A suburban school systewas saddened when its third student in several months died by suicide. The superintendent shared the most recent tragedy at a meeting with other local superintendents and was startled to learn that across four neighboring districts, nine teenagers had died by suicide in the last 18 months. Were they in the midst of a suicide cluster? If so, how could they stop it? Did these teens all know each other? How will further deaths be prevented? Who is most at risk?
Teenagers are the age group most susceptible to imitating suicidal behavior, and a plethora of significant research has shed light on the very real problem of contagion often not recognized by communities due to lack of awareness or desire to face the problem. How to identify those who may be most vulnerable in the aftermath of a suicide and how to address their needs are key. Postvention, or intervention done after a suicide to provide support to friends and family, when conducted properly leads to prevention. Administrators should review the extensive postvention literature prior to a tragedy and remember that no single entity or agency working alone is likely to stop a suicide cluster.
Suicide clusters account for 100-200 deaths annually, according to the Centers for Disease Control and Prevention (CDC). A suicide cluster is defined as multiple deaths by suicide that occur within a defined geographical area and fall within an accelerated time. These clusters consist of more than three victims, typically ranging from 13 to 24 years old, and occur within approximately a one-to-two-year period. Contagion is the process in which the death by suicide of an individual influences an increase in the suicides of others. Exposure to another individual’s suicide—assuming temporal, geographic and interpersonal proximity are involved—can precipitate imitative suicidal behavior.
- Develop a comprehensive plan to address suicides, one that involves various sectors of the community, including educational facilities, mental and public health agencies, crisis intervention centers, local government, police, clergy, media, survivor groups and local academic resources.
- Select a crisis team that identifies high-risk individuals, provides specific recommendations for schools, and conducts its work without sensationalism.
- Understand the “circles of vulnerability” in order to identify those most at risk after a suicide has occurred in the community. Circles of vulnerability include individuals who:
- Had a negative interaction with the victim shortly before the suicide occurred and who perhaps even encouraged it
- Were in a suicide pact but backed out at the last minute
- Realize now that they missed obvious warning signs of suicide
- Were suicidal at another time, regardless of whether they had known the victim
- Have mental health problems
Many schools that have experienced a cluster have not only trained all staff to better identify at-risk students but have partnered with local mental health personnel and implemented depression screening programs such as Teen Screen and Signs of Suicide.
Additionally, media coverage is now recognized as a factor in increasing contagion. Districts can influence the media by encouraging the limiting of coverage of the suicide, refraining from specifics on the method, and avoiding simplistic and romantic explanations. The media can be of further assistance by focusing on warning signs of suicide and sources of assistance available in the community.
Scott Poland is the Prevention Division director for the American Association of Suicidology. He has helped many school systems and communities respond to the tragedy of youth suicide. Aaron Hamann, a doctoral candidate at Nova Southeastern University, contributed to this article.