Suicide Contagion Research Articles

New research on media coverage of mental illness and suicide: implications for stigma, suicide mortality and social inclusion.

Abstract: IntroductionThe Werther effect is a phenomenon that has been demonstrated in the media. These media are being replaced by social media, the use of which has increased greatly over the decade especially among young people, allowing content to be streamed instantly and fostering connections around the world. At the same time, there is a deterioration in mental health among young people.ObjectivesTo know if there is a Werther effect on social networks, as well as to understand the relationship between this effect and social media. It was also wanted to know if the posts follow the guidelines for dealing with suicide if there are differences between types of social media and if this effect is observed after the death of celebrities.MethodsA systematic review was performed with analysis, data extraction and synthesis of the structured results following the PRISMA criteria.Results15 articles were included, 11 of which showed Werther effects on social media, while only 4 were unrelated. It was found that most publications did not follow the recommended guidelines. No differences were observed between social media, while a greater effect was observed when it was related to celebrity suicide.ConclusionsSocial media can act as a suicide support network, as it is a space where there is a risk of infection by normalizing suicide and treating it insecurely. However, it has also been shown that it can act as an agent of change and protection, as many public individuals on social media seek help and express their concerns. More studies are needed to know the magnitude of the Werther effect on social media and to know the potential benefits of talking about suicide if it is done safely.Disclosure of InterestNone Declared

Werther effect in the juvenile population. About a series of cases

IntroductionSuicide is currently one of the biggest public health problems, it is the third cause of death in the age group between 15 and 29 years (16.36% of young people who died in 2013). The ‘Werther effect’ refers to the mimetic behavior of the suicidal act, thus making reference to the controversial novel “The Sorrows of Young Werther” by Goethe, in 1774. The population most susceptible to this influence is the most vulnerable and ambivalent, such as they can be adolescents and young people, people with personality disorders and drug use. Durkheim considered that imitation was not due to the contagion effect of making suicides public, but to the social conditions of some places, which were what caused people to commit suicide.ObjectivesThe objective of the case is to expose the vulnerability to the imitation of suicidal behaviors of young people suffering from personality disorder and drug use.MethodsWe present the case of 4 young people between 18 and 21 years old (3 women and 1 man) from the same group of friends who, after the death by suicide of a 20-year-old boy, in the following 2 months, carried out suicidal behavior by taking medication they found at home and consumption of different drugs.ResultsThe two 21-year-old patients planned for the first month of the anniversary of the friend’s death, the intake of drugs and medication and leave a farewell note explaining the reasons. The patients required hospitalization in an acute mental health unit, one patient developed myocarditis secondary to toxins, during hospitalization they undergo psychotherapeutic treatment and are evaluated, leading to the diagnosis of Borderline Personality Disorder and Multiple Drug Use Disorder. The 20-year-old patient took medication on the anniversary month but did not require hospitalization. He underwent outpatient follow-up at a day hospital. During the therapeutic process, he was diagnosed with schizoid personality disorder. The 18-year-old patient required hospitalization for structured self-injurious ideation with a risk of acting out at 2 months, psychotherapeutic treatment was started and she was diagnosed with borderline personality disorder and harmful drug use. The 4 young people continue outpatient follow-up by both the community mental health unit and the addiction treatment center.ConclusionsWe observe in the series of cases exposed, the vulnerability of young people suffering from personality disorders and drug use to suicidal behavior, so risk factors for their prevention must be identified and continue working on adequate information of suicidal acts, whether completed or not, to avoid imitation phenomena. In all cases, suicide should not be seen as a desirable alternative and strategies to cope with difficulties and emotional management should be offered and promoted, especially in this young population that is still developing and is more vulnerable.Disclosure of InterestNone Declared

Geography, rurality, and community distress: deaths due to suicide, alcohol-use, and drug-use among Colorado Veterans

BackgroundIn the USA, deaths due to suicide, alcohol, or drug-related causes (e.g., alcohol-related liver disease, overdose) have doubled since 2002. Veterans appear disproportionately impacted by growing trends. Limited research has been conducted regarding the relationship between community-level factors (e.g., rurality, community distress resulting from economic conditions) and the presence of spatial clustering of suicide, alcohol-related, or drug-related deaths. We explored community-level relationships in Colorado Veterans and compared suicide, alcohol-, and drug-related death rates between the Colorado adult population and Veterans.Methods2009–2020 suicide, alcohol-related, and/or drug-related deaths were identified using qualifying multiple cause-of-death International Classification of Disease (ICD)-10 codes in CDC WONDER for the general adult population and Colorado death data for Veteran populations. Age and race adjusted rates were calculated to compare risk overall and by mortality type (i.e., suicide, alcohol-related, drug-related). In Veteran decedents, age-adjusted rates were stratified by rurality and community distress, measured by the Distressed Communities Index. Standardized mortality ratios were calculated to measure spatial autocorrelation and identify clusters using global and local Moran’s I, respectively.Results6.4% of Colorado Veteran deaths (n = 6948) were identified as being related to suicide, alcohol, or drugs. Compared to rates in the general population of Colorado adults, Veterans had 1.8 times higher rates of such deaths overall (2.1 times higher for suicide, 1.8 times higher for alcohol-related, 1.3 times higher for drug-related). Among Veterans, community distress was associated with an increased risk of alcohol-related [age-adjusted rate per 100,000 (95% CI) = 129.6 (89.9–193.1)] and drug-related deaths [95.0 (48.6–172.0)]. This same significant association was not identified among those that died by suicide. Rurality was not associated with risk for any of the deaths of interest. There was significant spatial clustering for alcohol-related deaths in southeast Colorado.ConclusionsColorado Veterans have higher rates of deaths due to suicide, alcohol-related, and drug-related causes compared to members of the general adult population. Upstream prevention efforts, such as community-based interventions targeting alcohol-use and community economic distress, are warranted. More research is also needed to understand how community distress and other social determinants of health impact the community burden of suicide, alcohol-related, and drug-related mortality.

Suicide among soldiers and social contagion effects: An interrupted time-series analysis

BackgroundSuicide has become an increasingly concerning problem among soldiers in recent years. Previous research has hypothesized that media-related social contagion effects, termed “Werther effects,” may contribute to military suicide numbers. Unfortunately, there is limited empirical knowledge on such social contagion effects in soldiers. We contribute to the literature by investigating this phenomenon in the context of a specific historical suicide case, allowing us to provide a longitudinal assessment: Crown Prince Rudolf, heir to the Imperial throne of the Austro-Hungarian Empire, who died by suicide in January 1889. His death was a well-known news story that shook the monarchy to its foundations. Notably, soldiers of the late nineteenth century were an especially vulnerable portion of the population, proven by the fact that the Austro-Hungarian military had one of the highest suicide rates at the time compared to other European countries. Methods and resultsAn interrupted time-series analysis, relying on annual military suicide rates between 1873 and 1910, indicated a significant increase in the suicide rate the year of Rudolf's death, a pattern consistent with a social contagion effect. In fact, time series analysis estimated that there were about 30 excess suicides per 100,000 population within the year of Rudolf's death. Additionally, we identified a substantial change in the trend after Rudolf's death, pointing to a long-term decrease in military suicide rates. The latter was not observed in the general population but appeared to be unique to soldiers. DiscussionAlthough we are very careful when interpreting causal effects with our historical data, we discuss the latter finding by questioning whether a change in military culture, that is, the establishment of better conditions for soldiers in the aftermath of Rudolf's suicide, contributed to decreasing suicide numbers. Although tentative, these findings are also highly relevant for the study of military suicide today.

Canadian news media coverage of suicide during the COVID-19 pandemic.

The COVID-19 pandemic led to concerns about increases in suicidal behaviour. Research indicates that certain types of media coverage of suicide may help reduce suicidality (the Papageno effect), while other types may increase suicidality (the Werther effect). This study aimed to examine the tone and content of Canadian news articles about suicide during the first year of the pandemic. Articles about suicide from Canadian news sources were collected and coded for adherence to responsible reporting of suicide guidelines. Articles which directly discussed suicidal behaviour in the COVID-19 context were identified and compared to other suicide articles in the same period. Lastly, a thematic analysis was conducted on the sub-sample of articles discussing suicide in the COVID-19 context. The sub-set of articles about suicide in the COVID-19 context (n = 103) contained significantly more putatively helpful content compared to non-COVID-19 articles (n = 457), such as including help information (56.3% Vs 23.6%), quoting an expert (68.0% Vs 16.8%) and educating about suicide (73.8% Vs 24.9%). This lower adherence among non-COVID-19 articles is concerning as they comprised over 80% of the sample. On the plus side, fewer than 10% of all articles provided monocausal, glamourized or sensational accounts of suicide. Qualitative analysis revealed the following three themes: (i) describing the epidemiology of suicidal behaviour; (ii) discussing self and communal care; and (iii) bringing attention to gaps in mental health care. Media articles about suicide during the first year of the pandemic showed partial adherence to responsible reporting of suicide guidelines, with room for improvement.

The Information Seeking Behaviors and Needs of Suicide Survivors During Bereavement

Abstract The suicide of one person impacts 60 people, known as suicide survivors. These survivors are at an increased risk for negative mental health outcomes including PTSD, suicidal ideation, and suicide contagion. Despite these consequences, there have not been any information science studies that have explored the information behaviors of people who have recently survived the suicide of a loved one. This article takes a unique approach in combining autoethnography with traditional survey research. One hundred and ninteen participants sourced from a private Facebook suicide bereavement group responded to a survey asking them about their information-seeking after a loved one committed suicide. The qualitative data were fragmented and grouped into like-responses and thematic codes that gave explanation to the research questions. These results are coupled with the author’s ethnographic recounting of a similar experience. Brenda Dervin’s sense-making is employed as the methodological lens through which the study is conducted. It is found that suicide survivors are highly unlikely to have their informational needs met. In the immediate aftermath of their loss, they are most likely to look for information related to the suffering of the deceased. As time passes, they begin to look for information about coping with their loss and preventing suicide of other people; either those close to them or in a larger community scale. Being a survivor motivated many participants to advocacy work. Finally, the author argues that the findings of this article should compel further research and the creation of information policy to aid survivors and prevent suicide contagion.

Space-time self-harm and suicide clusters in two cities in Taiwan.

Suicidal acts may cluster in time and space and lead to community concerns about further imitative suicidal episodes. Although suicide clusters have been researched in previous studies, less is known about the clustering of non-fatal suicidal behaviour (self-harm). Furthermore, most previous studies used crude temporal and spatial information, e.g., numbers aggregated by month and residence area, for cluster detection analysis. This study aimed to (i) identify space-time clusters of self-harm and suicide using daily incidence data and exact address and (ii) investigate the characteristics of cluster-related suicidal acts. Data on emergency department presentations for self-harm and suicide deaths in Taipei City and New Taipei City, Taiwan, were used in this study. In all-age and age-specific analyses, self-harm and suicide clusters were identified using space-time permutation scan statistics. A cut-off of 0.10 for the p value was used to identify possible clusters. Logistic regression was used to investigate the characteristics associated with cluster-related episodes. A total of 5,291 self-harm episodes and 1,406 suicides in Taipei City (2004-2006) and 20,531 self-harm episodes and 2,329 suicides in New Taipei City (2012-2016) were included in the analysis. In the two cities, two self-harm clusters (n [number of self-harm episodes or suicide deaths in the cluster]=4 and 8 in Taipei City), four suicide clusters (n=3 in Taipei City and n=4, 11 and 4 in New Taipei City) and two self-harm and suicide combined clusters (n=4 in Taipei City and n=8 in New Taipei City) were identified. Space-time clusters of self-harm, suicide, and self-harm and suicide combined accounted for 0.05%, 0.59%, and 0.08% of the respective groups of suicidal acts. Cluster-related episodes of self-harm and suicide were more likely to be male (adjusted odds ratio [aOR]=2.22, 95% confidence interval [CI] 1.26, 3.89) and young people aged 10-29years (aOR=2.72, 95% CI 1.43, 5.21) than their cluster-unrelated counterparts. Space-time clusters of self-harm, suicide, and self-harm and suicide combined accounted for a relatively small proportion of suicidal acts and were associated with some sex/age characteristics. Focusing on suicide deaths alone may underestimate the size of some clusters and/or lead to some clusters being overlooked. Future research could consider combining self-harm and suicide data and use social connection information to investigate possible clusters of suicidal acts.

Identifying spatial and temporal suicide clusters in a Californian county

Abstract Barriers to suicide cluster detection and monitoring include requiring advanced software and statistical knowledge. We tested face validity of a simple method using readily accessible household software, Excel 3D Maps, to identify suicide clusters in this county, years 2014–2019. For spatial and temporal clusters, respectively, we defined meaningful thresholds of suicide density as 1.39/km2 and 33.9/yearly quarter, defined as the 95th percentile of normal logarithmic and normal scale distributions of suicide density per area in each ZIP Code Tabulated Area and 24 yearly quarters from all years. We generated heat maps showing suicide densities per 2.5 km viewing diameter. We generated a one-dimensional temporal map of 3-month meaningful cluster(s). We identified 21 total population spatial clusters and one temporal cluster. For greater accessibility, we propose an alternative method to traditional scan statistics using Excel 3D Maps potentially broadly advantageous in detecting, monitoring, and intervening at suicide clusters.

Padrões espaciais e caracterização epidemiológica dos suicídios na microrregião de Chapecó, Santa Catarina: estudo ecológico, 1996-2018

to identify spatial clusters of suicide and its epidemiological characteristics in the Chapecó (SC) micro-region from 1996 to 2018. this was an exploratory ecological study, using data from the Mortality Information System; specific suicide rates and relative risks (RR) were calculated with a 95% confidence interval (95%CI); the scan statistic was used for spatial analysis. there were 1,034 suicides (13.7/100,000 inhabitants), with a male/female ratio of 3.79; the ≥ 60 age group was at higher risk for both sexes; a high risk cluster was found in the southwest region (RR = 1.57) and a low risk cluster in the southeast region, including Chapecó itself (RR = 0.68); risk of suicide among widowed (RR = 3.05; 95%CI 1.99;4.67), separated (RR = 2.48; 95%CI 1.44;4.27), and married (RR = 1.97; 95%CI 1.54;2.51) people was higher than among single people. The main methods were hanging (81.2%) and firearms (9.7%). there was a higher risk of suicide in the elderly, male and widowed people. Hanging was the most frequent method and risk clustering was found in the southwest.

Interventions during the copycat suicide crisis among Thai students: A follow-up study

Interventions during the copycat suicide crisis among Thai students: A follow-up study

Reach and perceived effectiveness of a community-led active outreach postvention intervention for people bereaved by suicide.

Postvention is a core component of suicide prevention strategies, internationally. However, the types of supports provided to people impacted by suicide vary widely. This study examines the perceived effectiveness of the Primary Care Navigator (PCN) model for people bereaved by suicide. The PCN model was implemented in response to a suicide cluster. It is an active outreach postvention intervention, initiated by police in response to a suspected suicide and links individuals to support in the immediate aftermath of their loss. A retrospective cross-sectional mixed methods approach was used to (1) identify the reach of the PCN model, (2) describe the type of support provided to people bereaved by a suspected suicide and (3) identify the perceived effectiveness of the PCN model from the perspective of WA police, postvention stakeholders and individuals bereaved by suicide. Quantitative data was used to examine the characteristics of suicide in the region, the characteristics of people who received bereavement support, and the types of support that were provided. Interviews with police, postvention stakeholders, and people bereaved by a suspected suicide were conducted to identify the perceived effectiveness of the intervention. Between 1 January 2019 and 31 March 2021 there were 80 suspected suicides. Active outreach was provided to 347 bereaved individuals via the PCN model. Just under half of those who were offered outreach accepted further support (N = 164) in the form of suicide bereavement information (98%), mental health or clinical support (49.6%), specialized postvention counseling (38.4%), financial assistance (16%) and assistance with meals (16%), followed by housing assistance (14%) and referral to community services (11%). Police, stakeholders, and people with lived experience of a suspected suicide perceived the PCN model to be effective at connecting them to the community, linking people to support, and preventing suicide. The results provide evidence supporting the perceived effectiveness of an active outreach approach to postvention that provides acute support to people bereaved by suicide. Findings highlight important practical areas of support such as providing referral pathways and information on grief and suicide loss in the immediate aftermath of a suicide loss.

Hotel Suicides in Australia 2006-2017.

Background: This study investigated the frequency, characteristics, and geospatial clustering of hotel suicides in Australia to inform suicide prevention efforts. Aims: (1) To determine the proportion of suicide deaths that occurred in hotels, (2) to determine differences in demographic characteristics of hotel deaths compared to other locations, (3) to assess level of planning, and (4) to determine whether these deaths form geographic clusters amenable to targeted suicide prevention activities. Methods: Archival data on suicide mortality were used to examine associations between incident location (hotels, home, away from home), demographic characteristics, and suicide means. Kernel density visualization was used to assess geospatial clustering of hotel suicides, and the degree of planning involved was assessed using the modified Suicide Intent Scale. Results: Hotels accounted for 2% of all suicide deaths and 6.2% of suicides occurring away from home. Females were over-represented (p < .0001), as were deaths by drug overdoses (p < .0001) and falls (p < .0001). Approximately 40% of incidents occurred within seven geospatial clusters. 85% of those who died were state residents, with a median distance from home of 13.0 km. Most individuals checked in to the hotel alone, for short stays, and displayed a high degree of suicidal planning. Limitations: Coronial records had limited information on narrative circumstances of deaths; other indicators of risk may not have been identified. A comparison against a general population of hotel guests, rather than all other suicide deaths would be more useful in terms of preventative activities, however these data were not readily available. Conclusion: This study identified characteristics, behaviors, and geographic locations associated with hotel suicides to inform training of hotel staff to recognize and respond to signs of risk. Males of working age who live locally and arrive alone for short stays could be considered at a higher risk of suicide, and prevention efforts should be prioritized in the identified high-risk areas.

Suicide Reporting in the Nineteenth Century

During the nineteenth century, suicide rates rose substantially in many countries, including the geographic region of the present state of Austria. Sensational news reporting about suicides may have contributed to this rise by eliciting so-called copycat suicides, a phenomenon termed the ‘Werther effect.’ We conducted a large-scale content analysis of nineteenth-century suicide reporting (N = 14,638) to provide a descriptive account of the quality of suicide reporting back then. We found that much of the sensational reporting of the nineteenth century was characterized by presenting vivid details on the suicide method, specific location, and personal details, such as the deceased’s name, occupation, and exact address. To put these findings into context, we compared them to twenty-first-century suicide reporting (N = 300 articles). We found that the quality of reporting has improved since then, containing less Werther-effect-facilitative elements, however, the reports still fail to adhere to modern-day guidelines of responsible reporting.

News for life: improving the quality of journalistic news reporting to prevent suicides

AbstractDespite much theorizing on the quality of journalism, there is limited actual empirical evidence for the effects of improved news quality on societal outcomes. This study provides such evidence for suicide reporting. News quality especially matters in this domain, as low-quality reporting can elicit “copycat” suicides (Werther effect). We developed and disseminated a web-based campaign promoting high-quality suicide reporting, targeting newsrooms in Germany. Twenty-two newsrooms participated. A content analysis (N = 4,015 articles) provided supporting evidence for an increase in high-quality reporting (Study 1). Interrupted time series analyses offered tentative evidence for a reduction in actual suicides (Study 2). Acknowledging limitations in terms of causal interpretations, the findings support the claim that high-quality news can save lives. Similar newsroom interventions run elsewhere may contribute to preventing suicides globally. We discuss the implications, including those of a theoretically meaningful discovery related to the suicide-protective effect’s underlying mechanism, termed the dampening-the-spikes hypothesis.

COVID-19 en los barrios populares de dos ciudades argentinas

Abstract This paper presents a synchronic analysis of the diseases during the emergence of COVID-19, the management and impact of the lockdown, and how the media narrated these events in working-class neighborhoods of the metropolitan areas of Buenos Aires and Gran Resistencia from March to November 2020. We resorted to quantitative methods on secondary sources to describe poverty and syndemics and conducted week-by-week ethnographic and media research on 38 neighborhoods with water shortages and critical overcrowding. As a result, COVID-19 syndemically emerged with dengue, measles, and tuberculosis, and the preventive measures exacerbated institutional and gender violence, the Werther effect, and the neglect of other illnesses. Ethnography revealed syndemics with noncommunicable diseases and the influence of structural violence on health. The media analysis shows interest in the districts associated with the fear of contagion, but they disappear from the media agenda once dispelled.

COVID-19 in working-class neighborhoods of two Argentine cities.

This paper presents a synchronic analysis of the diseases during the emergence of COVID-19, the management and impact of the lockdown, and how the media narrated these events in working-class neighborhoods of the metropolitan areas of Buenos Aires and Gran Resistencia from March to November 2020. We resorted to quantitative methods on secondary sources to describe poverty and syndemics and conducted week-by-week ethnographic and media research on 38 neighborhoods with water shortages and critical overcrowding. As a result, COVID-19 syndemically emerged with dengue, measles, and tuberculosis, and the preventive measures exacerbated institutional and gender violence, the Werther effect, and the neglect of other illnesses. Ethnography revealed syndemics with noncommunicable diseases and the influence of structural violence on health. The media analysis shows interest in the districts associated with the fear of contagion, but they disappear from the media agenda once dispelled.

The Werther effect: adherence of Italian newspapers to the “reporting on suicide” recommendations

Abstract Background Reporting a case of suicide on a newspaper could lead to an emulation effect (Werther effect). It is important to report suicide cases by following specific recommendations implemented by World Health Organization (WHO). This study aimed to analyze articles published on Italian newspapers to quantify the adherence to the WHO recommendations in suicide report. Methods All the articles published in the three most important Italian newspapers from June 2019 to May 2020 that described one or more cases of suicide were included. Two researchers analyzed all the articles through an ad-hoc checklist, constructed on the basis of the WHO recommendations, that included 18 “negative” items (e.g. “presence of suicide-related words in the title”) and nine “positive” items (e.g. “the article reports the contacts of a suicide-prevention hotline”). For each negative item a “-1” point, and for each positive item a + 1 point, was assigned. Multivariable linear regressions were performed to identify factors related with a lower adherence to the WHO recommendations and with higher social engagement of the articles. Results A total of 110 articles were analyzed. In the 73% of the cases, the individual was male. The 14.5% of the suicide cases were homicide-suicide, while 9% were femicide-suicide. The median score of the checklist was -6 (IQR 3). Only 5% of the articles had at least one positive item. The word “suicide” (or related words) were present in 90% of the titles. Multivariable analyses showed that female suicides were associated with a higher score of the checklist (coeff 0.816, p = 0.039). No correlation was retrieved between the score of the checklist and the social media engagement of the articles included. Conclusions Italian newspapers do not follow WHO recommendations on how to report suicide cases, leading to a potential emulation effect. Public health professionals should raise decision makers’ and journalists’ awareness about the importance of these recommendations. Key messages • Since Italian newspapers are not compliant with the recommendations of the World Health Organization on how to report a suicide case, there is the risk of a potential emulation effect. • Specific training for journalists and other professionals in the field of communication should be implemented, to raise the awareness on the importance of the “reporting on suicide” recommendation.

Adolescents' Experiences With School-Based Postvention Services: Needs, Supports, and Recommendations.

This exploratory qualitative study of youth (N = 13) exposed to a peer's suicide death examined responses to the death and needed school-based responses and supports. Youth reported emotions including anger, grief, and fear, described suicide as a profound and impactful experience, and shared beliefs about entitlement to grief. Participants wanted schools to provide support for grief, to feel cared about by adults at school, to receive education about grief and suicide at school, and to have school-based opportunities to commemorate the deceased. Recommendations for schools include strategies for facilitating healthy grieving, supporting students, educating the community, and memorializing the deceased, while remaining cognizant of the need to prevent suicide contagion in the community.

The Blue Whale Challenge, Social Media, Self-Harm, and Suicide Contagion.

This report describes an adolescent with a history of self-injurious behavior who was hospitalized for suicidal ideation, who was inspired by the Blue Whale Challenge to engage in self-injurious behavior and post it on social media.

Spatial analysis of mental health and suicide clustering among older adults in North Carolina: An exploratory analysis

Late-in-life suicide is a major public health issue, with adults over 65 comprising 18% of all suicide deaths. Yet, little research has identified geographic concentrations of older populations at-risk for the psychological conditions in the pathway of suicide. This research identified spatial clustering of suicide, anxiety, depression, and self-injury among older adults in North Carolina from 2009-18 and the individual and area-level factors influencing high-risk clusters. Kulldorff's spatial scan statistic identified significant spatial clusters of suicides, using data collected from the violent death reporting system, and anxiety, depression and self-injury, using emergency department admissions data for older adults aged 65 years and over. Logistic regression and generalized estimating equations were used to examine the influence of multiple contextual variables (e.g., rural-urban commuting area codes, racial segregation) and compositional variables (e.g., race, insurance) within high-risk cluster locations. High-risk suicide, anxiety, and depression clusters were identified in the western and northwestern regions of the state, whereas self-injury clusters were predominantly located in central and southeastern North Carolina. Low-income communities were associated with a higher risk of clustering for all mental health outcomes, and primarily Black communities were associated with an increased risk of self-injury clustering. Findings can be applied to public policy to focus suicide prevention efforts on older adults, particularly in low-income communities in rural Appalachia and the central, southeastern portion of North Carolina.