Ystgaard, Mette: Suicide among young people is it contagious?

Transcription

1 Ystgaard, Mette: Suicide among young people is it contagious? (First published in the Norwegian journal Suicidologi 1997, no. 3.) Occasionally we see newspaper headlines proclaiming "Suicide wave among young people in Finnmark" or "Suicide epidemics: growing number of young suicides in Aust-Agder". Such headlines shake us, primarily because young lives are lost and family and friends suffer. We also become afraid. Is it contagious? Are there more of them teetering on the brink? If such is the case, is there anything we who witness such a tragedy close up can do as friends, relatives, teachers or classmates something we can do to prevent others from following and taking the same way out? In a greater context, in what way could newspaper headlines and TV reports increase or reduce the danger of infection? We have clinical experiences in Norway that support the assumption that we occasionally witness something that is bigger than individual, independent suicides and suicide attempts. However, with the exception of one study, which due to method shortcomings does not draw certain conclusions (Riaunet et al. 1991), we have no research on this field in Norway. For this we must go abroad. Suicide and the media D.P. Phillips, the American sociologist, had already shown in the 1970s that sensationalism in a newspaper could increase the risk of suicides in the paper's catchment area (Phillips 1974). Later he and his collaborators documented a similar increase in suicides among young people after sensational stories on TV (Phillips and Carstensen 1986). This is a difficult and complex research field where the findings are often controversial. However, the findings have been supported by later independent studies which, while varying as to method, localization and the selection of variables, find similar support of the contagion hypothesis. In the former West Germany Schmidtke and Häfner (1989) described the impact of a six-episode TV series describing the sufferings of a young man. It showed in detail his route up to the moment he threw himself in front of a train and died. While intended as a suicide prevention information measure, the programme actually had the opposite effect. For a period of time after the programme an increase was shown in train suicides among young men, particularly among those who evidenced clear similarities with the TV character (Schmidtke and Häfner 1989). The findings from a large study in Vienna a few years later point in the same direction (Etzersdorfer et al. 1992). In Vienna there was a dramatic increase in subway suicides between 1984 and Then the figure dropped quite suddenly by 75%. This reduction came hard on the heels of a media halt on covering dramatic subway suicides. The change in attitude among reporters had come at the urging of the Austrian association for suicide prevention. They had drawn up guidelines for how the media should handle suicides a promising example of preventive efforts with a positive impact.

2 Local clusters A suicide cluster is taken to mean an uncommonly high number of suicides during a brief period of time within a restricted geographical area (Coleman 1987). Such clusters are described in various population groups and environments such as prisons, mental hospitals, the armed forces, local neighbourhoods and in school. However, researchers are often uncertain as to whether such time and place restricted clusters actually represent a genuine increase, i.e. whether the increase is larger that the occasional random increase. Findings from recent research show that this might be the case. Using comprehensive epidemiological studies of US suicide data for the period 1978 to 1984, Gould and his staff demonstrated significant increases of suicides restricted as to time and place, primarily among teenagers and adults (Gould et al. 1990). They estimated that 1% to 5% of suicides among young persons could be explained as pure contagion, i.e. they would not have happened if the persons in question had not been exposed to an contagious situation. Based on nationwide data from New Zealand they have later shown similar densities of suicide attempts among young persons (Gould et al. 1994). What is typical of a young person who is susceptible to infection? In a 1989 study Brent and his collaborators asked the question: what is typical of a young person who is easily swayed into committing suicidal acts by the suicidal behaviour of others? They carried out a study at a US high school immediately after two young men had committed suicide only a few days apart (Brent et al. 1989). A comprehensive survey was undertaken covering friendship ties, psychological functioning and suicidal behaviour among the students. At the school with students, seven attempted suicides and 23 students who had developed serious suicidal thoughts and plans were registered immediately after the two suicides. Seventy-five per cent of these 32 students suffered from serious mental problems (loss of a family member or broken families, depression, drugs or alcohol abuse, personality disorders and behavioural difficulties). Twenty-five per cent were close friends of one of the two deceased persons, and suffered less serious mental problems than the others. This might suggest that being a close friend in itself increases the risk of infection. These findings have been substantiated by other studies. Overall, there are strong indications that a high rate of known risk factors (such as mental problems, previous suicidal behaviour, drug and alcohol problems and loneliness), strong identification with the deceased and/or a close relationship to the deceased person increases the probability of contagion. Mechanisms of suicide contagion A tempting explanation of "suicide epidemics" is the imitation theory or the so-called Werther effect. This theory was initially introduced by Phillips in The name "Werther effect" stems from German author Goethe's story about the young, intelligent dreamer Werther, who shot himself for the sake of lost love. After the publication of this book, which became highly popular, many young men shot themselves, and the book was blamed for leading these highly impressionable young men to suicide. Imitation, reinforced by such matters as identification and suggestion,

3 is a common explanation today, supported, for example, by the fact that many "contagoin"suicides use the same method. Other infection mechanisms have also been discussed. For example, several researchers have wondered whether the frequent mention of suicide and the fact that it is so general in many contexts could make us more comfortable with and more ready to accept the concept of suicide as an idea? Contagion may be direct or indirect. Both suicidal conduct among friends and in the family and sensational suicides in the media lately also on the Internet, perhaps may trigger new suicides. There can also be many channels of infection in local clusters, from direct experience with the circumstances around a relevant suicide to fictitious or genuine stories told by others in the community or in the media. Kurt Cobain's suicide. The contagion that wasn't what can we learn? In 1994 the Seattle rock musician Kurt Cobain committed suicide. He was a cult figure and had many of the characteristics assumed to increase the risk of suicide among young and impressionable admirers. The report of his death made a huge splash in the media, shaking a whole generation of young people around the world. The danger of contagion was obvious. He had lived a difficult life, and in combination with his antifashion image he was an identification figure for many marginalized youths. Immediately after the news of his death D.A. Jobes and his staff initiated a study of the scope of any copycat suicides and analyzed how the news was handled in the media and elsewhere (Jobes et al. 1996). The data material showed that the expected Werther effect did not materialize. After a review of suicides in the age group in the aftermath only one suicide was identified as being triggered by Kurt Cobain's suicide. How could this unexpected outcome be explained? A number of factors have been suggested. Two days after Cobain died, a major memorial assembly was held in Seattle. The Seattle Crises Clinic used the opportunity to encourage grieving young people to not bottle up their grief, but to take care of and help each other and seek professional assistance if they needed it. Similar messages were repeated on a number of later occasions. Furthermore, the media displayed care and responsibility in their reporting. The recurrent theme in the media was the message that distinguished between the talented musician and his act. The general message went "great artist, great music... stupid act, don't do it!" His widow, Courtney Love, also supported this message by not only openly showing her grief, but also her anger that he committed suicide. Some precautions What does this knowledge mean for our practical day-to-day affairs? Initially it may be important to remind everyone that handling a suicide should comply with the same guidelines and action plans that apply to crisis management after sudden accidents and deaths in general. Such action plans should exist locally, adapted to schools and municipalities. Moreover, the following should be borne in mind:

4 Avoid romanticizing As with other unexpected accidents and deaths it is, needless to say, important to allow room for and help the grieving process. However, it is vital to avoid romanticizing. Showing respect for the deceased while at the same time avoiding hero worship and romanticizing of the suicide and its cause may occasionally be a difficult balancing act. It may be useful to bear in mind the importance of distinguishing between the act and the person. Focus attention on the life ahead for young people Many people may have a great need to speak about and recall the deceased person. However, it is also important that in the middle of their grief they should also be helped to focus on the joys and problems of their own lives and to think ahead. What can I do now that I feel so sad and lost? What can we do for each other? Can we improve on any of the negative circumstances that the suicide brought to light? Which good or enjoyable things can we build on? Be particularly aware of persons in the danger zone Special attention should be paid to young persons with major personal or social problems and those who were particularly close to the deceased person. It is very useful to have individual or group interviews as soon as possible after the death. Offer information about where assistance can be obtained and how to obtain assistance Recent research shows clearly that young persons are not very familiar with the assistance that is available. They do not use it to any great extent, and do not know what help there is or how to get into contact with relevant professionals. Assistance such as personal conversations should be made available to young persons in the period of time immediately after an event, and not the least specific and simple information must be provided as to where assistance can be found and what kind of help is available. Appoint one person to be in charge of media contact As general rule try to prevent media coverage. When this is not possible the information given should be kept to a minimum. About the author: Mette Ystgaard is an educational psychologist and Associate Professor at the Suicide Research and Prevention Unit. She has many years of experience from school psychology. Her research has particularly focused on suicide behaviour in a stresscoping perspective. She has published a number of scientific articles and chapters in textbooks.

5 Literature Brent DA, Kerr MM, Goldstein C, Bozigar J, Wartella M, Allan MJ. An outbreak of suicide and suicidal behavior in a high school. American Academy of Child and Adolescent Psychiatry 1989; Coleman L. Suicide Clusters. Boston MA: Faber & Faber, Etzersdorfer E, Sonneck G, Nagel-Kuess S. Newspaper reports and suicide. New England Journal of Medicine 1992; 327: Gould MS, Wallenstein S, Kleinman M. Time-space clustering of teenage suicide. American Journal of Epidemiology 1990; 131: Gould MS, Petrie K, Kleinman MH, Wallenstein S. Clustering of attempted suicide: New Zealand national data. International Journal of Epidemiology. 1994; 23: Jobes D. A, Berman AL, O'Carroll PW, Eastgard S, Knickmeyer S. The Kurt Cobain suicide crisis: Perspectives from research, public health and news media. Suicide and Life-threatening Behavior 1996; 26: Phillips D. P. The influence of suggestion on suicide: Substantive and theoretical implication of the Werther effect. American Sociological Review 1974; 39: Phillips DP, Carstensen LL. Clustering of teenage suicide after television news stories about suicide. New England Journal of Medicine 1986; Riaunet Å, Stiles TC, Rygnestad T, Bjerke T: Mass-media reports of suicide and suicide attempts, and the rate of parasuicide. In Bjerke T and Stiles TC. Suicide Attempts in the Nordic Countries. Trondheim: Tapir, Schmidtke A, Häfner H. Public attitudes towards an effect and mass media on suicide and deliberate selfharm. I RFW Diekstra. Suicide and its Prevention. The Role of Attitude and Imitation. Leiden: Brill, 1989;