Teen suicide: Prevention is contagious, too.
Teen suicide in the US continues at high rates, but the stories of lives saved often don't make headlines – and prevention experts are encouraged about progress in that direction.
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The subsequent decline could have been caused in part by increased mental-health treatment, experts say. Crisis hot lines were also established, and in recent years they have been migrating online and to texting formats to keep up with teen habits. Students in some schools have been offered screenings and referrals. "Gatekeepers" such as teachers and youth leaders have been trained, though not universally (18 states require suicide-prevention training for school personnel). Access to lethal means has been reduced – through more secure storage of firearms, for instance.Skip to next paragraph
Had such resources not been devoted to teen suicide prevention, the rate today could be much higher, says Madelyn Gould, a longtime youth-suicide researcher and professor of clinical epidemiology at Columbia University in New York. One can't know for sure because "you're not going to have a control group in an alternate universe," she says.
When a death becomes bigger than life
Lisa Schenke had a dress picked out for her son Tim's June 2008 graduation. In May, she wore it to his funeral.
Tim was a top student with a college scholarship in hand. He was a well-liked soccer player. But he was also depressed and tangled up with alcohol and drugs. He had undergone various treatments, and although he communicated very little with his parents in his later teen years, he had confided once to his mother that he wanted to die.
Ms. Schenke was deeply touched by the flowers, candles, T-shirts, and poems placed at the school and on the railroad tracks where Tim had stepped in front of a train. But after two more young men with ties to Tim's school, Manasquan High School in Monmouth County, N.J., died by suicide on train tracks within four months, "all the alarms really went off that this is becoming a contagion," she says.
Experts came in and explained that "the first two suicides might have been idealized," Schenke says, so from then on memorializing was kept to a minimum at the tracks, and police started watching out for vulnerable kids there.
It's problematic "if deaths are commemorated or memorialized in a way that the person's death becomes bigger than their life," says Maureen Underwood, clinical director of the Society for the Prevention of Teen Suicide (SPTS) in Freehold, N.J.
"I can remember seeing a suicide note from a 14-year-old girl saying, 'At least if I die they'll put a plaque up in the school hall with my name on it,' " Ms. Underwood says. That may seem "irrational," but the desire to be noticed can feed imitative behavior "for kids who are thinking about suicide and feel like their life isn't worth very much anyway."
SPTS's website offers guidelines for memorializing student deaths in ways that avoid contributing to contagion. Media guidelines have also been available for several decades, because research has shown that the way suicides are reported has an effect on contagion.
The contagion effect
When a student dies by suicide, the risk of contagion goes beyond just those who knew him or her personally.
Twelve- and 13-year-olds exposed to a schoolmate's suicide think about suicide at a rate approximately five times as high as peers who have not been exposed, and their attempt rates are affected at nearly the same level, according to a major study published this year in the Canadian Medical Association Journal. For 14-to-15-year-olds, those rates nearly triple, and for 16-to-17-year-olds, the rates roughly double. Even two years after a schoolmate's suicide, the rates remain elevated, though to a lesser degree.
Based on about 22,000 surveys of adolescents in Canada, the study controlled for various factors such as poverty and a history of mental illness. It was the first to look at contagion on such a broad scale, but other studies, including some in the US, have found significant effects from exposure to peer suicide.
The "dramatic" contagion effect is "relatively independent of other risk factors," says study coauthor Ian Colman, an epidemiology professor at the University of Ottawa. The one exception: a stronger effect for students who had experienced a major stressful event such as abuse or the death of a parent.