The occurrence of time-space contagion/clusters was examined in national mortality data on suicide among adolescents aged 15–19 years obtained from the National Center for Health Statistics Mortality Detail Files for 1978–1984. The analyses indicated that overall significant time-space clustering occurred among 15–19 year olds. The authors thus believe that they have documented for the first time that outbreaks of suicide occur more frequently than expected by chance alone. The occurrence of suicide dusters among teenagers appeared to vary considerably by state and year of investigation. There is some indication that there has been an increase In teenage clusters in more recent years.

13 Reasons Why and Suicide Contagion - Scientific American
To talk or not to talk? The dilemma of suicide contagion
Are Suicidal Behaviors Contagious in Adolescence?: Using Longitudinal Data to Examine Suicide Suggestion*
The Contagion of Suicidal Behavior
The Science Behind Suicide Contagion
Copycat suicide- Wikipedia
Suicide Contagion and the Reporting of Suicide
Suicide contagion and social media: The dangers of sharing ‘Genie, you’re free’
Changes in suicide rates following media reports on celebrity suicide: a meta-analysis
Teen Suicide is Contagious, and the problem may be worse than we thought
What You Need to Know About Suicide Contagion
Suicide Contagion
Suicide Contagion Facts
Teen suicide is contagious, and the problem may be worse than we thought
An Outbreak of Suicide and Suicidal Behavior in a High School
Time-Space Clustering of Teenage Suicide
After Rash of Teen Suicides in Palo Alto, the CDC Sends Team to Investigate
Exposure to Suicide in the Community: Prevalence and Correlates in One U.S. State
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Are Suicidal Behaviors Contagious in Adolescence? Using Longitudinal Data to Examine Suicide Suggestion ($) American Sociological Review (2014) 79 (2): 211-227
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Deliberate Self-Harm at an Adolescent Unit: A Qualitative Investigation. ($) Clin Child Psychol Psychiatry (2004) 9 (2): 185-204
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Is Suicide Contagious? A Study of the Relation between Exposure to the Suicidal Behavior of Others and Nearly Lethal Suicide Attempts. (8 Pages) Am J Epidemiol (2001) 154 (2): 120-127
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Adolescent Suicide Clusters: Evidence, Mechanisms and Prevention. ($) Aust N Z J Psychiatry (1993) 27 (4): 653-665
Related topics:
Copy Cat Suicide, Teen Suicide, Warning Signs, Suicide, 741741 Crisis Text Line, Semicolon Campaign, '13 Reasons Why', Suicide 10-14 Year-Olds, Stigma, Guns, Mental Illness, Crisis Trends, Depression, Blue Whale Suicide Challenge, Online Depression Screening Test Secrets No More, , How to talk with your kids about suicide, Need to Talk?



Suicide contagion refers to the process whereby one suicide or suicidal act within a school, community or geographic area increases the likelihood that others will attempt or die by suicide. Suicide contagion can lead to a suicide cluster, where a number of connected suicides occur following an initial death

13 Reasons Why and Suicide Contagion - Scientific American

What science shows about the dangers of suicide depictions.

The Netflix series, 13 Reasons Why, has caused a furor. In the show, a high school student who has died by suicide has left 13 tapes, one for each person she believes have contributed in some way to her eventual decision. Each episode relates to an individual tape. The penultimate episode depicts the suicide in a gruesome manner. Some say the series is an accurate and sensitive portrayal of the inner angst of an individual that will help enlighten us as to the motivations behind suicidal behaviour and suicide itself. Such an openness can only be good and may be helpful to others in similar predicaments. Critics, though, have worried that it may glamorise suicide or normalise it as a legitimate option when dealing with interpersonal predicaments—leading to more suicides.

It is well known that suicide can be a contagious phenomenon. “Copycat” suicides are seen in local clusters from time to time. Any possible causes of such contagion should be taken seriously, but the science shows that the role that fiction can play in inspiring suicide is at best unclear. 13 Reasons Why is not the first work of fiction to be embroiled in this type of controversy. Shakespeare’s Romeo and Juliet has been accused of glamorising suicide. Johann Wolfgang von Goethe’s novel, The Sorrows of Young Werther, released in 1774, describes the pain and heartache experienced by Werther because of his affection for Charlotte, who eventually married Albert, Werther’s friend. Unable to cope, Werther decides that one of them must die and ends up shooting himself with Albert’s pistol. It was widely believed that von Goethe’s work led to a wave of young men deciding to end their lives all over Europe, many of whom were dressed in the same clothing as von Goethe’s description of Werther and using similar pistols. Some even had the copies of the novel beside their bodies with the page opened to the page of the suicide scene. The suicide researcher, David Phillips, coined the term, “The Werther Effect,” to refer to the phenomenon of copycat suicides. The result of Phillips’ research from the 1970’s was the recommendation that stories about suicide not be placed on the front page of newspapers.

In Vienna of the 1980’s, a spate of subway suicides was combatted by the city’s main newspapers’ decision to substantially curtail the publicity surrounding these deaths. After a certain date, these suicides were no longer mentioned. This coincided with a progressive fall in the number of subway suicides illustrating the power for good of the media.

Counteracting the Werther Effect, though, is the Papageno Effect, taking its name from the character, Papageno in Mozart’s Opera The Magic Flute. Papageno tries to hang himself after he’s convinced that he will never win over his love, Papagena. He is persuaded, though, by 3 child-spirits not to end his life.

Research has shown that excessive media coverage of suicides of celebrity figures actually has led to an increase in suicide attempts and ideation. Women in their 30’s were more at risk of suicide after Marilyn Monroe’s death in 1962. Suicide experts King-wa Fu and Paul Yip examined the impacts of the deaths of 3 Asian celebrities on suicide using a time series analysis comparing the deaths in the weeks before and after the suicide. They found a substantial rise in the number of suicides in the first, second and third weeks after the death of each celebrity in Hong Kong, South Korea and Taiwan compared to a reference period. This was even more the case with people of the same gender as the celebrities.

However, the research evidence in relation to fictional portrayals of suicide in TV and film is more complicated. Pirkis and colleagues reviewed the literature regarding film and television drama portrayals of suicide. The group was unable to offer conclusive answers to questions surrounding the impact of fictional suicides on actual suicidal outcomes in the general population.

Studies attempting to assess the effect of broadcasting an episode of the British soap, Eastenders, on March 2nd, 1986 have been conducted. This episode featured an attempted overdose by a female character in her 30’s. The studies attempted to assess the attendance at emergency departments in the UK before and after the episode. Some of the studies provided evidence for a copycat effect, but some did not. Mixed findings were reported in others. Therefore, it just cannot be concluded whether fictional portrayals of suicidal behaviour on film and television increase its incidence in the population. While it is certainly true that over-the-top media representations of suicide of celebrity-type figures will have a copycat effect, it does appear that the public at large are able to distinguish fact from fiction.

Nevertheless, we should be aware of the Werther and Papageno Effects. It is difficult to see how the fictional portrayal of suicide in an explicit manner could have a positive effect in any way unless, of course, the downsides of suicide in terms of its effect on relatives and friends are also strongly portrayed. From a deterrent perspective, the gruesome nature of the suicide itself may be a positive feature, and the same could be said of the adverse effects on the survivors. However, the message that suicide can have simple, or a simple set, of causes, or that suicide represents some type of solution, is unfortunate. There is never one reason why, or even thirteen.

To talk or not to talk? The dilemma of suicide contagion

In recent years, research has shown that suicide has the potential to spread through social networks – phenomenon some have dubbed “suicide contagion.”

Sophisticated, diverse statistical modeling techniques have largely reached the same conclusion: if someone is exposed to the suicide attempt or death of a friend, it increases that person’s risk of suicidal thoughts and attempts.

The consequences can be devastating for families, classmates and townspeople, who are left struggling to understand why clusters of suicides are occurring in their communities, from Newton, Massachusetts to Palo Alto, California.

It’s a challenging question that scientists have struggled to answer for decades. The role of suicide contagion is perhaps one of the least understood aspects of suicide, which puts us at a significant disadvantage when it comes to designing effective strategies to prevent the spread of suicides.

For this reason, in our recent study, we examined adolescents. We wanted to know whether or not knowledge of a friend’s suicide attempt would change someone’s own risk of attempting suicide.

Using longitudinal data, we discovered that adolescents who know about a friend’s suicide attempt are nearly twice as likely to attempt suicide one year later. Youth who lose a friend to suicide are at an even higher risk. Interestingly, adolescents whose friends didn’t tell them about their suicide attempts didn’t experience a significant increase in their risk of suicide one year later.

Our study has several interesting implications for suicide prevention.

First, experiencing the suicide attempt or death of a friend appears to change adolescents’ risk profile in a meaningful way. We’re all exposed to suicide at some point, whether it’s through reading Romeo and Juliet or simply watching the news. But exposure to a friend’s suicide attempt or death appears to transform the distant idea of suicide into something very real: a meaningful, tangible cultural script that youth may follow to cope with distress.

Second, following the old adage “birds of a feather flock together,” some have argued that depressed teens may simply befriend one another, which explains why groups of friends have similar suicide rates (and which contradicts the theory of suicide contagion).

However our findings add to the literature indicating that suicide contagion is not merely a product of adolescents choosing friends who are similarly vulnerable to suicide. If contagion didn’t matter, knowledge about suicide attempts shouldn’t matter either. Rather, it’s apparent that only if youth know about their friend’s suicide attempt does their suicide risk spike.

So what do we do with this knowledge?

It’s clear that suicide is not simply a product of psychological illness or psychological risk factors. Exposure to suicide, even if it’s just an attempt, is emotionally devastating, and youth need support when coping with the complex emotions that follow. Here, prevention – or, as it’s sometimes called, “postvention strategies” – becomes crucial.

One clear implication of our work is that during screenings for suicide risk, youth should always be asked whether or not they’ve known someone who has attempted or died by suicide. In fact, many reliable tools (202 page PDF) for screening youth for suicide include questions about exposure to suicide.

This seems reasonable. But then things get murky.

Given what our research has shown, it’s only natural to wonder whether or not someone who has attempted suicide should be discouraged from talking about it. There’s the fear that if we talk about suicide, we may be inadvertently promoting it.

At the same time, if we encourage people to not talk about suicide – particularly young people – we might miss opportunities to help those who are suffering and contemplating taking their own lives.

Furthermore, feeling like you belong to a group – supported by friends and family, having a healthy social life – is essential to preventing suicide. If we encourage young people to not talk about suicide, we may unintentionally increase suicidal adolescents’ feelings of isolation, which contributes to risk of suicide.

Because of the pervasive stigma of mental illness and suicide, it’s often very difficult for people to admit they need help. So instead of encouraging silence on the topic of suicide, it may be better to train adolescents how to respond appropriately when a friend discloses a suicide attempt or suicidal thoughts.

Luckily, evidence-based programs like Question, Persuade, Refer (QPR) and the SOS Signs of Suicide program exist. These can teach young people strategies for getting friends help from appropriate sources (incidentally, these programs are often offered in schools).

Additionally, it’s important for parents, teachers, and coaches to feel comfortable talking about suicide; they need to be well-versed in the proper responses, and realize that a suicide attempt can have a ripple effect that reverberates beyond the individual.

After all, it’s when adolescents are left alone to cope with their friends’ distress that they become most vulnerable to succumbing to the same suicidal ideation and behaviors.

The Science Behind Suicide Contagion

When Marilyn Monroe died in August 1962, with the cause listed as probable suicide, the nation reacted. In the months afterward, there was extensive news coverage, widespread sorrow and a spate of suicides. According to one study, the suicide rate in the United States jumped by 12 percent compared with the same months in the previous year.

Mental illness is not a communicable disease, but there’s a strong body of evidence that suicide is still contagious. Publicity surrounding a suicide has been repeatedly and definitively linked to a subsequent increase in suicide, especially among young people. Analysis suggests that at least 5 percent of youth suicides are influenced by contagion.

People who kill themselves are already vulnerable, but publicity around another suicide appears to make a difference as they are considering their options. The evidence suggests that suicide “outbreaks” and “clusters” are real phenomena; one death can set off others. There’s a particularly strong effect from celebrity suicides .

“Suicide contagion is real, which is why I’m concerned about it,” said Madelyn Gould, a professor of Epidemiology in Psychiatry at Columbia University, who has studied suicide contagion extensively.

She’s particularly concerned this week, after the high-profile death of the comedian and actor Robin Williams.

Suicide prevention advocates have developed guidelines for news media coverage of suicide deaths. The idea is to avoid emphasizing or glamorizing suicide, or to make it seem like a simple or inevitable solution for people who are at risk. The guidelines have been shown to make a difference: A study in Vienna documented a significant drop in suicide risk when reporters began adhering to recommendations for coverage.

That aim has to be weighed against a journalistic duty to keep the public informed. And in the Internet era, a person who wants to know details of a suicide won’t have a hard time finding them. Most of the research on suicide contagion predates the rise of social media.

Few of the experts’ recommendations make much sense in the case of Mr. Williams. Studies suggest avoiding repetitive or prominent coverage; keeping the word suicide out of news headlines; and remaining silent about the means of suicide. “How can it not be prominent?” Ms. Gould said.

Experts also say articles should include information about how suicide can be avoided (for instance, noting that the National Suicide Prevention Lifeline is available 24 hours a day at 800-273-8255). as is the Crisis Text Line 741741.

They also recommend avoiding coverage that describes death as an escape for a troubled person. One example was the 1994 death of Kurt Cobain of Nirvana, who was beloved among young music fans, including in Seattle, where his career rose and where he was found dead. Local coverage of his suicide was closely tied to messages about treatment for mental health and suicide prevention, along with a very public discussion of the pain his death caused his family. Those factors may explain why his death bucked the pattern. In the months after Mr. Cobain’s death, calls to suicide prevention lines in the Seattle area surged and suicides actually went down.

“It’s different from any other cause of death,” said Christine Moutier, the chief medical officer at the American Foundation for Suicide Prevention. “When someone dies of cancer or heart disease or AIDS, you don’t have to worry about messaging it wrong.”

The Contagion of Suicidal Behavior


Evidence has accumulated to support the idea that suicidal behavior is “contagious” in that it can be transmitted, directly or indirectly, from one person to another (Gould, 1990). This evidence is derived from three bodies of research: studies of the impact of media reporting on suicide, studies of suicide clusters, and studies of the impact on adolescents of exposure to a suicidal peer. In each case, suicide contagion can be viewed within the larger context of behavioral contagion or social learning theory. While research has also addressed the distinct but related topic of the contagion of nonsuicidal self-injurious behavior (Jacobson and Gould, 2009; Hawton et al., 2010; Whitlock, 2010), the current review focuses specifically on attempted and completed suicide.

Impact of Media Reporting on Suicide

Research into the impact of media stories about suicide has demonstrated an increase in suicide rates after both nonfictional and fictional stories about suicide. Most research in this area has addressed nonfictional reporting, which has been shown to have a more powerful effect (Stack, 2003). More than 50 studies on nonfictional stories reported in newspapers, on television, and more recently on the Internet, have yielded consistent findings. Suicide rates go up following an increase in the frequency of stories about suicide (e.g., Hagihara et al., 2007). Moreover, suicide rates go down following a decrease in the frequency of stories about suicide (e.g., Motto, 1970). A dose-response relationship between the quantity of reporting on completed suicide and subsequent suicide rates has consistently been demonstrated (e.g., Phillips, 1974; Phillips and Carstensen, 1986; Pirkis et al., 2006). Changes in suicide rates following media reports are more pronounced in regions where a higher proportion of the population is exposed (Etzersdorfer et al., 2004). The prevalence of Internet users, with access to Internet stories about suicide, has been associated with general population suicide rates in males, but not females (Hagihara et al., 2007; Shah, 2010).

The way suicide is reported is a significant factor in media-related suicide contagion, with more dramatic headlines and more prominently placed (i.e., front page) stories associated with greater increases in subsequent suicide rates (Phillips, 1974, 1979; Kuess and Hatzinger, 1986; Michel et al., 1995). Repetitive reporting on the same suicide and definitive labeling of the death as a suicide have also been associated with greater increases in subsequent suicide rates (Niederkrotenthaler et al., 2009, 2010). Content analyses of suicide newspaper reports from six countries with different suicide rates (Austria, Finland, Germany, Hungary, Japan, and the United States) found that attitudes toward suicide in newspaper reports varied by country, and that national suicide rates were higher in countries where media attitudes toward suicide were more accepting (Hungary) and suicide completers were more positively portrayed (Japan) (Fekete et al., 2001). Conversely, national suicide rates were lower in countries (Finland, Germany, and the United States) where reporting tended to portray the suicide victim and act of suicide in terms of psychopathology and abnormality, and to describe the negative consequences of the suicide. Moreover, media stories about individuals with suicidal ideation who used adaptive coping strategies to handle adverse events and did not attempt suicide have been negatively associated with subsequent suicide rates (Niederkrotenthaler et al., 2010).

The impact of media reporting on subsequent suicides is not monolithic, but interacts with characteristics of the reported suicide and characteristics of the media audience, as well as with characteristics of the media portrayal, as noted above. For example, celebrity suicides are more likely and the suicides of criminals are less likely to be followed by increased suicide rates (Stack, 2003; Niederkrotenthaler et al., 2009); individuals with a recent history of suicide attempt and/or a concurrent severe depression are more likely to attempt suicide in the wake of a media report (Cheng et al., 2007a,b).

Ecological studies of the impact of media on suicide rates, like those described above, meet four of Hill's five criteria for demonstrating causality (namely, consistency, temporality, strength of association, and coherence), but provide less convincing evidence of specificity (Hill, 1965; Gould, 1990; Insel and Gould, 2008). A handful of extant individual-level studies, however, have examined whether individuals who attempted suicide following a media story were exposed to and influenced by the media report, and have contributed evidence to support the specificity of the media effect. Hawton and colleagues (1999) conducted a study in emergency departments in the United Kingdom, examining the pattern of suicide attempts before and after a fictional Royal Air Force pilot took an overdose of paracetamol (i.e., acetaminophen) in an episode of a popular weekly TV drama. Presentations for self-poisoning increased by 17 percent in the week after the broadcast and 9 percent in the second week. Increases in overdoses using the specific drug used by the model were more marked than increases in other types of overdoses. The most compelling evidence of modeling from this study was that use of the specific drug for overdose among overdose patients who were viewers of the drama doubled after the episode in question, compared with overdose patients who were viewers of the drama prior to that episode. Twenty percent of the interviewed patients reported that the model had influenced their behavior. In a more recent study, 63 individuals who attempted suicide in Taipei, Taiwan, following the suicide of a young female pop singer were assessed for exposure to media reporting about her death. Forty-three (68 percent) respondents had been exposed to the media reporting, of whom 37 percent reported that the media stories influenced their suicide attempts (Chen et al., 2010). This study also demonstrated a positive modeling effect on the chosen method of suicide (burning charcoal inside a closed car), with an adjusted odds ratio of 7:3 (for additional evidence of a modeling effect based on choice of suicide method, see also Etzersdorfer et al., 2004; Cheng et al., 2007b; Chen et al., 2012).

Suicide Clusters

A suicide cluster is an excessive number of suicides occurring in close temporal and/or geographical proximity (Gould et al., 1989). Clusters occur primarily among teenagers and young adults, with between 1 percent and 5 percent of teen suicides occurring in clusters (Gould, 1990; Gould et al., 1990; Hazell, 1993). A case-control study of two teen suicide clusters in Texas indicated that the clusters included teens who had close personal relationships with others in the cluster, as well as teens from the same community who were not directly acquainted with one another (Davidson et al., 1989). When compared with matched living controls, suicide completers were more likely to have preexisting vulnerabilities (e.g., emotional illness, substance abuse problems, frequent changes of residence, recent or anticipated relationship break-up) that may have increased their susceptibility to suicide contagion.

It has been suggested that teen suicide clusters may result from the combination of assortative relating, the tendency for similar individuals (in this case, teens at high risk of suicide) to preferentially associate with one another, with shared life stress (Joiner, 2003). According to this argument, which should apply only to those teens within a suicide cluster who were directly acquainted with one another, teen suicides may cluster within a peer group because of high levels of preexisting vulnerability across the peer group, not because of suicide contagion. A recent study used agent-based computer simulation modeling to test this hypothesis and to explore the possible mechanisms behind suicide clustering (Mesoudi, 2009). As programmed in the simulation model, social learning was sufficient to generate suicide clusters localized both in time and space. The simulation model further found that assortative relating, also known as homophily, was likely to generate spatially localized suicide clusters among high-risk peer groups, but less likely to generate spatiotemporal suicide clusters and unlikely to generate purely temporal clustering of suicides. As the study's author notes, homophily seems to provide no reason why suicides should be clustered in time. Finally, the model confirmed that media effects, in combination with the effects of prestige and similarity biases, were capable of generating suicide clusters localized in time, but not space.

Even within spatiotemporal suicide clusters, where decedents are more likely to have direct contact with one another, media reporting on suicide can play a role. A recent analysis of the Foxconn suicides in China found support for a temporal clustering effect (Cheng et al., 2011). National (but not local) newspaper reporting on the suicides and the occurrence of a Foxconn suicide or suicide attempt were each associated with elevated chances of a subsequent suicide 3 days later, demonstrating the impact of both media-related contagion and direct contagion within the Foxconn company.

Impact on Adolescents of Exposure to a Suicidal Peer

Of 16 studies reviewed by Insel and Gould (2008) on the impact on adolescents of exposure to a suicidal peer, the majority found a significant association between exposure to the suicidal behavior of an adolescent peer and a subsequent adolescent suicide attempt. Odds ratios ranged from 2.8 to 11.0 for attempted suicide. Analysis of data on a nationally representative sample of U.S. high school students from the National Longitudinal Study of Adolescent Health (ADD Health) found that “teens who know friends or family members who have attempted suicide are about three times more likely to attempt suicide than are teens who do not know someone who attempted suicide” (Cutler et al., 2001). Girls were more likely to attempt suicide if they knew someone who had survived a suicide attempt, while boys were more likely to attempt suicide if they knew someone who had died by suicide. Teens who had not made a suicide attempt in wave one of the study were more likely to have attempted suicide in wave two if they knew someone who had attempted suicide in the interim; this temporal sequencing lends support for the role of contagion alongside the possible effect of assortative relationships among high-risk teens. In the context of exposure to the suicidal behavior of an intimate, contagion may operate via the impact on a vulnerable teen of stress or grief at the loss of a loved one, as well as via social learning about suicide.

Strategies to Prevent Suicide Contagion

A number of evidence-based interventions capable of combating suicide contagion have been developed. Studies have shown that it is possible to intervene to mitigate media-driven suicide contagion by implementing media guidelines for suicide reporting (Gould, 2001; Pirkis and Nordentoft, 2011). Media guidelines can interrupt the transmission of suicidality by identifying the types of media reporting through which suicidality is likely to be transmitted, and by modifying the volume and content of media reporting, with resultant decreases in suicide rates. For example, suicides in the Vienna subway system decreased by approximately 75 percent in 1987 following implementation of media guidelines for reporting on subway system suicides (Etzersdorfer et al., 1992). Applying media guidelines to new electronic media, including social networking websites, presents a new challenge to the suicide prevention community (Pirkis and Nordentoft, 2011; Robertson et al., 2012).

Screening for suicide risk can also interrupt the transmission of suicidality by identifying in advance individuals who may be susceptible to suicide contagion (Gould et al., 2009). In addition, suicide screening works to alleviate that susceptibility by enabling services to be directed to at-risk individuals identified by the screen. Key settings for suicide screening include schools and primary care practices. A range of school- and community-based psychosocial programs may also work to alleviate susceptibility to suicide contagion by, for example, changing adolescent peer norms through positive messaging (Wyman et al., 2010), or educating and empowering parents to communicate with teens (Toumbourou and Gregg, 2002). Finally, research suggests that coordinated postvention/crisis intervention efforts following a death by suicide may minimize and contain the effects of suicide contagion (Poijula et al., 2001; Hacker et al., 2008).


While the complex etiology of suicidal behavior is recognized (Gould et al., 2003), it has become increasingly apparent that suicide contagion exists and contributes to suicide risk along with psychopathology, biological vulnerability, family characteristics, and stressful life events. Strategies to prevent suicide contagion are essential and require ongoing evaluation.

Suicide contagion and social media: The dangers of sharing ‘Genie, you’re free’

On Monday night, as fans around the world began to grieve Robin Williams’s death, the Academy of Motion Picture Arts and Sciences — best known, in many circles, as the people behind the Oscars — sent out what may be the iconic social media image of Williams’s death.

More than 270,000 people have shared the tweet, which means that, per the analytics site Topsy, as many as 69 million people have seen it.

The problem? It violates well-established public health standards for how we talk about suicide.

“If it doesn’t cross the line, it comes very, very close to it,” said Christine Moutier, chief medical officer at the American Foundation for Suicide Prevention. “Suicide should never be presented as an option. That’s a formula for potential contagion.”

Moutier is referring to a well-documented phenomenon, better-known as “copycat suicide,” in which media coverage or publicity around one death encourages other vulnerable people to commit suicide in the same way. Adolescents are most at risk of suicide contagion; in recent years, groups like AFSP have also become particularly attentive to the role the Internet plays in romanticizing notorious or high-profile deaths, something it has long asked both the news and entertainment industries to avoid.

“The potential for online reports, photos/videos and stories to go viral makes it vital that online coverage of suicide follow site or industry safety recommendations,” one media guide reads. The corner of the Internet and interesting.

But in the hours since @TheAcademy’s tweet went viral, professionals like Moutier have become concerned that it doesn’t, in fact, follow established safety recommendations. The starry sky from Disney’s Aladdin, and the written implication that suicide is somehow a liberating option, presents suicide in too celebratory a light, Moutier said.

Now that media is social, however, and anyone can go viral, it’s more difficult to educate influencers on those issues. (It’s unclear who at the Academy sent the tweet, and the Academy did not respond to requests for further comment.) In either case, Moutier has some advice for organizations and individuals talking about Williams’s death online: Be sure to acknowledge that suicide has underlying issues — and those issues can be addressed. The focus, she adds, should be on his incredible life. It certainly shouldn’t celebrate or glorify how he died.

“A quarter of the population suffers from mental health issues that could potentially drive suicidal thoughts,” Moutier said. “This is a very important issue, from a public health standpoint, and one we need to bring to light.”

Copycat suicide - Wikipedia

A copycat suicide is defined as an emulation of another suicide that the person attempting suicide knows about either from local knowledge or due to accounts or depictions of the original suicide on television and in other media.

A spike of emulation suicides after a widely publicized suicide is known as the Werther effect, following Goethe's novel The Sorrows of Young Werther.[1]

The publicized suicide serves as a trigger, in the absence of protective factors, for the next suicide by a susceptible or suggestible person. This is referred to as suicide contagion.[2] They occasionally spread through a school system, through a community, or in terms of a celebrity suicide wave, nationally. This is called a suicide cluster.[2] Suicide clusters are caused by the social learning of suicide-related behaviors, or "copycat suicides". Point clusters are clusters of suicides in both time and space, and have been linked to direct social learning from nearby individuals.[3] Mass clusters are clusters of suicides in time but not space, and have been linked to the broadcasting of information concerning celebrity suicides via the mass media.[4]

To prevent this type of suicide, it is customary in some countries for the media to discourage suicide reports except in special cases.


One of the earliest known associations between the media and suicide arose from Goethe's novel Die Leiden des jungen Werthers (The Sorrows of Young Werther). Soon after its publication in 1774, young men began to mimic the main character by dressing in yellow pants and blue jackets. In the novel, Werther shoots himself with a pistol after he is rejected by the woman he loves, and shortly after its publication there were reports of young men using the same method to kill themselves in an act of hopelessness.[5]

This resulted in the book being banned in several places. Hence the term "Werther effect", used in the technical literature to designate copycat suicides.[6] The term was coined by researcher David Phillips in 1974, two centuries after Goethe's novel was published.[7]

Reports in 1985 and 1989 by Phillips and his colleagues found that suicides and other accidents seem to rise after a well-publicized suicide.[5]

Demographic factors

People who are young or old – but not middle-aged – seem to be most susceptible to this effect.[8]

Due to the effects of differential identification, the people who attempt to copy a suicidal act tend to have the same age and gender as the triggering suicide.[8]


These suicidal actions tend to happen in the days and sometimes weeks after a suicide is announced.[8] In exceptional cases, such as a widely discussed suicide by a celebrity, an increased level of thinking about suicide may persist for up to one year.[8]

Factors in suicide reporting

Copycat suicide is mostly blamed on the media. "Hearing about a suicide seems to make those who are vulnerable feel they have permission to do it," Phillips said. He cited studies that showed that people were more likely to engage in dangerous deviant behavior, such as drug taking, if someone else had set the example first.[3]

The Werther effect not only predicts an increase in suicide, but the majority of the suicides will take place in the same or a similar way as the one publicized. The more similar the person in the publicized suicide is to the people exposed to the information about it, the more likely the age group or demographic is to die by suicide. The increase generally happens only in areas where the suicide story was highly publicized.[5] Upon learning of someone else's suicide, some people decide that action may be appropriate for them as well, especially if the publicized suicide was of someone in a similar situation as them.

Publishing the means of suicides, romanticized and sensationalized reporting, particularly about celebrities, suggestions that there is an epidemic, glorifying the deceased and simplifying the reasons all lead to increases in the suicide rate. People may see suicide as a glamorous ending, with the young person or elderly person getting a lot of attention, lots of sympathy, and lots of national concern that they never got in life. The second possible factor is that vulnerable youth may feel like, "If they couldn't cut it, neither can I".[9] Increased rate of suicides has been shown to occur up to ten days after a television report.[10] Studies in Japan[11] and Germany[12] have replicated findings of an imitative effect. Etzersdorfer et al.[13] in an Austrian study showed a strong correlation between the number of papers distributed in various areas and the number of subsequent firearm suicides in each area after a related media report. Higher rates of copycat suicides have been found in those with similarities in race,[11] age, and gender[1] to the victim in the original report.

Stack[14] analyzed the results from 42 studies and found that those measuring the effect of a celebrity suicide story were 14.3 times more likely to find a copycat effect than studies that did not. Studies based on a real as opposed to fictional story were 4.03 times more likely to uncover a copycat effect and research based on televised stories was 82% less likely to report a copycat effect than research based on newspapers. Other scholars have been less certain about whether copycat suicides truly happen or are selectively hyped. For instance, fears of a suicide wave following the death of Kurt Cobain never materialized in an actual increase in suicides.[15] Furthermore, there is evidence for an indirect Werther effect, i.e. the perception that suicidal media content influences others which, in turn, can concurrently or additionally influence one person's own future thoughts and behaviors.[16] Similarly the researcher Gerard Sullivan has critiqued research on copycat suicides, suggesting that data analyses have been selective and misleading, and that the evidence for copycat suicides are much less consistent than suggested by some researchers.[17]

Many people interviewed after the suicide of a relative or friend have a tendency to simplify the issues; their grief can lead to their minimizing or ignoring significant factors. Studies show a high incidence of psychiatric disorders in suicide victims at the time of their death with the total figure ranging from 98%[18] to 87.3%[19] with mood disorders and substance abuse being the two most common. These are often undiagnosed or untreated and treatment can result in reductions in the suicide rate. Reports that minimize the effect of psychiatric disorders contribute to copycat suicides whereas reports that mention this factor and provide help-line contact numbers and advice for where sufferers may gain assistance can reduce suicides.[citation needed]

Social proof model

An alternate model to explain copycat suicide, called "social proof" by Cialdini,[20] goes beyond the theories of glorification and simplification of reasons to look at why copycat suicides are so similar, demographically and in actual methods, to the original publicized suicide. In the social proof model, people imitate those who seem similar, despite or even because of societal disapproval. This model is important because it has nearly opposite ramifications for what the media ought to do about the copycat suicide effect than the standard model does.[citation needed] To deal with this problem, Alex Mesoudi of Queen Mary University, London, developed a computer model of a community of 1000 people, to examine how copycat suicides occur. These were divided into 100 groups of 10, in a model designed to represent different levels of social organization, such as schools or hospitals within a town or state. Mesoudi then circulated the simulation through 100 generations. He found the simulated people acted just as sociologists' theory predicted. They were more likely to die by suicide in clusters, either because they had learned this trait from their friends, or because suicidal people are more likely to be like one another.[21]

Journalism codes

Various countries have national journalism codes which range from one extreme of, "Suicide and attempted suicide should in general never be given any mention" (Norway) to a more moderate, "In cases of suicide, publishing or broadcasting information in an exaggerated way that goes beyond normal dimensions of reporting with the purpose of influencing readers or spectators should not occur." The study's author, University of London psychologist Alex Mesoudi, recommends that reporters follow the sort of guidelines the World Health Organization and others endorse for coverage of any suicide: Use extreme restraint in covering these deaths—keep the word "suicide" out of the headline, don't romanticize the death, and limit the number of stories.[22] Photography, pictures, visual images or film depicting such cases should not be made public" (Turkey).[23] While many countries do not have national codes, media outlets still often have in-house guidelines along similar lines. In the United States, there are no industry-wide standards. A survey of in-house guides of 16 US daily newspapers showed that only three mentioned the word suicide, and none gave guidelines about publishing the method of suicide. Craig Branson, online director of the American Society of News Editors (ASNE), has been quoted as saying, "Industry codes are very generic and totally voluntary. Most ethical decisions are left to individual editors at individual papers. The industry would fight any attempt to create more specific rules or standards, and editors would no doubt ignore them."[23] Guidelines on the reporting of suicides in Ireland were introduced recently which attempt to remove any positive connotations the act might have (e.g. using the term "completed" rather than "successful" when describing a suicide attempt which resulted in a death).[citation needed]

The Canadian Broadcasting Corporation's journalistic standards and practices manual discourages the reporting of the details of suicide.[24]

Journalist training

Australia is one of the few countries where there is a concerted effort to teach journalism students about this subject. The Mindframe national media initiative[25] followed an ambivalent response by the Australian Press Council to an earlier media resource kit issued by Suicide Prevention Australia and the Australian Institute for Suicide Research and Prevention. The UK-based media ethics charity MediaWise provides training for journalists on reporting suicide and related issues.[26]

Headline is Ireland's media monitoring programme for suicide and mental health issues, set up by Shine and the Health Service Executives National Office for Suicide Prevention as part of 'Reach Out: National Strategy for action on Suicide Prevention.' Headline works with media professionals and students to find ways to collaborate to ensure that suicide, mental health and mental illness are responsibly covered in the media and provides information on reporting on mental health and suicidal behavior, literature and daily analysis of news stories. Headline also serves as a vehicle for the public to become involved in helping to monitor the Irish media on issues relating to mental health and suicide.


The Papageno effect is the effect that mass media can have by presenting non-suicide alternatives to crises. It is named after a lovelorn character, Papageno, from the 18th-century opera The Magic Flute. This character was contemplating suicide until other characters showed him a different way to resolve his problems.[8]

There is more research into the damage done by "irresponsible media reports" than into the protective effects of positive stories, but when newspapers refuse to publicize suicide events or change the way that they provide information about suicide events, the risk of copycat suicides declines.[8]


Examples of celebrities whose suicides have triggered suicide clusters include Ruan Lingyu, the Japanese musicians Yukiko Okada, Miyu Uehara and hide, and Marilyn Monroe, whose death was followed by an increase of 200 more suicides than average for that August month.[2] Another famous case is the self-immolation of Mohamed Bouazizi, a Tunisian street vendor who set himself on fire on December 17, 2010, an act that was a catalyst for the Tunisian Revolution and sparked the Arab Spring, including several men who emulated Bouazizi's act.

In fiction

Heathers, a 1989 black comedy film in which the murders of popular high school students disguised as suicides spur copycat suicide attempts.

Suicide Club, a 2002 Japanese horror film which revolves largely around a string of nationwide copycat suicides.

Tenth-season Supernatural episode "The Werther Project" features an invention called a Werther Box, which causes any who try to open it to release a magical force that propagates suicides within a short radius of the box.

See also

Copycat crime
Epidemiology of suicide
Herd behavior
Sati (practice)


1: a b Schmidtke A, Häfner H (1988). "The Werther effect after television films: new evidence for an old hypothesis". Psychol Med. 18 (3): 665–76. doi:10.1017/s0033291700008345. PMID 3263660.

2: a b c Halgin, Richard P.; Susan Whitbourne (January 2006). Abnormal Psychology with MindMap II CD-ROM and PowerWeb. McGraw-Hill. p. 62. ISBN 0-07-322872-9.

3: a b Golman, D (1987-03-18). "Pattern of Death: Copycat Suicides among Youths.". 1987. New York Times. Retrieved April 21, 2011.

4 Mesoudi, A (2009). "The Cultural Dynamics of Copycat Suicide.". PLoS ONE. 4 (9): e7252. doi:10.1371/journal.pone.0007252. PMC 2748702?Freely accessible. PMID 19789643.

5 a b c Meyers, David G. (2009). Social Psychology (10th Ed). New York: McGraw Hill. ISBN 978-0-07-337066-8.

6 "Preventing suicide: A report for media professionals" (PDF). World Health Organization. 2000. Retrieved 2007-06-09.

7^ De Wyze, Jeannette (2005-03-31). "Why Do They Die?". San Diego Reader. Retrieved 2008-02-05.

8: a b c d e f Sisask, Merike; Värnik, Airi (2017-01-04). "Media Roles in Suicide Prevention: A Systematic Review". International Journal of Environmental Research and Public Health. 9 (1): 123–138. doi:10.3390/ijerph9010123. ISSN 1661-7827. PMC 3315075?Freely accessible. PMID 22470283.

9 Mulvihill, G (2010). "Experts Fear Copycat Suicides After Bullying Cases. Experts fear a spate of copycat suicides after bullying cases grab national headlines.". ABC News. Retrieved April 21, 2011.

10 ^ Phillips, David P. (May 1982). "The Impact of Fictional Television Stories on U.S. Adult Fatalities: New Evidence on the Effect of the Mass Media on Violence". The American Journal of Sociology. 87 (6): 1340–59. doi:10.1086/227596.

11 to: a b Stack S (1996). "The effect of the media on suicide: evidence from Japan, 1955-1985". Suicide Life Threat Behav. 26 (2): 132–42. PMID 8840417.

12Jonas K (1992). "Modelling and suicide: a test of the Werther effect". Br J Soc Psychol. 31 (4): 295–306. doi:10.1111/j.2044-8309.1992.tb00974.x. PMID 1472984.

13 Etzersdorfer E, Voracek M, Sonneck G (2004). "A dose-response relationship between imitational suicides and newspaper distribution". Arch Suicide Res. 8 (2): 137–45. doi:10.1080/13811110490270985. PMID 16006399.

14 ^ Stack S (2002). "Media coverage as a risk factor in suicide". Inj. Prev. 8 Suppl 4: IV30–2. PMC 1765497?Freely accessible. PMID 12460954.

15 Jobes D.; Berman A.; O'Carroll P.; Eastgard S. (1996). "The Kurt Cobain suicide crisis: Perspectives from research, public health and the news media". Suicide and Life-Threatening Behavior. 26 (3): 260–271.

16 Scherr, S.; Reinemann, C. (2011). "Belief in a Werther effect. Third-Person effects in the perceptions of suicide risk for others and the moderating role of depression". Suicide and Life-Threatening Behavior. 41 (6): 624–634. doi:10.1111/j.1943-278X.2011.00059.x.

17 Sullivan, G. (2007). Should Suicide Be Reported in the Media? A Critique of Research. Remember me: Constructing immortality--Beliefs on immortality, life and death (pp. 149-158). New York, NY US: Routledge/Taylor & Francis Group.

18 Bertolote JM, Fleischmann A, De Leo D, Wasserman D (2004). "Psychiatric diagnoses and suicide: revisiting the evidence". Crisis. 25 (4): 147–55. doi:10.1027/0227-5910.25.4.147. PMID 15580849.

19 Arsenault-Lapierre G, Kim C, Turecki G (2004). "Psychiatric diagnoses in 3275 suicides: a meta-analysis". BMC Psychiatry. 4: 37. doi:10.1186/1471-244X-4-37. PMC 534107?Freely accessible. PMID 15527502.

20 Robert B. Cialdini (1993). Influence: the psychology of persuasion. New York: Morrow. p. 336. ISBN 0-688-12816-5.

21 Hamzelou, J (2009). "Copycat suicides fuelled by media reports.". Newscientist. Retrieved April 21, 2011.

22Franklin, D (2009). "Copycat Suicides: What's The Media's Role?". NPR. Retrieved August 1, 2015.

23: a b Norris, Bill; Mike Jempson; Lesley Bygrave (September 2001). "Covering suicide worldwide: media responsibilities" (PDF). The MediaWise Trust. Archived from the original (PDF) on 2007-06-14. Retrieved 2007-06-09.

24"Suicide". Journalistic standards and practices. CBC/Radio-Canada. Retrieved 2014-02-05.

25 "Reporting Suicide: Guidance for journalists". The MediaWise Trust, Spanish, French. Retrieved 2007-06-09.


Suicide Contagion and the Reporting of Suicide


In November 1989, a national workshop that included suicidologists, public health officials, researchers, psychiatrists, psychologists, and news media professionals was held to address general concerns about, and specific recommendations for, reducing the possibility of media-related suicide contagion. These recommendations, which are endorsed by CDC, outline general issues that public officials and health and media professionals should consider when reporting about suicide. These recommendations include a depiction of those aspects of news coverage that can promote suicide contagion, and they describe ways by which community efforts to address this problem can be strengthened through specific types of news coverage.


Suicide rates among adolescents and young adults have increased sharply in recent decades -- from 1950 through 1990, the rate of suicide for persons 15-24 years of age increased from 4.5 to 13.5 per 100,000 (1,2). In comparison with older persons, adolescents and young adults who commit suicide are less likely to be clinically depressed or to have certain other mental disorders (3) that are important risk factors for suicide among persons in all age groups (4). This has led to research directed at the identification of other preventable risk factors for suicide among young persons.

One risk factor that has emerged from this research is suicide "contagion," a process by which exposure to the suicide or suicidal behavior of one or more persons influences others to commit or attempt suicide (5). Evidence suggests that the effect of contagion is not confined to suicides occurring in discrete geographic areas. In particular, nonfictional newspaper and television coverage of suicide has been associated with a statistically significant excess of suicides (6). The effect of contagion appears to be strongest among adolescents (7,8), and several well publicized "clusters" among young persons have occurred (9-11).

These findings have induced efforts on the part of many suicide- prevention specialists, public health practitioners, and researchers to curtail the reporting of suicide -- especially youth suicide -- in newspapers and on television. Such efforts were often counterproductive, and news articles about suicides were written without the valuable input of well- informed suicide-prevention specialists and others in the community.

In November 1989, the Association of State and Territorial Health Officials and the New Jersey Department of Health convened a workshop * at which suicidologists, public health officials, researchers, psychiatrists, and psychologists worked directly with news media professionals from around the country to share their concerns and perspectives on this problem and explore ways in which suicide, especially suicide among persons 15-24 years of age, could be reported with minimal potential for suicide contagion and without compromising the independence or professional integrity of news media professionals.

A set of general concerns about and recommendations for reducing the possibility of media-related suicide contagion were developed at this workshop, and characteristics of news coverage that appear to foster suicide contagion were described. This report summarizes these concerns, recommen- dations, and characteristics and provides hypothetical examples of news reports that have high and low potential for causing suicide contagion (see Appendix).

General Concerns and Recommendations

The following concerns and recommendations should be reviewed and understood by health professionals, suicidologists, public officials, and others who provide information for reporting of suicide:

  • Suicide is often newsworthy, and it will probably be reported.

    The mission of a news organization is to report to the public information on events in the community. If a suicide is considered newsworthy, it will probably be reported. Health-care providers should realize that efforts to prevent news coverage may not be effective, and their goal should be to assist news professionals in their efforts toward responsible and accurate reporting.

  • "No comment" is not a productive response to media representatives who are covering a suicide story.

    Refusing to speak with the media does not prevent coverage of a suicide; rather, it precludes an opportunity to influence what will be contained in the report. Nevertheless, public officials should not feel obligated to provide an immediate answer to difficult questions. They should, however, be prepared to provide a reasonable timetable for giving such answers or be able to direct the media to someone who can provide the answers.

  • All parties should understand that a scientific basis exists for concern that news coverage of suicide may contribute to the causation of suicide.

    Efforts by persons trying to minimize suicide contagion are easily misin- terpreted. Health officials must take the time to explain the carefully established, scientific basis for their concern about suicide contagion and how the potential for contagion can be reduced by responsible reporting.

  • Some characteristics of news coverage of suicide may contribute to contagion, and other characteristics may help prevent suicide.

    Clinicians and researchers acknowledge that it is not news coverage of suicide per se, but certain types of news coverage, that promote contagion. Persons concerned with preventing suicide contagion should be aware that certain characteristics of news coverage, rather than news coverage itself, should be avoided.

  • Health professionals or other public officials should not try to tell reporters what to report or how to write the news regarding suicide.

    If the nature and apparent mechanisms of suicide contagion are under- stood, the news media are more likely to present the news in a manner that minimizes the likelihood of such contagion. Instead of dictating what should be reported, public officials should explain the potential for suicide contagion associated with certain types of reports and should suggest ways to minimize the risk for contagion (see Appendix).

  • Public officials and the news media should carefully consider what is to be said and reported regarding suicide.

    Reporters generally present the information that they are given. Impromptu comments about a suicide by a public official can result in harmful news coverage. Given the potential risks, public officials and the media should seek to minimize these risks by carefully considering what is to be said and reported regarding suicide.

Aspectsd of news coerage that can promote suicide contagion

Clinicians, researchers, and other health professionals at the workshop agreed that to minimize the likelihood of suicide contagion, reporting should be concise and factual. Although scientific research in this area is not complete, workshop participants believed that the likelihood of suicide contagion may be increased by the following actions:

  • Presenting simplistic explanations for suicide.

    Suicide is never the result of a single factor or event, but rather results from a complex interaction of many factors and usually involves a history of psychosocial problems (12). Public officials and the media should carefully explain that the final precipitating event was not the only cause of a given suicide. Most persons who have committed suicide have had a history of problems that may not have been acknowledged during the acute aftermath of the suicide. Cataloguing the problems that could have played a causative role in a suicide is not necessary, but acknowledgment of these problems is recommended.

  • Engaging in repetitive, ongoing, or excessive reporting of suicide in the news.

    Repetitive and ongoing coverage, or prominent coverage, of a suicide tends to promote and maintain a preoccupation with suicide among at-risk persons, especially among persons 15-24 years of age. This preoccupation appears to be associated with suicide contagion. Information presented to the media should include the association between such coverage and the potential for suicide contagion. Public officials and media representatives should discuss alternative approaches for coverage of newsworthy suicide stories.

  • Providing sensational coverage of suicide.

    By its nature, news coverage of a suicidal event tends to heighten the general public's preoccupation with suicide. This reaction is also believed to be associated with contagion and the development of suicide clusters. Public officials can help minimize sensationalism by limiting, as much as possible, morbid details in their public discussions of suicide. News media professionals should attempt to decrease the prominence of the news report and avoid the use of dramatic photographs related to the suicide (e.g., photographs of the funeral, the deceased person's bedroom, and the site of the suicide).

  • Reporting "how-to" descriptions of suicide.

    Describing technical details about the method of suicide is undesirable. For example, reporting that a person died from carbon monoxide poisoning may not be harmful; however, providing details of the mechanism and procedures used to complete the suicide may facilitate imitation of the suicidal behavior by other at-risk persons.

  • Presenting suicide as a tool for accomplishing certain ends.

    Suicide is usually a rare act of a troubled or depressed person. Presen- tation of suicide as a means of coping with personal problems (e.g., the break-up of a relationship or retaliation against parental discipline) may suggest suicide as a potential coping mechanism to at-risk persons. Although such factors often seem to trigger a suicidal act, other psychopathological problems are almost always involved. If suicide is presented as an effective means for accomplishing specific ends, it may be perceived by a potentially suicidal person as an attractive solution.

  • Glorifying suicide or persons who commit suicide.

    News coverage is less likely to contribute to suicide contagion when reports of community expressions of grief (e.g., public eulogies, flying flags at half-mast, and erecting permanent public memorials) are minimized. Such actions may contribute to suicide contagion by suggesting to susceptible persons that society is honoring the suicidal behavior of the deceased person, rather than mourning the person's death.

  • Focusing on the suicide completer's positive characteristics.

    Empathy for family and friends often leads to a focus on reporting the positive aspects of a suicide completer's life. For example, friends or teachers may be quoted as saying the deceased person "was a great kid" or "had a bright future," and they avoid mentioning the troubles and problems that the deceased person experienced. As a result, statements venerating the deceased person are often reported in the news. However, if the suicide completer's problems are not acknowledged in the presence of these laudatory statements, suicidal behavior may appear attractive to other at-risk persons -- especially those who rarely receive positive reinforcement for desirable behaviors.


In addition to recognizing the types of news coverage that can promote suicide contagion, the workshop participants strongly agreed that reporting of suicide can have several direct benefits. Specifically, community efforts to address this problem can be strengthened by news coverage that describes the help and support available in a community, explains how to identify persons at high risk for suicide, or presents information about risk factors for suicide. An ongoing dialogue between news media professionals and health and other public officials is the key to facilitating the reporting of this information.


1. National Center for Health Statistics. Health, United States, 1991. Hyattsville, MD: US Department of Health and Human Services, Public Health Service, CDC, 1992.

2. National Center for Health Statistics. Mortality data tapes {machine- readable data tapes}. Hyattsville, MD: US Department of Health and Human Services, Public Health Service, CDC, 1993.

3. Shaffer D, Garland A, Gould M, Fisher P, Trautman P. Preventing teenage suicide: a critical review. J Am Acad Child Adolesc Psychiatry 1988;27:675-87.

4. O'Carroll PW. Suicide. In: Last JM, Wallace RB, eds. Maxcy-Rosenau-Last public health and preventive medicine. 13th ed. Norwalk, CT: Appleton & Lange, 1992:1054-62.

5. Davidson LE, Gould MS. Contagion as a risk factor for youth suicide. In: Alcohol, Drug Abuse, and Mental Health Administration. Report of the Secretary's Task Force on Youth Suicide. Vol 2. Risk factors for youth suicide. Washington, DC: US Department of Health and Human Services, Public Health Service, 1989:88-109; DHHS publication no. (ADM)89-1622.

6. Gould MS, Davidson L. Suicide contagion among adolescents. In: Stiffman AR, Felman RA, eds. Advances in adolescent mental health. Vol III. Depression and suicide. Greenwich, CT: JAI Press, 1988.

7. Gould MS, Wallenstein S, Kleinman MH, O'Carroll PW, Mercy JA. Suicide clusters: an examination of age-specific effects. Am J Public Health 1990;80:211-2.

8. Phillips DP, Carstensen LL. The effect of suicide stories on various demographic groups, 1968-1985. Suicide Life Threat Behav 1988;18:100-14.

9. CDC. Cluster of suicides and suicide attempts -- New Jersey. MMWR 1988;37:213-6.

10. CDC. Adolescent suicide and suicide attempts -- Santa Fe County, New Mexico, January 1985-May 1990. MMWR 1991;40:329-31.

11.Davidson LE, Rosenberg ML, Mercy JA, Franklin J, Simmons JT. An epidemi- ologic study of risk factors in two teenage suicide clusters. JAMA 1989;262:2687-92.

12. O'Carroll PW. Suicide causation: pies, paths, and pointless polemics. Suicide Life Threat Behav 1993;23:27-36.

CDC, which participated in developing the concepts for discussion and assisted in the operations of this workshop, supports these recommen- dations. Funding for the workshop was provided by the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Depart- ment of Health and Human Services.


Examples of Hypothetical News Reports * with High and Low Potential for Promoting Suicide Contagion

Report with High Potential for Promoting Suicide Contagion

Hundreds turned out Monday for the funeral of John Doe, Jr., 15, who shot himself in the head late Friday with his father's hunting rifle. Town Moderator Brown, along with State Senator Smith and Selectman's Chairman Miller, were among the many well-known persons who offered their condolences to the City High School sophomore's grieving parents, Mary and John Doe, Sr.

Although no one could say for sure why Doe killed himself, his class- mates, who did not want to be quoted, said Doe and his girlfriend, Jane, also a sophomore at the high school, had been having difficulty. Doe was also known to have been a zealous player of fantasy video games.

School closed at noon Monday, and buses were on hand to transport students who wished to attend Doe's funeral. School officials said almost all the student body of 1,200 attended. Flags in town were flown at half staff in his honor. Members of the School Committee and the Board of Selectmen are planning to erect a memorial flag pole in front of the high school. Also, a group of Doe's friends intend to plant a memorial tree in City Park during a ceremony this coming Sunday at 2:00 p.m.

Doe was born in Otherville and moved to this town 10 years ago with his parents and sister, Ann. He was an avid member of the high school swim team last spring, and he enjoyed collecting comic books. He had been active in local youth organizations, although he had not attended meetings in several months.

Alternative Report with Low Potential for Promoting Suicide Contagion

John Doe, Jr., 15, of Maplewood Drive, died Friday from a self-inflicted gunshot wound. John, the son of Mary and John Doe, Sr., was a sophomore at City High School.

John had lived in Anytown since moving here 10 years ago from Otherville, where he was born. His funeral was held Sunday. School counselors are available for any students who wish to talk about his death.

In addition to his parents, John is survived by his sister, Ann.

  • The names of persons and places in these examples are fictitious and do not refer to an actual event.

Disclaimer All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

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What You Need to Know About Suicide Contagion

Suicide, the third leading cause of death among 15-24 year olds according to the Centers for Disease Control and Prevention (the CDC), has been in the news several times in the last year due to suicide “clusters” at Cornell University and in California and Pennsylvania. A suicide cluster is defined by the CDC as “a group of suicides or suicide attempts, or both, that occur closer together in time and space than would normally be expected in a given community.” 1 “Suicide contagion” or “copycat” suicides is the behavior that leads to clusters of suicides. The idea that suicide clusters occur as a result of a contagious type of behavior has not been established through studies, but suggested by anecdotal evidence and statistical analysis. These seem to indicate that suicides occurring later in a cluster appear to have been influenced by suicides earlier in the cluster.

Note: A suicide cluster is not the same thing as a suicide pact. A suicide pact is an agreement between two or more individuals to commit suicide at the same time, and is rare, according to the CDC. The individuals in a suicide cluster may have had no actual contact with each other at all.

Who’s at Risk?


Teenagers and young adults tend to be the most vulnerable to suicide “contagion,” predominantly for two reasons:

1. They model the behavior of their peers. Teenagers often give the opinion and actions of their peers more weight than that of their parents or other adults.

2. They have a tendency to act impulsively, due to their prefrontal cortex (where complex cognitive functions occur) not being fully developed yet.

At the greatest risk are individuals with an underlying mental health problem like depression, anxiety or substance abuse.

Media Coverage

Media coverage of suicides, especially when it is both dramatic and extensive, can encourage vulnerable individuals to seek attention, or retaliation, by committing suicide.

Media outlets should avoid:

  • Dramatic headlines and glorifying the suicide.
  • Detailed descriptions of the method and location of the suicide, as this is believed to encourage imitation.

And instead, focus on:

  • Identifying signs, myths about suicide, treatment and how to prevent someone from committing suicide.
  • Providing details of local screening programs and available mental health programs.
  • Reporting on the factors that may have led to the suicide, including mental illness and making it clear that the causes are complex.

Recently, officials in a city that had seen several suicides asked the “Dr. Phil” show not to focus on their city when doing a show about teen suicide. Although teenagers from that city were interviewed on the show, the city was not named and the discussion focused on stress and mental health issues that might lead teens to commit suicide, suicide warning signs and ways to help someone who is displaying them.


Identifying signs of suicidal behavior, especially among people who were acquainted with the person who committed suicide.

Parents, counselors, teachers and other adults should not avoid raising the topic with youths. Contrary to popular belief, discussing suicide with an individual who is at risk does not plant an idea in their head. In fact, it’s believed that discussing suicide with someone at risk can help to prevent it.


The CDC suggests in CDC Recommendations for a Community Plan for the Prevention and Containment of Suicide Clusters that communities should consider downplaying memorials to individuals who committed suicide.


1 CDC Recommendations for a Community Plan for the Prevention and Containment of Suicide Clusters


CDC Suicide Fact Sheet
Society for the Prevention of Teen Suicide
American Association of Suicidology
American Foundation for Suicide Prevention
Source: /

Teen Suicide is Contagious, and the problem may be worse than we thought

Students of Rampart High School practice a performance about suicide prevention on September 27. Because they are facing a teen suicide cluster, many schools in the Colorado Springs area now have presentations about spotting the danger signs for suicide and encouraging students in need to seek help.

ucrecia Sjoerdsma knew what to watch for: the lingering moodiness, the sudden disinterest in what once brought joy. But her daughter, Riley Winters, a ninth-grader at Discovery Canyon Campus High School in Colorado Springs, Colorado, was always smiling—the 15-year-old used whitening strips because she loved showing off her perfect teeth. “Her smile really matched her personality,” Sjoerdsma says. A petite girl with brown hair that went just past her shoulders, Riley seemed to be a happy, goofy kid and a kind young woman who could sense when others were down and find a way to cheer them up. Riley liked hiking and rock climbing. She spoke of joining the military or becoming an archaeologist, a physical therapist or a dental hygienist. She had plenty of time to decide.Even though her mother had no sense that Riley was having problems, she knew it was important to talk to her daughter about suicide, and so she did. Between 2013 and 2015, 29 kids in their county had killed themselves, many from just a handful of schools, including Riley’s. There had been gunshot deaths, hangings and drug overdoses. And then there were those choking deaths the victims’ parents insisted were accidental. Subscribe to Newsweek from $1 per week Riley knew of at least two of the kids who had killed themselves the previous winter: an older girl at school (they had mutual friends) and a boy in her Christian youth group. Such peripheral connections are all that seem to connect most of the kids in the area who had killed themselves, and school and county officials began to worry they were witnessing a copycat effect...until copycat became too weak a word. It was more like an outbreak, a plague spreading through school hallways.About a year after Sjoerdsma and her daughter last spoke about suicide, Riley was staying at her father’s house one night when she downed a small bottle of whiskey, then sent out a series of troubling texts and Snapchat messages. “I’m sorry it had to be me,” she wrote to one friend. Then she slipped on a blue Patagonia fleece and snuck out the basement window, carrying her father’s gun.

When Riley’s mother and friends saw the messages, they went looking for her at local parks, gas stations and friends’ houses, all the while begging her via texts and calls to come home.The next morning, they found her body in the woods behind her father’s house. She’d shot herself in the head.Three days later, and two days before Riley’s memorial service, another Discovery Canyon Campus student killed himself. Her daughter probably knew the boy, but they weren’t close, Riley’s mother says. Nine days later, yet another classmate committed suicide. He had been on the swim team with the boy who’d just killed himself. And that wasn’t the end of it: Five students from the school of 1,180 died by suicide between late 2015 and summer 2016, a rate almost 49 times the yearly national average for kids their age.It’s not just at that one school. As of mid-October, the total for teen suicides this year in El Paso County, home to Colorado Springs, is 13, one short of the total for all of 2015. Neighboring Douglas County had a similar crisis a few years ago, and news of a classmate’s suicide no longer fazes students in the area, kids say. “It’s become almost commonplace,” says Gracie Packard, a high school junior in Riley’s district. “Because it doesn’t happen once every four years. It happens four times in a month, sometimes.”

The youngest person to die this year in El Paso County was 13. “[Even] for a job that’s generally pretty tragic, it’s disheartening,” says Dr. Leon Kelly, the county’s deputy chief medical examiner. “You feel powerless. You feel like, Another one?“Another day, another kid. It’s hard.”

Death on InstagramSociologists have long said people who form bonds are less likely to kill themselves, but sometimes the opposite is true—studies now show that one person’s suicidal behavior can spur another’s, and one death can lead to more deaths.Decades of research prove that a startling range of emotions and behaviors can be contagious—from moodiness to yawning. Young people are especially susceptible; they obsess over fads and fashion trends and copy illicit behaviors from peers, such as smoking, drinking or speeding. Or suicide. Using a statistical formula typically applied to tracking outbreaks of diseases, researchers at Columbia University and other institutions confirmed in 1990 that suicide is contagious and can be transmitted between people. Contagion spreads either directly, by knowing a suicide victim, or indirectly, by learning of a suicide through word-of-mouth or the media. Those same researchers found that people ages 15 to 19 are two to four times more prone to suicide contagion than people in other age groups. The way it spreads can be so similar to that of diseases that the Centers for Disease Control and Prevention (CDC) has sometimes gone into a region to investigate spikes in suicides.Analysts call those spikes suicide clusters—an unusually high number of people in an area kill themselves (or attempt to) in a short period of time. The clusters tend to happen where people socialize, such as schools, psychiatric hospitals or military units. Madelyn Gould, one of the analysts who made the contagion discovery, has said these clusters make up between 1 and 5 percent of teen suicides but are vitally important to understand because “they represent a class of suicides that may be particularly preventable.” And a few consecutive suicides can devastate a community.Another reason it is crucial to understand these clusters is that suicide is likely becoming more contagious, thanks in large part to social media. Analysts have long assumed that a suicide typically has a profound impact on six people, but that estimate is from the early 1970s and limited to close family members. Social networks (both online and in real life) are much bigger today, and soon-to-be-published research by Julie Cerel, president-elect of the American Association of Suicidology, shows that a suicide may now touch around 135 people, and about one-third of them experience a severe life disruption because of that suicide. She and her colleagues previously found, in 2015, that people who know a suicide victim are almost twice as likely to develop suicidal thoughts as the general population. The closer the relationship, the greater the risk; the younger the person exposed, the greater the risk.Young people aren’t the only ones facing a suicide problem; the national suicide rate across all demographics is at an almost 30-year high. But more than three times as many teens are killing themselves now than in the 1950s. Most of these suicides aren’t copycats, but some areas across the country are suffering from the sort of contagion that has stricken Colorado Springs; the CDC investigated cases in Fairfax County, Virginia, in 2014 and Palo Alto, California, in 2016. Other clusters have likely gone undetected because it’s often so difficult to make the connections between victims.

Suicide prevention advocates tend to blame television and newspaper coverage for inspiring copycats, but for teens, social media are a growing problem. Instagram pages for kids who kill themselves sometimes contain hundreds of comments. Many are about how beautiful or handsome the deceased were, how they can finally rest in peace and how there should be a party for them in heaven. Dr. Christine Moutier, chief medical officer at the American Foundation for Suicide Prevention, says the message seems to be that if you kill yourself, you’ll not only end your suffering but also become the most popular kid in school. Teens sometimes have more than 1,000 Instagram followers, so kids far beyond one school or community can see digital shrines to dead friends. Moutier says those posts can seem as if they’re romanticizing death.Scholars are struggling to keep up with the evolving technology, and they say there’s still a paucity of research on how suicidal thoughts spread through social media. “It makes these deaths no longer isolated,” says Cerel, and kids “are exposed and perhaps profoundly affected by someone they might have never even met in person.” Analysts say clusters could become harder to spot, because they typically occur in a specific area, but social networks for teens now spread far beyond a school, a neighborhood, even a city.The Choking GameIt’s hard to identify “patient zero” in the Colorado Springs suicide outbreak because kids today are so interconnected, and the families involved have kept many details private. Researchers also know that they can’t limit their search to one group; the first suicide at one school may have been inspired by the death of a student at another. Other factors muddling the search: The coroner’s office doesn’t always track where the deceased went to school, and districts are hesitant to say how many teens they’ve lost to suicide, citing student privacy laws and fear of copycats.One known precursor to the current wave of suicides was in 2011, when a Colorado Springs father found his 12-year-old son suspended from a bunk bed. The parents insist it was not a suicide and instead blame the “choking game,” in which a person cuts off blood flow to the brain and then releases it in order to feel lightheaded or even high. The coroner’s office ruled the cause of death “undetermined.” In 2013, a 15-year-old from the same school district strangled himself, and his parents blamed the choking game. The number of teen suicides started picking up in the spring of 2015, when a Discovery Canyon Campus student shot herself. The next month, three local kids took their own lives. From June to November, there were five more suicides in the Colorado Springs area; in December, there was on average one teen suicide per week. The deaths surged again toward the end of the last school year, beginning with Riley’s suicide.Those tracking the situation are convinced it’s a contagion, but they’re unsure how it’s spreading. That makes it all the more frightening and difficult to stop. “It’s two years in a row we’ve dealt with the same sort of terrifying trend,” says Kelly, the medical examiner.

Colorado’s Child Fatality Prevention System, which investigated all youth suicides in the state from 2010 to 2014, identified risk factors, including family arguments, relationship breakups and physical or emotional abuse. Others blame regional factors, like the nearby Army and Air Force bases, as the children of people serving in the military are at elevated risk for suicidal thoughts. (A parent’s deployment can lead to increased responsibilities at home for a kid or emotional problems because of the separation and possibility of a parent’s death.) Some blame the high altitude, which researchers have linked to suicide.Analysts also point out that young people don’t always know how to get through stressful times. Adults tend to end their lives because of major life stressors, Kelly says, but for a kid, the breaking point is often less significant. “These risk factors line up like lights on the street,” says Richard Lieberman, a mental health consultant for the Los Angeles County Office of Education. “For a kid to go from thinking about suicide to attempting suicide, all these lights have to turn green.” One light might be a fight with a parent. Another might be a flunked test, a breakup, a peer’s suicide. Kids might contemplate suicide for months, and then the final act is often on impulse, “if everything falls into place,” says Scott Poland, a school crisis expert from Nova Southeastern University in Florida. Poland and Lieberman are working with Discovery Canyon Campus and its district.Riley didn’t show any obvious signs of mental health problems, according to her mother, and wasn’t in therapy or on medication. “Teachers even said, If you would have given me 200 names, hers would have been at the bottom of kids who would do this.”But Riley was having trouble in the classroom—she fooled around during class, and her grades suffered, which added pressure. “She kept saying she hated school; she just didn’t want to be there,” Sjoerdsma says. She also struggled with her parents’ 2005 divorce. But even a few hours before her death, at a Christian youth group gathering she was dancing around and holding hands with friends, says Sjoerdsma, acting like “her normal self.” In the car with family friends on the way to her father’s house, Riley rolled down the window and stuck her hands outside. She liked to feel the cool mountain air on her palms. When she was dropped off, she told the people she was with that she’d see them tomorrow.‘Unhang’ YourselfA little more than a week after Riley’s suicide, Brittni Darras, an English teacher at a different school in the area, posted on Facebook that she had learned of another student’s attempted suicide during a parent-teacher conference. “As her mom sat across from me, we both had tears streaming down our faces,” Darras wrote. “Feeling helpless, I asked if I could write my student a letter to be delivered to her at the hospital.” The mother agreed. After the student received it, the mother emailed Darras to share what the girl had said: “How could somebody say such nice things about me? I didn’t think anybody would miss me if I was gone.”Darras had lost a student to suicide a few years earlier. “It’s something that, as a teacher, you never entirely recover from,” she says. “Losing one in my teaching career was more than anybody should ever have to go through.” When she heard how the girl in the hospital had reacted, Darras decided to write letters to the rest of her 130 students. It took her two months. Her students were thankful, and word of what she did spread; nearly 200,000 people have shared her Facebook post.Darras is one of many people in the Colorado Springs area fighting to stop the suicides. The initiative Safe2Tell, which began as a pilot program in the city in the 1990s and expanded statewide after the Columbine High School killings in 1999, lets young people anonymously report threats by others. State police receive the reports and connect with local law enforcement and schools to intervene. Last school year, Safe2Tell received 5,821 tips, up 68 percent from the previous year. The largest category involved suicide threats. “For years, in all the work in suicide prevention, we’ve really focused on one thing, and that is seeking help if you need it,” says Susan Payne, the initiative’s executive director. “That meant putting it on the victim that’s struggling to make a phone call or seek help.” Her program encourages bystanders to look for warning signs in others and report them.Daniel Brewster wants that too. On December 31, 2015, hours before he and his daughter Danielle, 17, a Discovery Canyon Campus student, planned to celebrate the new year, she hanged herself. Brewster later looked at his daughter’s phone. “This is the part that kills me—I know she was texting other kids at the time and letting them know,” he says. She wrote, “My feet are off the floor,” and “Everything is getting hazy and dark.” None of the kids intervened; one responded by suggesting she “unhang.”

“Just having a meeting with [teens] and saying, ‘OK, here are the signs; here’s what you look for; here’s what you need to do’—that’s not enough,” Brewster says. “It needs to be ingrained in these kids’ heads, because they’re our first line of defense.” Of all the young people in Colorado who killed themselves from 2008 to 2012, more than a third had told someone of their plans, according to a state report.Danielle’s was one of at least three teen suicides in the Colorado Springs area in a three-week span. Then, six weeks later, Danielle’s mother hanged herself in her daughter’s bedroom. “They’re supposed to be here,” Brewster says, choking on the words. “We’re supposed to be in this house together.”

Some local students are starting their own prevention efforts. Gracie Packard was in the eighth grade when she set a date to kill herself. She had struggled with anxiety and depression since she was young and later practiced cutting. She couldn’t sleep, her grades were slipping, and she was losing weight. She would cancel plans with friends and stopped dancing, once a passion of hers. Meanwhile, other kids around town, as well as one of her siblings, were killing themselves or attempting to. “It was pretty much all around you,” she says. She recalls telling herself, “If things aren’t better by this date, then you’ve tried your best, and you can end it.”Her friends sensed something was wrong. Days before she planned to die, they staged an intervention. “We’re worried about you,” they told her. Their concern, plus a suicide prevention nonprofit she stumbled upon called To Write Love on Her Arms, convinced her to ask her mom for help. “I was physically shaking. I could hardly breathe,” she says. But “that 30 seconds of bravery in being willing to say out loud to somebody you trust that, ‘Hey, I’m not OK,’ it’s going to be one of the scariest things you’ll ever do, but it will be one of the best things you’ll ever do.” She soon started therapy. Now 17, Gracie shares her mental health story publicly and advocates for suicide prevention. An event she hosted in September drew 150 people.City and school officials are also working to stem the rising death toll. Last spring, the El Paso County Public Health department hired a specialist to create a screening system to identify young people at risk.But not all parents are willing to address the problem. Kelly, the medical examiner, says family members almost always request that his office cite a cause of death other than suicide, such as the choking game. “I’ve had relatives ask me if I would call it an autoerotic asphyxia because they didn’t want to tell Grandpa that his grandson had committed suicide,” he says. “That really speaks to what we as Americans think about mental illness.” None of the obituaries for the Colorado Springs kids seem to mention suicide (a common omission everywhere), and it’s unlikely that their memorial services included more than a vague reference.Some worry that discussing suicide might inspire more kids to do it, but just because suicidal behavior can spread quickly doesn’t mean it has to. Moutier, from the American Foundation for Suicide Prevention, says thinking suicide is contagious might give young people the impression that anyone can “catch” it, even a stable, happy kid. That’s not true, she says.Whether the parents of the deceased will admit it or not, suicide in most cases involves an underlying mental health condition. Researchers have found that if someone close to an adolescent dies by suicide, the adolescent’s mental health history is a bigger predictor of future suicidal behavior than his or her relationship to the suicide victim.El Paso County’s most recent teen suicide was on September 19—a hanging on school grounds. Because teen suicides there tend to spike at the end of semesters—when students may feel as if they’re losing whatever support they had at school, Kelly says—officials may not know until winter break if things are improving. Students aren’t necessarily sending panicked glances around the classroom, wondering whom this plague will strike next. They have other things to worry about—exams, rehearsals, sports games, college applications. “When it first happens, that’s all that is on everyone’s mind,” says Chloe Love, a junior at Discovery Canyon Campus, who does suicide prevention work. Then they move on. They have to. “Sometimes,” she says, “the memories just hurt too much.”

Sjoerdsma says she won’t hide how Riley died. “I’m fully aware that my daughter committed suicide, and I don’t know why.” She has done social work, and her husband is a local middle school teacher; neither saw the signs. Since her daughter’s death, she hasn’t been sleeping well, and the spate of suicides makes the grieving process more difficult. At night, she often lies awake, thinking about how she and Riley used to say good night: “I love you here to heaven,” Sjoerdsma would say. “I love you back to heaven,” Riley would respond.Sjoerdsma still says it every night. Only now, there’s no one to say it back.

Changes in suicide rates following media reports on celebrity suicide: a meta-analysis .


Background A growing number of studies indicate that sensationalist reporting of suicide is associated with increases in suicide rates, but in the light of some negative findings, the issue has remained controversial. The aim of this study was to evaluate the best current evidence on the association between celebrity suicide stories and subsequent suicides.

Methods Literature searches of six data sources (Medline, Psychlit, Communication Abstracts, Education Resources Information Center, Dissertation Abstracts and Australian Public Affairs Database (APAIS)) were conducted. Studies were included if they (1) adopted an ecological design, (2) focused on celebrity suicide, (3) had completed suicide as outcome variable, (4) analysed suicide rates across all suicide methods, (5) used data from after World War II and (6) satisfied basic quality criteria.

Results 10 studies with totally 98 suicides by celebrities met the criteria. The pooled estimate indicated a change in suicide rates (suicides per 100?000 population) of 0.26 (95% CI 0.09 to 0.43) in the month after a celebrity suicide. There was substantial heterogeneity between studies, which was explained by the type of celebrity (entertainment elite vs others) and the region of study, as indicated by mixed-effects meta-regression. The region-of-study–specific effect of reporting a suicide by an entertainment celebrity was 0.64 (95% CI 0.55 to 0.73) in North America, 0.58 (95% CI 0.47 to 0.68) in Asia, 0.36 (95% CI -0.10 to 0.61) in Australia and 0.68 (95% CI 0.51 to 0.85) in Europe. There was no indication of publication bias.

Conclusions Reports on celebrity suicide are associated with increases in suicides. Study region and celebrity type appear to have an impact on the effect size.