Pathway of Contagion: The Identification of a Youth Suicide Cluster

By Zenere, Frank J. | National Association of School Psychologists. Communique, December 2008 | Go to article overview

Pathway of Contagion: The Identification of a Youth Suicide Cluster


Zenere, Frank J., National Association of School Psychologists. Communique


As a school psychologist and crisis management specialist for Miami-Dade County Public Schools, a member of the NASP National Emergency Assistance Team, and an independent consultant, I have provided postvention services following the suicides of over 50 students, including several suicide clusters. Providing assistance in the aftermath of a youth suicide requires a delicate and well-planned approach; responding to the occurrence of multiple youth suicides provides an even greater challenge for the school mental health professional. This article will provide the reader with information regarding the critical factors of influence that drive the process of contagion and thereby enhance the potential for imitative suicide among youth. Findings gleaned from a case study will also be reviewed.

The delivery of crisis response services in the aftermath of a youth suicide is referred to as suicide postvention, which is defined as "the provision of crisis intervention, support and assistance for those affected by a completed suicide (American Association or Suicidology, 1998, p.1). The goals of postvention include supporting the bereaved survivor, preventing imitative suicides by identifying other individuals at risk for self-destructive behavior and connecting them to intervention services, reducing survivor identification with the deceased, and providing long-term surveillance (Gould & Kramer, 2001).

Of primary concern following a youth suicide is the potential for contagion, defined as the process in which the suicidal behavior or suicide of an individual influences an increase in the suicidal behaviors or suicides of others (U.S. Department of Health & Human Services, 2008). Multiple suicidal behaviors or suicides that occur within a defined geographical area and fall within an accelerated time frame may represent a potential cluster (Berman & Jobes, 1994). It has been stated that a single adolescent suicide increases the risk of additional suicides within a community and may serve as a catalyst for the development of a cluster (Gould, Wallenstein, & Kleinman, 1990; Gould, Wallenstein, Kleinman, O'Carroll, & Mercy, 1990). Although suicide clusters are rare, they tend to be most prevalent among adolescents (Davidson, 1989; Phillips & Carstensen, 1986), accounting for 1%-5% of teenage suicides and 100-200 deaths annually (Gould, 2004). As part of her research, Gould (as cited in Joyce, 2008) identified 53 suicide clusters (defined as 3-11 victims ranging from 13-20 years of age who took their life within a 1-year period) in the United States.

CIRCLES OF VULNERABILITY

Some have argued that the singular exposure to the suicidal behavior of others does not result in imitative behavior, but that exposure must be linked with a predisposed vulnerability factor to determine contagion (Berman & Jobes, 1994). Suicide clusters have been viewed as the end result of a contagious disease in which vulnerable individuals connect to super-infect each other (Johansson, Lindqvist, & Eriksson, 2006) .This perspective can be further detailed by examining a community trauma assessment model titled "Circles of Vulnerability." This method, developed at the Community Stress Prevention Center in Kiryat Shmona, Israel (Lahad & Cohen, 2006), is utilized to determine the degree of emotional impact upon members of a community following the occurrence of a critical incident or disaster, and may be applied in assessing the impact of suicidal behavior or suicides on the greater community, as well as individuals. Circles of Vulnerability are best depicted as three intersecting circles representing cal proximity, psychosocial proximity, and population at risk.

Geographical proximity is defined as the physical distance a person is from the location of an incident, including eye witnesses to a suicide or those discovering or exposed to the immediate aftermath of the event. Extensive and repetitive media coverage serves to narrow this form of proximity, thus exposing more of the community to the potential deleterious effects associated with such accounts. …

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