PEDIATRIC SCHOOL PSYCHOLOGY
The Morbidity and Mortality Weekly Report published by the Centers for Disease Control (CDC, 2007) reported that in 2004, suicide was the third leading cause of death among 10- to 24-year olds and accounted for 4,599 deaths. From 2003 to 2004, suicide rates of females age 10-14 years and 15-19 years and males age 15-19 years increased significantly. The CDC advisedfederal and state agencies along with various health authorities to aim suicide prevention initiatives specifically at these groups. The U.S. Department of Health and Human Services (2002) reported that within a 12-month period, approximately 19% of teens seriously consider attempting suicide, 15% formulate a suicide plan, 9% actually attempt suicide, and 2.6% of adolescents' suicide attempts are so serious that they require emergency medical treatment. Based on these rates, about 2 million suicide attempts by adolescents occur per year.
The aim of this article is to investigate how several forms of media (newspapers, television, and the Internet) can influence the suicidality of teenagers who are predisposed to this type of ideation. Currently, there is no research asserting that suicide is caused by any type of newspaper report, television program (either real or fictional), or movie. Our objective was to identify specific characteristics of media accounts that tend to precede increases in the suicide rates of a particular community or region. In other words, can a media report or depiction of suicide actually induce a copycat effect or suicide contagion on predisposed adolescents?
This question is important because children and adolescents appear to be particularly vulnerable to outside influences, media included (Hawton 8c Williams, 2001). Compared to other age groups, the relative risk of suicide was 2 to 4 times higher among 15- to 19-year-olds following exposure to someone else's suicide (Gould, Wallenstein, Kleinman, O'Carroll, 8c Mercy, 1990) . Adolescents report much higher rates of suicidal ideation than older individuals (Jamieson, Jamieson, & Romer, 2003). Furthermore, research in Germany identified significant imitation effects after the fictional televised railway suicide of a 19-year-old male. After the airing of this program, suicides by that same methodfor teenage males closest in age to the model increased by 147%. No effect, however, was observable for males over the age of 40 (Schmidtke & Hafner, 1988).
A recent Communiqué article examining an adolescent suicide cluster (Zenere, 2008) concluded that "a strong imitative contagion" was likely present between the suicides of five individuals ranging in age from 13 to 18. This case study also explored various factors (geographical proximity, psychosocial proximity, and population at risk) that increased the likelihood of suicide contagion.
Given these findings, depressed teenagers maybe more susceptible to media messages that speak directly to their psychological distress, glamorize suicide, or seek to martyr the victims of suicide.
FACTORS INFLUENCING SUICIDAL BEHAVIOR
One single factor rarely accounts for an individual's suicidal behavior (Hawton 8c Williams, 2001) . Some teenagers manifest psychological or physiological characteristics that, when presented along with environmental stressors, may predispose them to suicidal ideation and attempts (APA Online, 2008). Spirito and Esposito-Smythers (2006) describe suicidal behavior as emerging "from reciprocal relations among learned maladaptive cognition, behavior, and affective responses to stressors in adolescents with predisposing vulnerabilities" (p. 218). Such stressors typically involve interpersonal conflict or other negative life events combined with increasing severity of psychiatric symptoms. Severe depression is the most prev^ent characteristic of suicidal adolescents. Indeed' sisnificant psychiatric niness has been present in more than 9°/o of sui" cide victims of all ages at the time of their deaths. …