Suicide Contagion Research Articles

Suicide and Family Contagion

Background Suicidal behaviour is generally considered to be a multi-determined act with psychosocial, personality, family, psychiatric, biologic, genetic and psychodynamic risk factors. Recent studies have suggested that one important suicide risk factor is having a family history of suicidal behaviour and the media often report on the contagious effect of suicide. There is a need to understand the risk factors for suicide so that interventions …

Le traitement médiatique du suicide : du constat épidémiologique aux pistes de prévention

Media coverage of suicide can result in increased morbi-mortality suicidal rates, due to an imitation process in those who are particularly vulnerable. This phenomenon is known as "Werther effect". Werther effect's magnitude depends on several qualitative and quantitative characteristics of the media coverage, in a dose-effect relationship. An extensive (in terms of audience and history repetition) and salient coverage (glorification of suicide, description of the suicidal method, etc.) increases the risk of contagion. Celebrities' suicide is particularly at risk of Werther effect. Media may also have a preventive role with respect to suicide. Indeed, according to "Papageno effect", journalists could, under certain conditions, help preventing suicide when reporting suicide stories. Two main theories in the field of social psychology have been proposed to account for Werther and Papageno effects: social learning theory and differential identification. Identification of Werther and Papageno effects uncovers new responsibilities and potentialities for the journalists in terms of public health. Their description provides a basis for promising targeted prevention actions.

The Aftermath of a Suicide Cluster in the Age of Online Social Networking: a Qualitative Analysis of Adolescent Grief Reactions

Although suicide clusters have been identified in many populations, research exploring the role of online communication in the aftermath of a suicide cluster is extremely limited. This study used the Consensual Qualitative Research method to analyze interviews with ten high school students 1 year after a suicide cluster in a small suburban school district. Interviewee’s responses were organized into four domains: The Suicide, Impact, Perceptions of School Environment, and Recovery. The role of social networking emerged as a common theme across domains, suggesting broad relevance to adolescents’ experience following the suicide of a peer. Implications for clinical intervention, research, and school policies in the response to student suicides are discussed.

A Case Series Analysis of a Cluster of 25 Sudden Service User Deaths; Summary Data and Profiling of the Grouping of Risk Factors in Patients.

Introduction 25 suspected cases of suicide occurred in a 20 month period. A literature review revealed some differences in this sample that merited further study. Objectives To summarise the demographics, risk factors and service contact history of a suicide cluster and identify specific risk profiles and to compare these findings with international data. Aims To produce a data set that informs suicide intervention and suicide prevention. Methods A case notes review of patients’ charts was carried out. Other variables were chosen because of their importance in the existing suicide literature. Recommendations from the UK National Confidential Inquiry (NCI) were also used to assess the data. Clinical perception of risk was also recorded. Results In grouping risk factors together 3 profiles emerged. A chaotic pattern, a masking pattern and a recovered group whose response to relapse was increased suicidality. Conclusions This cluster have similarities and differences from the risk profile for patient suicides described in the existing literature. There was a large amount of substance misuse. Risk recognition for immediate risk of suicide was just as challenging in this group as in much larger studies. Questions regarding service provision and hypotheses about cluster occurrence are also discussed.

Suicidal disclosures among friends: using social network data to understand suicide contagion.

A robust literature suggests that suicide is socially contagious; however, we know little about how and why suicide spreads. Using network data from the National Longitudinal Study of Adolescent to Adult Health, we examine the effects of alter's (1) disclosed and (2) undisclosed suicide attempts, (3) suicide ideation, and (4) emotional distress on ego's mental health one year later to gain insights into the emotional and cultural mechanisms that underlie suicide contagion. We find that when egos know about alter's suicide attempt, they report significantly higher levels of emotional distress and are more likely to report suicidality, net of extensive controls; however, alter's undisclosed suicide attempts and ideation have no significant effect on ego's mental health. Finally, we find evidence that emotional distress is contagious in adolescence, though it does not seem to promote suicidality. We discuss the implications of our findings for suicide contagion specifically and sociology more generally.

Between Werther and Papageno effects

Research on the impact of suicide depictions in the media is traditionally focussed on two possible outcomes: on the one hand, there is ample evidence for additional copycat effects after media coverage of suicides referred to as the Werther effect but on the other hand, suicide rates decrease after appropriate media depictions of suicides referred to as the Papageno effect. It is still uncertain what exactly qualifies studies that only limitedly support an imitative or preventive media effect, i.e. studies with ambiguous findings, as they are often disregarded. The present literature review focuses on equivocal studies (n = 25) on copycat suicides that were systematically analyzed based on theoretically derived criteria. The results of the systematic analysis of all identified studies imply that media effects on suicidality are better understood and discussed as a continuum between the two extremes that were introduced as either a damaging Werther effect or a beneficial Papageno effect. Future studies must clarify what factors contribute to a shift from ambiguous findings to harmful media effects on individual suicidality.

Suicide acceptability as a mechanism of suicide clustering in a nationally representative sample of adolescents

PurposeThe goal of the present study was to examine suicide acceptability as a mechanism of suicide clustering in adolescents. MethodsData were drawn from The National Annenberg Survey of Youth, a sample of 3302 adolescents aged 14–22 collected between 2002 and 2004. ResultsResults indicated that beliefs of the acceptability of suicide partially mediated the effect of exposure to suicide (defined as knowing someone who attempted or completed suicide) on 1) serious suicidal ideation and 2) suicide planning behaviors. ConclusionsThe present study demonstrated that suicide acceptability is in small part a possible reason why suicides tend to cluster in adolescents. It contributes not only to the knowledge of how the phenomenon of suicide clustering might occur, but more broadly highlights the importance of examining mediators of suicide clustering.

APA Contributes to Guide for Suicide Response at Colleges

Back to table of contents Previous article Next article Professional NewsFull AccessAPA Contributes to Guide for Suicide Response at CollegesNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:2 Feb 2015https://doi.org/10.1176/appi.pn.2015.2a5AbstractAPA teams with other organizations dedicated to student mental well-being to develop a guide to help colleges manage and move on from a suicide on campus.When a tragic event like a suicide hits a community, most questions instinctively reflect back—“Why did this happen?” “What signs did we miss?” and perhaps most agonizingly, “How could we have prevented this?”However, looking forward is a critical part of the process as well; a suicide needs to be properly acknowledged and managed to help a community move on. It’s a strategy known as “postvention,” and it’s particularly important in places like college campuses, where a student’s suicide can strongly reverberate among a population that is young, vulnerable, and undoubtedly dealing with many stressors of its own.“While none of us wants to experience a student suicide, it is an important reality of working on a campus,” said Leigh White, M.D., the chief of psychiatry services for Michigan State University Student Health.The use of suicide postvention plans is becoming more prominent across colleges and universities, though there has not been much research in this area, forcing college officials to develop plans ad hoc from their own experiences.“Colleges are well suited to manage a suicide in that they have an infrastructure to allow for a coordinated response in a way that a neighborhood community cannot,” said White, pointing to features such as on-campus security, counseling centers, and readily available ways to contact every student or his or her family. “What many of us in this field realized was missing was some overarching guidance as to what college campuses should do to make best use of these resources.” HEMHA’s suicide “postvention” guide is designed as both a campus planning tool and a useable guide for responding to a crisis situation.HEMHAWhite also serves as the APA representative to the Higher Education Mental Health Alliance (HEMHA), a consortium of groups dedicated to promoting mental well-being for students. The result of HEMHA’s efforts to address this issue is Postvention: A Guide for Response to Suicide on College Campuses, a resource to help colleges more effectively and sensitively respond to campus deaths. Published in November 2014, the postvention guide was designed to provide “actionable” guidance that colleges can adapt for their unique circumstances but is broad enough to be applicable to any campus environment from a tiny liberal arts college to a massive, multicampus state university.And while the guide was envisioned as a planning tool, it was kept concise to enable it to be useable in a crisis if a suicide occurs at a college before a postvention strategy has been fully developed.“Every suicide situation is unique, so this guide cannot provide a prescriptive set of best practices,” cautioned Victor Schwartz, M.D., the medical director for fellow HEMHA member the Jed Foundation, a nonprofit organization that works to promote mental health and prevent suicides in college students.“However, the guide can identify specific intervention areas to target and offer suggestions for implementation strategies,” he added.The key areas highlighted in the guide involve managing communications, providing proper clinical and support services, handling memorials and services, and getting back to the routine. Effective communication in particular can be complicated in a modern world where the facts—and rumors—regarding a suicide can spread rapidly via social media.Schwartz noted that HEMHA will make the guide a downloadable online resource and treat it as a living document that can be updated as schools implement the recommendations and provide feedback on effective approaches.Critically, noted White, a commitment to postvention does not diminish campus efforts to prevent suicides from occurring. “One of the biggest worries following a suicide is suicide contagion spreading through the campus and affecting other vulnerable people,” she told Psychiatric News. “And the HEMHA guide specifically addresses this risk and how to limit it. So if done properly, a postvention strategy is also a prevention strategy,” she said.In addition to APA and the Jed Foundation, other HEMHA members that helped develop this guide include the American College Counseling Association, American College Health Association, American College Personnel Association, American Psychological Association, Association for University and College Counseling Directors, and NASPA-Student Affairs Administrators in Higher Education. ■“Postvention: A Guide for Response to Suicide on College Campuses” can be accessed here. This site also contains HEMHA’s previous guide, “Balancing Safety and Support on Campus.” ISSUES NewArchived

Fatal aluminum phosphide poisonings in Tirana (Albania), 2009 - 2013.

BackgroundAcute poisonings particularly through pesticides have become a major public health concern in Albania during the last decade.FindingsThe number of fatalities due to aluminum phosphide intoxications was more than doubled during a five year-period from 2009 to 2013, and a cluster of suicides perpetrated with Phostoxin was registered. Several factors are accountable for such a phenomenon, including the fact that aluminum phosphide agents are freely available in the Albanian market, their price is extremely low and they are sold without any legal restriction. The mass media unfortunately warranted an emulating effect to dramatic intoxications, which gained by such means the notoriety of a secure lethal weapon.ConclusionsOur experience with more than three hundred intoxications with aluminum phosphide agents in the last five years, showed that a considerable delay from the moment of exposure (mainly through ingestion) to specialized medical help seeking, created a considerable obstacle for a successful treatment of cases, and eventually for the survival of patients. The lack of a specific antidote adds further challenges to all these exposures. The need for public health policies aiming at prevention, awareness, and possibly the substitution of Phostoxin or other aluminum phosphide pesticides with less dangerous agents is formulated.

Space–time suicide clustering in the community of Antequera (Spain)

IntroductionApproximately 3500 people commit suicide every year in Spain. The main aim of this study is to explore if a spatial and temporal clustering of suicide exists in the region of Antequera (Málaga, España). MethodsSample and procedure. All suicides from January 1, 2004 to December 31, 2008 were identified using data from the Forensic Pathology Department of the Institute of Legal Medicine, Málaga (España).Geolocalisation. Google Earth was used to calculate the coordinates for each suicide decedent's address.Statistical analysis. A spatiotemporal permutation scan statistic and the Ripley's K function were used to explore spatiotemporal clustering. Pearson's chi-squared was used to determine whether there were differences between suicides inside and outside the spatiotemporal clusters. ResultsA total of 120 individuals committed suicide within the region of Antequera, of which 96 (80%) were included in our analyses. Statistically significant evidence for seven spatiotemporal suicide clusters emerged within critical limits for the 0–2.5km distance and for the first and second semanas (p<0.05 in both cases) after suicide. There was not a single subject diagnosed with a current psychotic disorder, among suicides within clusters, whereas outside clusters, 20% had this diagnosis (χ2=4.13; df=1; p<0.05). ConclusionsThere are spatiotemporal suicide clusters in the area surrounding Antequera. Patients diagnosed with current psychotic disorder are less likely to be influenced by the factors explaining suicide clustering.

Detecting Changes in Suicide Content Manifested in Social Media Following Celebrity Suicides.

The Werther effect describes the increased rate of completed or attempted suicides following the depiction of an individual's suicide in the media, typically a celebrity. We present findings on the prevalence of this effect in an online platform: r/SuicideWatch on Reddit. We examine both the posting activity and post content after the death of ten high-profile suicides. Posting activity increases following reports of celebrity suicides, and post content exhibits considerable changes that indicate increased suicidal ideation. Specifically, we observe that post-celebrity suicide content is more likely to be inward focused, manifest decreased social concerns, and laden with greater anxiety, anger, and negative emotion. Topic model analysis further reveals content in this period to switch to a more derogatory tone that bears evidence of self-harm and suicidal tendencies. We discuss the implications of our findings in enabling better community support to psychologically vulnerable populations, and the potential of building suicide prevention interventions following high-profile suicides.

The Press Coverage of Celebrity Suicide and the Development of Suicide Frequencies in Germany

The existence of the so-called “Werther effect” is well confirmed, and there are several recommendations on how the media should (not) report suicide to minimize the risk of copycat behavior. Unfortunately, very little is known about how suicide is actually reported. The article examines the German press coverage of six celebrity suicides with respect to compliance with guidelines on suicide reporting and analyzes changes in suicides in the wake of the reporting. It concludes that German media do not respect the recommendations in a substantial number of their articles. In addition, a significant increase in suicides and similar suicides is found.

Suicide contagion: a systematic review of definitions and research utility.

ObjectivesDespite the common use of contagion to analogize the spread of suicide, there is a lack of rigorous assessment of the underlying concept or theory supporting the use of this term. The present study aims to examine the varied definitions and potential utility of the term contagion in suicide-related research.Methods100 initial records and 240 reference records in English were identified as relevant with our research objectives, through systematic literature screening. We then conducted narrative syntheses of various definitions and assessed their potential value for generating new research.Results20.3% of the 340 records used contagion as equivalent to clustering (contagion-as-cluster); 68.5% used it to refer to various, often related mechanisms underlying the clustering phenomenon (contagion-as-mechanism); and 11.2% without clear definition. Under the category of contagion-as-mechanism, four mechanisms have been proposed to explain how suicide clusters occurred: transmission (contagion-as-transmission), imitation (contagion-as-imitation), contextual influence (contagion-as-context), and affiliation (contagion-as-affiliation). Contagion-as-cluster both confounds and constrains inquiry into suicide clustering by blending proposed mechanism with the phenomenon to be studied. Contagion-as-transmission is, in essence, a double or internally redundant metaphor. Contagion-as-affiliation and contagion-as-context involve mechanisms that are common mechanisms that often occur independently of apparent contagion, or may serve as a facilitating background. When used indiscriminately, these terms may create research blind spots. Contagion-as-imitation combines perspectives from psychology, sociology, and public health research and provides the greatest heuristic utility for examining whether and how suicide and suicidal behaviors may spread among persons at both individual and population levels.ConclusionClarifying the concept of “suicide contagion” is an essential step for more thoroughly investigating its mechanisms. Developing a clearer understanding of the apparent spread of suicide-promoting influences can, in turn, offer insights necessary to build the scientific foundation for prevention and intervention strategies that can be applied at both individual and community levels.

Predictors of suicides occurring within suicide clusters in Australia, 2004–2008

A number of studies have investigated the presence of suicide clusters, but few have sought to identify risk and protective factors of a suicide occurring within a cluster. We aimed to identify socio-demographic and contextual characteristics of suicide clusters from national and regional analyses of suicide clusters. We searched the National Coroners Information System for all suicides in Australia from 2004 to 2008. Scan statistics were initially used to identify those deaths occurring within a spatial-temporal suicide cluster during the period. We then used logistic regression and generalized estimation equations to estimate the odds of each suicide occurring within a cluster differed by sex, age, marital status, employment status, Indigenous status, method of suicide and location. We identified 258 suicides out of 10,176 suicides during the period that we classified as being within a suicide cluster. When the deceased was Indigenous, living outside a capital city, or living in the northern part of Australia (in particular, Northern Territory, Queensland and Western Australia) then there was an increased likelihood of their death occurring within a suicide cluster. These findings suggest that suicide clustering might be linked with geographical and Indigenous factors, which supported sociological explanations of suicide clustering. This finding is significant for justifying resource allocation for tackling suicide clustering in particular areas.

Associations between film preferences and risk factors for suicide: an online survey.

Several studies indicate that exposure to suicide in movies is linked to subsequent imitative suicidal behavior, so-called copycat suicides, but little is currently known about whether the link between exposure to suicidal movies and suicidality is reflected in individual film preferences. 943 individuals participated in an online survey. We assessed associations between preferred film genres as well as individual exposure to and rating of 50 pre-selected films (including 25 featuring a suicide) with suicidal ideation, hopelessness, depression, life satisfaction, and psychoticism. Multiple regression analyses showed that preferences for film noir movies and milieu dramas were associated with higher scores on suicidal ideation, depression and psychoticism, and low scores on life satisfaction. Furthermore, preferences for thrillers and horror movies as well as preferences for tragicomedies, tragedies and melodramas were associated with higher scores of some of the suicide risk factors. There was also a dose-response relationship between positive rating of suicide films and higher life satisfaction. Due to the cross-sectional design of the study causality cannot be assessed. Individual film genre preferences seem to reflect risk factors of suicide, with film genres focusing on sad contents being preferred by individuals with higher scores on suicide risk factors. However, suicide movies are more enjoyed by viewers with higher life satisfaction, which may reflect a better ability to cope with such content.

Space-time suicide clustering in the community of Antequera (Spain)

Approximately 3,500 people commit suicide every year in Spain. The main aim of this study is to explore if a spatial and temporal clustering of suicide exists in the region of Antequera (Málaga, España). Sample and procedure: All suicides from January 1, 2004 to December 31, 2008 were identified using data from the Forensic Pathology Department of the Institute of Legal Medicine, Málaga (España). Geolocalisation. Google Earth was used to calculate the coordinates for each suicide decedent's address. Statistical analysis. A spatiotemporal permutation scan statistic and the Ripley's K function were used to explore spatiotemporal clustering. Pearson's chi-squared was used to determine whether there were differences between suicides inside and outside the spatiotemporal clusters. A total of 120 individuals committed suicide within the region of Antequera, of which 96 (80%) were included in our analyses. Statistically significant evidence for 7 spatiotemporal suicide clusters emerged within critical limits for the 0-2.5 km distance and for the first and second semanas (P<.05 in both cases) after suicide. There was not a single subject diagnosed with a current psychotic disorder, among suicides within clusters, whereas outside clusters, 20% had this diagnosis (X2=4.13; df=1; P<.05). There are spatiotemporal suicide clusters in the area surrounding Antequera. Patients diagnosed with current psychotic disorder are less likely to be influenced by the factors explaining suicide clustering.

Newspaper coverage of suicide and initiation of suicide clusters in teenagers in the USA, 1988–96: a retrospective, population-based, case-control study

Public health and clinical efforts to prevent suicide clusters are seriously hampered by the unanswered question of why such outbreaks occur. We aimed to establish whether an environmental factor-newspaper reports of suicide-has a role in the emergence of suicide clusters. In this retrospective, population-based, case-control study, we identified suicide clusters in young people aged 13-20 years in the USA from 1988 to 1996 (preceding the advent of social media) using the time-space Scan statistic. For each cluster community, we selected two matched non-cluster control communities in which suicides of similarly aged youth occurred, from non-contiguous counties within the same state as the cluster. We examined newspapers within each cluster community for stories about suicide published in the days between the first and second suicides in the cluster. In non-cluster communities, we examined a matched length of time after the matched control suicide. We used a content-analysis procedure to code the characteristics of each story and compared newspaper stories about suicide published in case and control communities with mixed-effect regression analyses. We identified 53 suicide clusters, of which 48 were included in the media review. For one cluster we could identify only one appropriate control; therefore, 95 matched control communities were included. The mean number of news stories about suicidal individuals published after an index cluster suicide (7·42 [SD 10·02]) was significantly greater than the mean number of suicide stories published after a non-cluster suicide (5·14 [6.00]; p<0·0001). Several story characteristics, including front-page placement, headlines containing the word suicide or a description of the method used, and detailed descriptions of the suicidal individual and act, appeared more often in stories published after the index cluster suicides than after non-cluster suicides. Our identification of an association between newspaper reports about suicide (including specific story characteristics) and the initiation of teenage suicide clusters should provide an empirical basis to support efforts by mental health professionals, community officials, and the media to work together to identify and prevent the onset of suicide clusters. US National Institute of Mental Health and American Foundation for Suicide Prevention.

Improving our understanding of youth suicide clusters

Improving our understanding of youth suicide clusters

Grief and attitudes toward suicide in peers affected by a cluster of suicides as adolescents.

Eighty-five young adults exposed to a cluster of peer suicides as adolescents completed measures of attitudes toward suicide, grief, and social support. Closeness to the peers lost to suicide was positively correlated with grief and the belief that suicide is not preventable, with grief further elevated in close individuals with high social support from friends. Overall, social support was related to healthy attitudes about suicide including preventability, yet it was also related to some stigmatizing beliefs. Compared with 67 young adults who had not been exposed to a suicide cluster, the exposed sample was more likely to think that suicide is normal but more likely to think of it as incomprehensible.

PTSD Symptom Clusters Are Differentially Associated with Components of the Acquired Capability for Suicide

Previous research has established the link between posttraumatic stress disorder (PTSD) and suicidal behavior. In the current study, constructs proposed to explain this relationship were examined, applying the framework of the interpersonal-psychological theory of suicide (IPTS). Relationships between acquired capability for suicide (ACS; i.e., fearlessness about death [FAD] and pain tolerance) and specific PTSD symptom clusters were explored. In a sample of 334 trauma-exposed undergraduates, anxious arousal and FAD were negatively associated, and numbing and pain tolerance were positively associated. Results establish a foundation for investigating the role of ACS in understanding observed relationships between suicidal behavior and PTSD symptoms.