health and well-being, managed by the major telecommunications company Bell Canada. Its 4 aims are to fight stigma, improve access to mental healthcare, support research, and improve mental health in the workplace. Since January 2011, Bell Let’s Talk has launched an annual social media–based MHA campaign, known as Bell Let’s Talk Day (BLTD)…The Twitter content published on BLTD is vast; according to the event organizers, #BellLetsTalk has been the most used hashtag in the world on the day of the event and the top Twitter trend in Canada…”

So begins a paper by Côté et al.

Here’s what they did:

  • “This study examined social media and suicides in Ontario, Canada. It involved (a) a content analysis of suicide-related social media (Twitter) posts associated with the 2016 BLTD campaign geolocated to Ontario and (b) an analysis to determine whether there was an associated change in suicides during and immediately following BLTD campaign (2011 to 2016).”
  • “Counts of suicide in Ontario obtained from the Office of the Chief Coroner were compared between ‘exposure’ and ‘control’ windows in 2011 to 2016 (i.e., years in which the campaign occurred) according to previously established procedures. Exposure windows were predefined as 7-day epochs spanning day 0 to day +6 with day 0 specified as BLTD in each year. Two control windows of the same length (day −14 to day −8 and −21 to −15) were used as comparators.”
  • “All suicide-related tweets geolocated to Ontario, posted from July 1, 2015, to June 30, 2016…” Two investigators coded the tweets.

Here’s what they found:

  • Suicide. “There was no significant difference in overall suicide counts in Ontario in the week subsequent to BLTD compared to the control…” And, considering age: “There was also no difference when the analysis was restricted to only those 10 to 30 years old…”
  • Twitter content. “Very few tweets were related to one’s personal experience with suicide/suicidality (either in the person tweeting or someone they know) with the exception of the suicide death of a relative, acquaintance or friend which was noted in 268 (7.1%) tweets. The problem of suicide was highlighted in 1,610 (42.8%) tweets compared to only 321 (8.5%) tweets that described solutions to suicide.”

A few thoughts:

  1. This is a good study.
  1. We can marvel at the freshness of the approach – considering tweets and the larger topic of social media.
  1. There is much to like here, including the number of tweets considered and the suicide data drawn from the Coroner’s Office.
  1. Needless to say, the paper has made a bit of a splash on social media, and was also the subject of a Toronto Star article. For his part, senior author Dr. Mark Sinyor commented: “The way that I view these results is that there may be an opportunity here that we could leverage that so far hasn’t been harnessed.”
  1. The news article is thoughtful, and includes comments by others, including CAMH’s Dr. Juveria Zaheer. The article can be found here:
  1. Would the authors have found a different result with a longer time-frame?
  1. Should the campaign be bettered to focus more on suicide prevention, as the authors suggest? Or is this analysis missing the point, since Bell Let’s Talk Day is about raising awareness – like criticizing the winning NBA team for not having better three-point shot stats?

The full paper can be found here:


Selection 2: What all physicians need to know about race and racism in mental health care

Drs. Amy Gajaria and Saadia Sediqzadah, with David Gratzer

Quick Takes, 3 March 2021


Race and racism in mental health – it’s a topic that we often avoid talking about. But the Quick Takes podcast series explores different subjects, including the tough ones. I sat down with two guests, Drs. Amy Gajaria and Saadia Sediqzadah.

On Clinical Practice

Dr. Gajaria: “Racism exists and it exists in the lives of our patients. And we have to acknowledge that. And we have to create a space where people are willing to talk to us about their experiences. And that sometimes means asking them directly. And sometimes that just means signalling to someone through your language and your way of hearing them that you are willing to hear all of their stories and all of who they are.”

On Informal Mentorship

Dr. Sediqzadah: “I found throughout my residency training: you kind of find your people. You find those racialized co-learners (as in other residents) or staff psychiatrists who, again, it’s informal – like reaching out in situations where something felt amiss. Or I might have been struggling with a particular case because there was an element that I thought was missing in terms of race or culture, ethnicity, religion, et cetera.”

On Better Understanding Culture

Dr. Gajaria: “There are certain shows and things that I recommend. Black-ish is great. Also McKayla Cole did a beautiful short series called I May Destroy You, which was about her experience of sexual assault. And the beautiful thing about that series is that she’s a black young woman and she created that whole thing. She wrote it. She directed it. It’s her baby. And that is what’s so important. If you’re going to engage with art… make sure that it’s by people of colour and it’s authentically about their experience.”

Dr. Sediqzadah: “I recommend Desmond Cole’s The Skin We’re In because I find a lot of the literature and books that we read come from the United States; we don’t have as many resources in Canada and especially Toronto-specific. So Desmond Cole’s book is wonderful, particularly because he has one chapter dedicated to, for example, racism within the education system focusing on the Peel district school board. He also has an entire chapter dedicated to the Toronto Police Service and the racism that has been documented that exists there. So for me, The Skin We’re In is a must read for not only psychiatrists, but health care providers in general.”


(The above comments have been edited for length.)

The podcast can be found here, and it is just under 30 minutes:


Selection 3: “A Content Analysis of Mental Health Discourse in Popular Rap Music

Alex Kresovich, Meredith K. Reffner Collins, Daniel Riffe, et al.

JAMA Pediatrics, 7 December 2020  Online First


“Young Black/African American male individuals constitute a significant portion of the audience for rap music, which has been suggested by some scholars as a promising intervention for at-risk youth. Rap music is one of the ‘most significant influences on the social development’ of YBAAM.

“However, by 2018, rap music had attracted the youngest US audience demographic and was considered a favorite genre among most US youths aged 16 to 24 years, crossing all socioeconomic strata and ethnicities. This is significant, because US youth spend almost 40 hours per week listening to music, and listening time in the US in general has risen by 36.6% from 2015 to 2017. Rap artists have also been found to serve as role models for their younger audiences, influencing the development of these young people’s identities.

“The aim of this study is to investigate the prevalence of mental health themes in popular rap music to test whether mental health references have increased amid a period of increasing mental health distress and suicide risk among US youths, including and extending beyond YBAAM.”

So begins a paper by Kresovich et al.

Here’s what they did:

  • “We analyzed the lyrics of 125 popular rap songs sampled across 2 decades beginning in 1998, the year rap music first outsold the former top-selling genre in the US, country music.”
  • The 25 most popular songs were chosen in 5-year increments.
  • There were two trained coders for references to anxiety, depression, suicide, metaphors suggesting mental health struggles, and stressors associated with mental health risk.

Here’s what they found:

  • “Of the 125 songs sampled and analyzed, a total of 105 songs (84%) featured a Black/African American male artist either as the lead artist (97 [78%]) or as a guest (8 [6%]).”
  • “Nearly all songs analyzed (123 [98%]) featured lead artists from North America. The mean (SD) age of the leading artist across the sample was 28.2 (4.5) years. Prominent artists captured in the sample included 50 Cent, Drake, Eminem, Kanye West, Jay-Z, and Lil’ Wayne, among others.”
  • “Across all sampled years, 94 of the 125 total songs (75%) referenced negative emotion, and 57 of the songs with negative emotion (61%) referenced mental health.”
  • “Specifically, 35 of the total sample (28%) referenced anxiety, 28 (22%) referenced depression, 8(6%) referenced suicide, and 26 (21%) used at least 1 mental health metaphor.”


A few thoughts:

  1. This is an interesting study.
  1. Of course, the authors focused on popular rap songs – and a larger review of rap music may have resulted in different findings.
  1. And not all music is rap, or so I’ve been told.
  1. Still, it gives a clear result – and not a surprising one. Mental health is discussed far more than ever before. There is no one reason for this, but more people are speaking out, including rap artists.

The full JAMA Pediatrics paper can be found here:


Reading of the Week. Every week I pick articles and papers from the world of Psychiatry.

1 Comment

  1. It’s good to call attention to the valuable work that the Let’s Talk campaign does both in promoting some conversations and in supporting worthy projects.

    However, BLTD isn’t a substitute for the robust mental illness literacy program that Canada needs. This kind of program would also help the Bell campaign, since it’s hard to discuss severe mental illnesses, like schizophrenia, when people lack basic information.

    The lack of basic understanding of these disorders also impacts mental illness policies as I discuss in this article: