ArticlePDF AvailableLiterature Review

Adolescent Suicide Myths in the United States

Authors:

Abstract

In the United States, teen suicide rates tripled over several decades, but have declined slightly since the mid-1990s. Suicide, by its nature, is a complex problem. Many myths have developed about individuals who complete suicide, suicide risk factors, current prevention programs, and the treatment of at-risk youth. The purpose of this article is to address these myths, to separate fact from fiction, and offer recommendations for future suicide prevention programs. Myth #1: Suicide attempters and completers are similar Myth #2: Current prevention programs work. Myth #3: Teenagers have the highest suicide rate. Myth #4: Suicide is caused by family and social stress. Myth #5: Suicide is not inherited genetically. Myth #6: Teen suicide represents treatment failure. Psychiatric illnesses are often viewed differently from other medical problems. Research should precede any public health effort, so that suicide prevention programs can be designed, implemented, and evaluated appropriately. Too often suicide prevention programs do not use evidence-based research or practice methodologies. More funding is warranted to continue evidence-based studies. We propose that suicide be studied like any medical illness, and that future prevention efforts are evidence-based, with appropriate outcome measures.
M.A.Mosk os et al.: Adolescent Suicide Myths in the United StatesCrisis25 (4), © 2004 Hogrefe & Huber Publishers
Research Trends
Adolescent
Suicide Myths
in the United States
Michelle Ann Moskos
1
, Jennifer Achilles
2
, and Doug Gray
3
1
Univ. of Utah School of Medicine, Department of Pediatrics, Intermountain Injury Control Research Center,
2
University of Utah School of Medicine,
3
University of Utah, Department of Psychiatry,
Child and Adolescent Specialty Clinic, Salt Lake City, UT, USA
Abstract: In the United States, teen suicide rates tripled over several decades, but have declined slightly since the mid-1990s. Suicide,
by its nature, is a complex problem. Many myths have developed about individuals who complete suicide, suicide risk factors, current
prevention programs, and the treatment of at-risk youth. The purpose of this article is to address these myths, to separate fact from
fiction, and offer recommendations for future suicide prevention programs. Myth #1: Suicide attempters and completers are similar.
Myth #2: Current prevention programs work. Myth #3: Teenagers have the highest suicide rate. Myth #4: Suicide is caused by family
and social stress. Myth #5: Suicide is not inherited genetically. Myth #6: Teen suicide represents treatment failure. Psychiatric illnesses
are often viewed differently from other medical problems. Research should precede any public health effort, so that suicide prevention
programs can be designed, implemented, and evaluated appropriately. Too often suicide prevention programs do not use evidence-based
research or practice methodologies. More funding is warranted to continue evidence-based studies. We propose that suicide be studied
like any medical illness, and that future prevention efforts are evidence-based, with appropriate outcome measures.
Keywords: Antidepressants, adolescents, evidence based, school health, suicide
Introduction
The prevention of violence, in particular suicide, is of in-
ternational concern (Cantor, 2000; Weber, 2000). In 1999,
the United States Surgeon General issued a Call to Action
to Prevent Suicide because the most current statistics iden-
tified suicide as the ninth leading cause of mortality in the
United States with nearly 31,000 deaths. Concomitantly,
the World Health Organization (WHO) recognized suicide
as a growing problem worldwide with nearly 1,000,000
deaths and urged member nations to take action (World
Health Organization, 1996). The WHO document, Preven-
tion of Suicide: Guidelines for the Formulation and Imple-
mentation of National Strategies (1996), motivated a part-
nership to seek a national strategy in the United States (In-
stitute of Medicine, 2002). In 2001, the United States
Surgeon General released the National Strategy for Suicide
Prevention: Goals and Objectives for Action, which is a
plan that will guide the nation’s suicide prevention efforts
for the next ten years (Satcher, 2001). This document pro-
vides essential guidance and suggests the fundamental ac-
tivities that must follow–activities based on scientific evi-
dence. The National Strategy emphasized that, “much of
the work of suicide prevention must occur at the commu-
nity level where human relationships breathe life into pub-
lic policy (Satcher, 2001).” In 2002, the Institute of Medi-
cine (IOM) released Reducing Suicide: A National Imper-
ative. The IOM clarifies the medical, social, psychological,
economic, moral, and political facets of suicide and the
need for prevention. Teen suicide rates tripled over several
decades in the United States, but have declined slightly
since the mid-1990s (American Psychiatric Association,
2003; Kachur, Potter, James, & Powell, 1995). Suicide, by
its nature, is a complex problem. Many myths have devel-
oped about individuals who complete suicide, suicide risk
factors, current prevention programs, and the treatment of
at-risk youth in the United States. There are certain myths
that suicidologists encounter in their work with the general
population, health professionals, school administrators,
and other government officials, as well as the media. The
purpose of this article is to address these myths related to
suicide in the United States, to separate fact from fiction,
and offer recommendations for future suicide prevention
programs.
DOI: 10.1027/0227-5910.25.4.176
Crisis 2004; Volume 25 (4): 176–182 © 2004 Hogrefe & Huber Publishers
Myths and Recommendations
Myth #1: Suicide Attempters and
Completers Are Similar
The epidemiology of suicide attempts and completions
vary internationally. In the United States, males are four
times more likely to die from suicide than females, but fe-
males are more likely to attempt suicide than males (Cen-
ters for Disease Control and Prevention, 2003). In 1999,
83% of teenage suicide completers were male (Arias, An-
derson, Kung, Murphy, & Kochanek, 2003). The only state-
wide hospital surveillance study of child and adolescent
suicide attempters in the United States demonstrated that
84% of attempters were female (Andrus et al., 1991). Sui-
cide attempts peak in the teenage years, while suicide com-
pletion peaks in old age (Birkhead, Galvin, Meehan,
O’Carroll, & Mercy, 1993; Centers for Disease Control and
Prevention, 1998; Kachur et al., 1995). The United States
does not have an official source that compiles suicide-at-
tempt data nationwide, therefore, reported rates are specu-
lative (Mancinelli, 2002; Maris, Berman, & Silverman,
2000). However, the average estimated ratio between non-
fatal youth suicide attempters and youth suicide completers
in the United States was 100–200:1(Maris, 2002; McIn-
tosh, 2003). In a smaller study, researchers found that ado-
lescent suicide attempters are a large group, with a 1 year
incidence rate of 130/100,000 suicide attempts among
those with no baseline suicidal behaviors (McKeown et al.,
1998). By contrast suicide completion is a rare event, in-
volving only 1–2/10,000 teenagers each year (Kachur et al.,
1995). While suicide attempts increase the long-term risk
of suicide, the majority of teen suicide completers have
never made a prior attempt (American Psychiatric Associ-
ation, 2003; Brent, Perper, & Moritz, 1993; Maris et al.,
2000). Gender differences can be explained by the choice
of more lethal means by males, and by cultural influences
making it more acceptable for males to complete rather
than attempt suicide (American Psychiatric Association,
2003; Canetto, 1997; Maris et al., 2000; Moscicki, 1994).
Recommendations
It will be important to recognize that suicide attempters and
completers are two different groups, with some overlap.
These two groups will require separate treatment interven-
tions, and outcome measures specific to each group. Cul-
tural influences must also be addressed.
Myth #2: Current Prevention Programs Work
National suicide prevention efforts have focused on school
education programs, teen suicide hotlines, media guide-
lines, and efforts to limit firearm access for at-risk youth
(Gould & Kramer, 2001; Shaffer, 1988). Unfortunately,
these prevention methods have not had a significant impact
in lowering teen suicide rates. Historically, suicide preven-
tion programs have not been rigorously evaluated, and,
consequently, resources have not been focused on high-risk
groups (Hazell & King, 1996; Shaffer, Garland, Vieland,
Underwood, & Busner, 1991). School-based suicide pre-
vention programs have not been demonstrated to effect sui-
cide rates, and educational benefits have been limited to a
few studies (Spirito, Overholser, Ashworth, Morgan, &
Benedict-Drew, 1988). In 2004, an evaluation of Signs of
Suicide (SOS), a school-based suicide prevention program,
documented a reduction in self-reported suicide attempts
for the first time using a randomized experimental design
(Aseltine & DeMartino, 2004). This study was unique, be-
cause it incorporated screening and referral of high-risk
youth in addition to an educational component. Teen hot-
lines are primarily used by females, rather than males, thus
having little effect on the group with the highest risk for
death (Grossman, 1992). Approximately 5% of all teen sui-
cides are believed to be “cluster” suicides (Hazell, 1993).
Cluster suicides involve additional imitative suicides,
based on the idea of a contagion, which may be associated
with the way the media describes suicide (Gould, 2001;
Schmidtke & Hafner, 1988). The Centers for Disease Con-
trol and Prevention (CDC) have developed guidelines for
the reporting of suicide in the media in the United States.
Because the implementation of similar recommendations
for media coverage of suicide has been shown to decrease
suicide rates in Europe, (Etzersdorfer & Sonneck, 1998;
Sonneck, Etzersdorfer, & Nagel-Kuess, 1994) we strongly
support the use of the CDC guidelines for media in the
United States, although their effectiveness warrants exam-
ination. There is general agreement that reducing access to
lethal means can reduce suicide completion rates, in fact,
according to the CDC, restricting access to lethal means
may be one of the most promising underused strategies that
warrant further examination (Centers for Disease Control
and Prevention, 1994, 2003). Unfortunately, a recent study
demonstrated that only 25% of gun owners remove fire-
arms from their home when repeatedly asked to do so by
their teenagers mental health provider (Brent, Baugher,
Brimaher, Kolko, & Bridge, 2000). In Canada, Leenaars
and colleagues (2003) explored the relationship between
Canada’s Criminal Law Amendment Act of 1977 (Bill C-
51) and Canadian suicide rates; although legislative gun
control correlated with a decrease in suicide rates, this ap-
proach is probably unfeasible in the United States (Lee-
naars, Moksony, Lester, & Wenckstern, 2003).
Recommendations
Suicidologists recommend that future efforts in the educa-
tional system use evidence-based screening tools to identi-
fy youth at risk, and link screening responses to appropriate
treatment referrals. Limitations include the cost of screen-
ing tools used in school settings, as well as the number of
false positives (Satcher, 2001). Educational programs
M.A. Moskos et al.: Adolescent Suicide Myths in the United States 177
© 2004 Hogrefe & Huber Publishers Crisis 2004; Volume 25 (4): 176–182
which consist only of a brief, one-time lecture regarding
risk factors for youth suicide have not been effective (Cen-
ters for Disease Control and Prevention, 1994). Teen hot-
lines may be effective in helping suicide attempters. An
appropriate outcome measure for hotlines could be a reduc-
tion in the number of emergency room visits for suicide
attempts rather than a reduction in the number of suicide
deaths. Reducing access to lethal means may require health
professionals to change their strategy of encouraging the
removal of firearms to encouraging the safe storage of fire-
arms (American Psychiatric Association, 2003; Centers for
Disease Control and Prevention, 2003; Christoffel, 2000).
Recently published data from the Utah Youth Suicide Study
by Gray and colleagues (2002) indicated that the Juvenile
Justice System provides a unique opportunity to identify
youth at risk for suicide. The study found that 63% of youth
suicide completers had contact with Juvenile Justice, usu-
ally multiple minor offenses over many years. Less than
half (46%) of the youths found in the justice system could
also be located in the public educational system. This find-
ing suggests that mental health screening and treatment
should be integrated into the nation’s Juvenile Justice sys-
tems (Gray, Achilles, & Keller, 2002).
Myth #3: Teenagers Have the Highest
Suicide Rate
In the United States, elderly white males have always had
the highest risk for completed suicide (Arias et al., 2003).
Often suicide in the geriatric population is related to a med-
ical disability. However, older adult suicide rates have
stayed relatively constant in the United States, while ado-
lescent and young adult suicide rates have more than tripled
between the 1960s and 1990s (Centers for Disease Control
and Prevention, 2003; Kachur et al., 1995). The CDC con-
siders years of potential life lost (YPLL) to gauge the im-
pact of an illness on a population (Centers for Disease Con-
trol and Prevention, 2003). Teen suicide involves consider-
able YPLL, and for teenagers nationwide, suicide is one of
the leading causes of death (Centers for Disease Control
and Prevention, 2003). In addition, cluster suicides pre-
dominately occur in the teenage population (Gould, Wal-
lenstein, Kleinman, O’Carroll, & Mercy, 1990). Rates of
suicide among minorities are low compared to whites. The
rate of suicide among African American youth in the United
States is increasing faster than any other ethnic group (Cen-
ters for Disease Control and Prevention, 1998). Surprising-
ly, the rise in African American youth suicide in the United
States is concentrated in those with higher socioeconomic
status (Centers for Disease Control and Prevention, 1998).
Recommendations
Future prevention efforts should continue to be focused on
adolescents and young adults, given the social, economic,
and emotional impact of youth suicide. While the white
population has had the highest suicide rates, other ethnic
groups need greater consideration, because of changing
epidemiology.
Myth #4: Suicide Is Caused by Family and
Social Stress
When interviewing families of suicide victims, relatives of-
ten point to an adverse precipitant, such as breaking off a
romantic relationship, an argument with parents, or a dis-
ciplinary action (Shaffer et al., 1996). One feature of ado-
lescent suicide is that it may be precipitated by a psycho-
social stressor associated with a recent loss, rejection, or
disciplinary crisis. However, stressors related to these
events are common in a normal teenager’s life, and suicide
is a rare outcome (Zamekin, Alter, & Yemini, 2001). Stud-
ies have shown that over 90% of teen suicide completers
have psychiatric diagnoses, most commonly a mood disor-
der with comorbid substance abuse or conduct problems
(Brent et al., 1993; Shaffer et al., 1996). Teens who com-
plete suicide have more stress and family dysfunction
(Gould, Fisher, Parides, Flory, & Shaffer, 1996). However,
we know that mental illness runs in families, and either
child psychopathology or parental psychopathology may
account for stressors related to family dysfunction. For ex-
ample, Brent (1994) found that parent-child discord was
associated with adolescent suicide, yet when this study
controlled for proband psychopathology, parent-child dis-
cord made no significant contribution (Brent et al., 1994).
The largest controlled studies conducted to date come to
different conclusions regarding negative interactions be-
tween victims and their parents, and whether history of se-
vere physical punishment plays a role in youth suicide
(Brent et al., 1993; Brent et al., 1994; Gould et al., 1996).
While suicide victims are more likely to come from nonin-
tact families, the overall effect of divorce on suicide risk is
small (Brent et al., 1993; Brent et al., 1994; Gould et al.,
1996). While 19% of youth suicide completers in Utah had
been reported to Child Protective Services, most reports
involved teenagers having physical altercations with their
parents, rather than abuse or neglect of small children
(Gray et al., 2002). The available information leads to the
question of whether the family dysfunction contributes to
mental illness, or whether the mental illness contributes to
the family dysfunction. Separate from family dysfunction,
both child and parent psychopathology have been associ-
ated with an increased risk for suicide in Denmark (Agerbo,
Nordentoft, & Mortensen, 2002).
Recommendations
Suicide “is caused” by an interplay of biological, psycho-
logical, environmental, and social factors. However, it is
essential to screen, identify, and treat mental illness in teen-
178 M.A. Moskos et al.: Adolescent Suicide Myths in the United States
Crisis 2004; Volume 25 (4): 176–182 © 2004 Hogrefe & Huber Publishers
agers, because mental illness is a known risk factor for sui-
cide. Furthermore, the identification and referral for mental
health treatment of any psychopathology in parents of teen-
agers at risk for suicide is needed. Treating either child or
parental psychopathology, or both, should decrease both
parent-child discord and family dysfunction.
Myth #5: Suicide Is not Inherited
Genetics has a critical role in mental illness and suicide. If
an individual who is adopted at birth completes suicide, it
is their biological relatives who are at increased risk for
suicide, not the adoptive family members (Schulsinger,
Kety, Rosenthal, & Wender, 1979). Suicide rates are higher
among monozygotic twins, compared with dizygotic twins
(Roy, Segal, Centerwall, & Robinette, 1991). The genetics
of suicide are complex. For example, some families are at
increased risk for depression over multiple generations,
while other families have increased risk for both depression
and suicide. Perhaps the later families inherit a more viru-
lent form of depression? A study in Denmark confirmed
that youth are more likely to commit suicide if they had a
family history of mental illness or they had been diagnosed
with a mental illness; however, no one psychiatric diagno-
sis versus another in parents was associated with an in-
creased risk for suicide among their children (Agerbo et al.,
2002). Brent raises the possibility of a two-factor genetic
model, where a patient must inherit both a mental illness,
and a second factor, such as impulsivity/aggression (Brent,
Perper, & Goldstein, 1988).
Recommendations
Future suicide prevention efforts need to focus on identify-
ing a phenotype that predisposes to suicide. A more specific
phenotype will help us to identify individuals at risk. Clar-
ifying the phenotype is an integral step in discovering the
genetic basis of suicide, because it is unknown whether risk
for suicide is mediated by a history of mental illness in the
family or the presence of a phenotype that could be asso-
ciated with either suicide or mental illness, or both.
Myth #6: Teen Suicide Represents Treatment
Failure
National studies indicate that very few suicide completers
were in treatment at the time of their death (Shaffer et al.,
1996). According to Gray and colleagues (2002), govern-
ment agency data revealed that only 1% of youth suicide
completers were in public mental health treatment at the
time of their suicide, and only 3% of youth suicide com-
pleters had detectable levels of psychotropic medication in
their blood sample at autopsy. From 1952–1995, the inci-
dence of suicide among adolescents nearly tripled; howev-
er, rates began to level off in the mid 1990s, and are begin-
ning to decline (Centers for Disease Control and Preven-
tion, 2003). Interestingly, this change in suicide rate coin-
cides with the rapid increase in use of antidepressants and
mood stabilizers in children and adolescents (Olfson et al.,
1998). In Sweden, there was a 25% reduction in the overall
suicide rate, which accompanied a four-fold increase in an-
tidepressant use (Isacsson, 2000; Isacsson, Holmgran, Dru-
id, and Bergman, 1997). While there is no proof of a causal
relationship between the use of antidepressants or mood
stabilizers and a decrease in suicide completion, other
known factors affecting suicide completion rates such as
divorce or substance abuse were unchanged (Gould,
Greenberg, Velting, & Shaffer, 2003; Shaffer & Craft,
1999). Moskos and colleagues (2002) conducted a study of
parent and community contacts of teen suicide completers
and found that a lack of appropriate treatment, or compli-
ance with treatment (i.e., use of psychotropic medications)
for mental illness, leads to suicide completion rather than
mental illness alone. Additionally, parents identified the
stigma of mental illness and the denial of mental illness as
the most significant barriers between teen suicide complet-
ers and treatment (Moskos, Achilles, Keller, Workman, &
Gray, 2002). More recently, a study by Olfson and col-
leagues (2003) examined the relationship between regional
changes in antidepressant medication treatment and suicide
rates in the United States, and reported a relationship be-
tween increased antidepressant use and decreased suicide
rates, especially among teenage males. Psychotropic med-
ications can ameliorate symptoms, reduce disability, short-
en the course of several psychological disorders, and pre-
vent relapse (World Health Organization, 2001). However,
in the United States (Druce, Hoff, & Rosenheck, 2000) and
Finland (Laukkala et al., 2001), while there has been a sev-
eral fold increase in antidepressant use in the general pop-
ulation, most individuals with major depression remain un-
treated. Undertreatment is more prevalent among children
and adolescents than young adults (Haarasilta, Marttunen,
Kaprio, & Aro, 2003). A limiting factor in treating psychi-
atric disorders is the lack of psychopharmacologic studies
with children and adolescents. While some psychotropic
medications (i.e., antidepressants) have FDA approved
uses in the pediatric population, many medications ap-
proved for adults are yet to receive adequate trials in
younger age groups. The lack of empirically-based studies,
which exist but were not made public due to proprietary
issues (Zito, Derivan, & Greenhill, 2004), has led to some
controversy regarding the use of certain Selective Seroto-
nin Reuptake Inhibitors (SSRIs) to treat depression in chil-
dren and adolescents (Sood, Weller, & Weller, 2004).
Recommendations
The association between the increase of antidepressant use
and decrease of suicide rates warrants further examination.
We recommend government intervention to require phar-
maceutical companies to study new psychotropic medica-
M.A. Moskos et al.: Adolescent Suicide Myths in the United States 179
© 2004 Hogrefe & Huber Publishers Crisis 2004; Volume 25 (4): 176–182
tions in pediatric populations, and to inform the public of
their findings before these drugs come to public market
(Zito et al., 2004). More research into biological and psy-
chosocial aspects of mental health is necessary to increase
the understanding of the cause, course, and outcomes of
mental illness and to develop more effective treatment op-
tions (World Health Organization, 2001). We also recom-
mend that all pediatric psychopharmacologic studies be
published, including studies with negative results (Whit-
tington et al., 2004; Zito et al., 2004). Public awareness of
the available treatments for psychiatric disorders is vital. It
may not be the mental illness itself, but rather the lack of
treatment or compliance with treatment, which may lead to
suicide completion. Barriers to treatment for mental illness
must be addressed if the teen suicide rate is to be reduced.
These include denial of mental illness, stigma, mental
health insurance parity, and other barriers. Public aware-
ness can reduce the stigma of both the diagnosis and treat-
ment of mental illness (World Health Organization, 2001).
Conclusion
Unfortunately, the six myths of teen suicide outlined above
indicate that evidence-based information is still needed to
combat the high teen suicide rate in the United States. Psy-
chiatric illnesses are often viewed differently from other
medical problems. Research should precede any public
health effort, so that prevention programs can be designed,
implemented, and evaluated appropriately. Too often sui-
cide prevention programs do not use evidence-based re-
search or practice methodologies. More funding is warrant-
ed to continue evidence-based studies in suicide. In accord
with the United States Surgeon General, we support the
position that the public should view mental illness or sub-
stance abuse disorders as a real illness. Public awareness
could close the gap in the perception of mental illness and
physical illness as two distinct separate issues. Increased
public awareness regarding the frequency, treatment, and
recovery process of mental illness, and the human rights of
people with mental illness could reduce barriers to treat-
ment and care (World Health Organization, 2001). Suicidal
persons with underlying mental illness who are seeking
mental health treatment should be viewed as persons who
are pursuing basic health care. Concomitantly, the United
States Surgeon General reports that our nation is facing a
public health crisis in pediatric mental health. This is of
importance for pediatric populations because untreated
mental illness is a known risk factor for youth suicide
(Satcher, 2001). According to the World Health Organiza-
tion (2001), countries have the responsibility to give prior-
ity to mental health in their health planning, as enlightened
mental health policy, legislation, professional training, and
sustainable fiscal resources will facilitate the delivery of
the appropriate mental health services to those who need
them at all levels of health care.
References
Agerbo E, Nordentoft M, Mortensen P. Familial, psychiatric, and
socioeconomic risk factors for suicide in young people: Nest-
ed case-control study. British Medical Journal 2002; 325:
1–5.
Andrus JK, Fleming DW, Heumann MA, Wassell JT, Hopkins
DD, Gordon J. Surveillance of attempted suicide among ado-
lescents in Oregon, 1988. American Journal of Public Health
1991; 81: 1067–1069.
Arias E, Anderson R, Kung H, Murphy S, Kochanek K. Deaths:
final data for 2001. Hyattsville, MD: National Center for
Health Care Statistics, American Association of Suicidology,
2003.
Aseltine RJ, DeMartino R. (2004). An outcome evaluation of the
SOS suicide prevention program. American Journal of Public
Health 2004; 94: 446–451.
American Psychiatric Association, A.P. Practice guideline for the
assessment and treatment of patients with suicidal behavior.
American Journal of Psychiatry 2003; 160(11): 1–60.
Birkhead G, Galvin V, Meehan P, O’Carroll P, Mercy J. The emer-
gency department in surveillance of attempted suicide: Find-
ings and methodologic considerations. Public Health Reports
1993; 108: 323–331.
Brent D, Baugher M, Brimaher B, Kolko D, Bridge J. Compliance
with recommendations to remove firearms in families partic-
ipating in a clinical trial for adolescent depression. Journal of
the American Academy of Child and Adolescent Psychiatry
2000; 39: 1220–1226.
Brent D, Perper J, Goldstein C. Risk factors for adolescent suicide:
A comparison of adolescent suicide victims with suicidal in-
patients. Archives of General Psychiatry 1988; 45: 581–588.
Brent D, Perper J, Moritz G. Psychiatric risk factors for adolescent
suicide: A case-control study. Journal of the American Acad-
emy of Child and Adolescent Psychiatry 1993; 32: 521–529.
Brent D, Perper JA, Moritz G, Liotus L, Schweers J, Balach L, et
al. Familial risk factors for adolescent suicide: A case-control
study. Acta Psychiatrica Scandinavica 1994; 89: 52–58.
Canetto SS. Meanings of gender and suicidal behavior during
adolescence. Suicide and Life Threatening Behavior 1997; 27:
339–351.
Cantor C. Suicide in the western world. In K Hawton and K van
Heeringen (Eds.), The international handbook of suicide and
attempted suicide (pp. 9–28). New York: Wiley, 2000.
Centers for Disease Control and Prevention, N. Programs for the
prevention of suicide among adolescent and young adults.
Atlanta: National Center for Injury Prevention and Control,
Centers for Disease Control, 1994.
Centers for Disease Control and Prevention, N. Suicide among
black youths United States, 1980–1995. Morbidity and Mor-
tality Weekly Report 1998; 27(10).
Centers for Disease Control and Prevention, N. Web-based injury
statistics query and reporting system (WISQARS) 2003.Re-
trieved March 27, 2003.
Christoffel K. Commentary: When counseling parents on guns
doesn’t work: Why don’t they get it? Journal of the American
Academy of Child and Adolescent Psychiatry 2000; 39: 1226–
1228.
Druce B, Hoff R, Rosenheck R. Underuse of antidepressants in
major depression: Prevalence and correlates in a national sam-
ple of young adults. Journal of Clinical Psychiatry 2000; 61:
234–239.
Etzersdorfer E, Sonneck G. Preventing suicide by influencing
180 M.A. Moskos et al.: Adolescent Suicide Myths in the United States
Crisis 2004; Volume 25 (4): 176–182 © 2004 Hogrefe & Huber Publishers
mass-media reporting. Archives of Suicide Research 1998; 4:
67–74.
Gould M. Suicide and the media. In H. Hendin & J. Mann (Eds.),
The clinical science of suicide prevention (pp. 200–224). New
York: Annals of the New York Academy of Sciences, 2001.
Gould M, Fisher P, Parides M, Flory M, Shaffer D. Psychosocial
risk factors of child and adolescent completed suicide. Archive
of General Psychiatry 1996; 53: 1155–1162.
Gould M, Greenberg T, Velting D, Shaffer D. Youth suicide risk
and preventive interventions: A review of the past 10 years.
Journal of the American Academy of Child and Adolescent
Psychiatry 2003; 42: 386–405.
Gould M, Kramer R. Youth suicide prevention. Suicide and Life
Threatening Behavior 2001; 31(Suppl.): 6–31.
Gould M, Wallenstein S, Kleinman M, O’Carroll P, Mercy J. Sui-
cide clusters: An examination of age-specific effects. Ameri-
can Journal of Public Health 1990; 80: 211–212.
Gray D, Achilles J, Keller T. Utah youth suicide study, phase I:
Government agency contact before death. American Academy
of Child and Adolescent Psychiatry 2002; 41: 427–434.
Grossman D. Risk and prevention of youth suicide. Pediatric An-
nals 1992; 21: 448–454.
Haarasilta L, Marttunen M, Kaprio J, Aro H. Major depressive
episode and health care use among adolescents and young
adults. Social Psychiatry and Psychiatry Epidemiology 2003;
38: 366–372.
Hazell P. Adolescent suicide clusters: Evidence, mechanisms, and
prevention. Australia and New Zealand Journal of Psychiatry
1993; 27: 653–665.
Hazell P, King R. Arguments for and against teaching suicide
prevention in schools. Australia and New Zealand Journal of
Psychiatry 1996; 30: 633–642.
Isacsson G. Suicide prevention: A medical breakthrough. Acta
Psychiatrica Scandinavica 2000; 102: 113–117.
Isacsson G, Holmgran P, Druid H, Bergman U. The utilization of
antidepressants – a key issue in the prevention of suicide: An
analysis of 5281 suicides in Sweden during the period
1992–1994. Acta Psychiatrica Scandinavica 1997; 96: 94–
100.
Kachur S, Potter L, James S, Powell K. Suicide in the United States
1980–1992 (No. 1). Atlanta: Centers for Disease Control,
1995.
Laukkala T, Isometsa E, Hamalainen J, Heikkinen M, Lindeman
S, Aro H. Antidepressant treatment of depression in the Finn-
ish general population. American Journal of Psychiatry 2001;
158: 2007–2079.
Leenaars A, Moksony F, Lester D, Wenckstern S. The impact of
gun control (Bill C-51) on suicide in Canada. Death Studies
2003; 27: 103–124.
Mancinelli W. Mass suicide: Historical and psychodynamic con-
siderations. Suicide and Life Threatening Behavior 2002; 32:
91–100.
Maris R. Suicide. The Lancet 2002; 360: 319–326.
Maris R, Berman A, Silverman M. Comprehensive textbook of
suicidology. New York: Guilford, 2000.
McIntosh J. USA suicide: 2001 official final data. Washington,
DC: American Association of Suicidology, 2003.
McKeown R, Garrison C, Cuffe S, Waller J, Jackson K, Addy C.
Incidence and predictors of suicidal behaviors in a longitudi-
nal sample of young adolescents. Journal of the American
Academy of Child and Adolescent Psychiatry 1998; 37: 612–
619.
Institute of Medicine, I.o. Reducing suicide: A national impera-
tive
. Washington, DC: The National Academies Press, 2002.
Moscicki EK. Gender differences in completed and attempted
suicides. Annals of Epidemiology 1994; 4(2): 152–158.
Moskos M, Achilles J, Keller T, Workman J, Gray D. Utah youth
suicide study: Contacts before death, barriers to treatment.
Paper presented at the Scientific Proceedings of the 49th An-
nual Meeting of the American Academy of Child and Adoles-
cent Psychiatry, San Francisco, California, 2002.
Olfson M, Marcus S, Pincus H, Zito J, Thompson J, Zarin D.
Antidepressant prescribing practices of outpatient psychia-
trists. Archives of General Psychiatry 1998; 55: 310–316.
Roy A, Segal N, Centerwall B, Robinette C. Suicide in twins.
Archives of General Psychiatry 1991; 48(1): 29–32.
Satcher W. National strategy for suicide prevention: Goals and
objectives for action. Washington: SAMHSA, CDC, NIH,
HRSA, 2001.
Schmidtke A, Hafner H. The Werther effect after television films:
New evidence for an old hypothesis. Psychological Medicine
1988; 18: 665–676.
Schulsinger F, Kety S, Rosenthal D, Wender P. A family study of
suicide. In Schou M & Stromgren E (Eds.), Origin, preven-
tion, and treatment of affective disorders. London: Academic
Press, 1979.
Shaffer D. The epidemiology of teen suicide: An examination of
risk factors. Journal of Clinical Psychiatry 1988; 49: 36–41.
Shaffer D, Craft L. Methods of adolescent suicide prevention.
Journal of Clinical Psychiatry 1999; 60(Suppl. 2): 70–74.
Shaffer D, Garland A, Vieland V, Underwood M, Busner C. The
impact of curriculum-based suicide prevention programs for
teenagers. Journal of the American Academy of Child and
Adolescent Psychiatry 1991; 30: 588–596.
Shaffer D, Gould M, Fisher P, Trautman P, Moreau D, Kleinman
M, et al. Psychiatric diagnosis in child and adolescent suicide.
Archive of General Psychiatry 1996; 53: 339–348.
Sonneck G, Etzersdorfer E, Nagel-Kuess S. Imitative suicide on
the Viennese subway. Social Science and Medicine 1994; 38:
453–457.
Sood A, Weller E, Weller R. SSRIs in children and adolescents:
Where do we stand? Current Psychiatry 2004; 3(3): 83–89.
Spirito A, Overholser J, Ashworth S, Morgan J, Benedict-Drew C.
Evaluation of a suicide awareness curriculum for high school
students. Journal of the American Academy of Child and Ad-
olescent Psychiatry 1988; 27: 705–711.
Weber W. EU calls for action to prevent youth suicide. Lancet
2000; 356: 1090.
Whittington C, Kendall T, Fonagy P, Cottrell D, Cotgrove A, Bod-
dington E. Selective serotonin reuptake inhibitors in child-
hood depression: A systematic review of published versus
unpublished data. Lancet 2004; 363(9418): 1341–1345.
World Health Organization, W.H. Prevention of suicide: Guide-
lines for the formulation and implementation of national strat-
egies. Geneva: World Health Organization, 1996.
World Health Organization, W.H. Mental health: New understand-
ing, new hope. Geneva: World Health Organization, 2001.
Zamekin A, Alter MR, Yemini T. Suicide in teenagers: Assess-
ment, management, and prevention. Journal of the American
Medical Association 2001; 286: 3120–3125.
Zito J, Derivan A, Greenhill L. Making research data available; an
ethical imperative demonstrated by the SSRI debate. Journal
of the American Academy of Child and Adolescent Psychiatry
2004; 43: 512–514.
M.A. Moskos et al.: Adolescent Suicide Myths in the United States 181
© 2004 Hogrefe & Huber Publishers Crisis 2004; Volume 25 (4): 176–182
About the authors:
MichelleAnn Moskos, PhD, MPH, is currently a Research Instruc-
tor at the Intermountain Injury Control Research Center through
the Department of Pediatrics at the University Of Utah School Of
Medicine. Dr. Moskos serves as a consulting epidemiologist for
the Utah Department of Health, the American Association of Sui-
cidology, and the National Suicide Prevention Resource Center.
She has presented at several national conferences as the Co-Prin-
cipal Investigator for the Utah Youth Suicide Study since 2001.
Jennifer Achilles, MA is a fourth-year medical student at the Uni-
versity of Utah School of Medicine. Ms. Achilles was the Study
Coordinator and managed the day-to-day operations of the Utah
Youth Suicide Study from 1992–2001. She has presented at na-
tional conferences and has co-authored several articles on youth
suicide.
Doug Gray, MD is a child and adolescent psychiatrist and an As-
sistant Professor in the Department of Psychiatry at the University
of Utah School of Medicine. For the last 12 years, Dr. Gray has
served as the Principal Investigator for the Utah Youth Suicide
Study. Dr. Gray is the Director of Outpatient Child Psychiatry
Clinical Services at the University of Utah Neuropsychiatric In-
stitute. Dr. Gray is the Chair for the Utah Youth Suicide Task Force.
Address for correspondence:
Michelle Moskos
615 Arapeen Drive Suite 202
Salt Lake City, UT 84102
USA
Tel. +1 801 585-9511
E-mail michelle.moskos@hsc.utah.edu
182 M.A. Moskos et al.: Adolescent Suicide Myths in the United States
Crisis 2004; Volume 25 (4): 176–182 © 2004 Hogrefe & Huber Publishers
... Existen en la literatura previa diferentes programas de prevención desarrollados específicamente para entornos escolares, si bien es cierto, aunque sea sorprendente, que muy pocos trabajos han demostrado evidencias en la reducción de la conducta suicida (por ejemplo, ideación, tenta-pi00355801_09.indd 171 13/3/19 12:55 tiva) (Katz et al., 2013). Se quiera o no, la evidencia científica de estos programas es aún limitada (Bennett et al., 2015;Katz et al., 2013;Robinson et al., 2013;Yonemoto, Kawashima, Endo y Yamada, 2018), siendo el caso que algunos autores consideran un mito que los programas de prevención funcionan (Moskos, Achilles y Gray, 2004). Por ejemplo, existen escasos ensayos controlados aleatorizados y que concedan un nivel alto de evidencia y por tanto recomiendan su uso. ...
... Fatal suicidal behavior tends to have distinct societal, clinical and demographic characteristics from those non-fatal suicidal behaviors (De Leo et. al. 2004, Schmidtke & Lohr, 2004Kerkhof, 2006;Moskos, Achilles & Gray, 2004) Additionally there is a vast amount of epidemiological data that shows a difference in socio-demographics and psychopathological characteristics between individuals who communicate suicidal ideation including those who ideate, attempt suicide, and those who commit suicide (Van Herinegeen, 2002;Rudd, Joiner & Rajab, 1996). On the other hand, others claim that the presence of suicidal ideation in a person's history appears to be a long term predictor of suicide and that socio-demogra-phics of suicide ideators resemble those of attempters (Wiess-man, et al., 1999). ...
Thesis
Full-text available
After the war in 1999, suicide has become one of the major causes of death for youth in Kosova. This study reports on and evaluates the level of reported suicidal ideation and behavior among Kosovar adolescents, and tests relation to demographic variables (gender, rural/urban), self esteem, reported happiness and wellbeing, self-esteem, negative life events (including war events) and coping mechanisms. The interacttion of each variable to reported suicide ideation and suicide behaviour is studied among a representative sample of 2077 male and female Kosovar adolescents with an average age of 17. Results indicate that self esteem, reported happiness and wellbeing are in negative relation to reported suicidal ideation and suicide behavior. The study also learned that emotion coping mechanisms are reported to be used more in stressful situation by adolescents that have reported suicidal ideation and suicide attempt. War events did not appear to be related to reported suicide ideation and behavior, however the reported stressful events after the war show positive relation with reported suicide ideation and suicide behavior. The Multiple regression analysis that for suicidal ideation reveals that wellbeing (and self-esteem coping mechanism factor were highly significant predictors followed by self-blame coping mechanism factor acceptance and venting coping mechanism factor; stressful events after the war; disengagement coping mechanism factor (; suicide in family; active coping and planning coping mechanism coping mechanism factor; humor coping mechanism factor; life happiness. iv these variables accounted for 23.3% or almost 1/5 of variance in the suicide ideation scores. The multiple regression analysis for the suicide behavior reveals that the linear regression analysis of variance revealed 35.3 % more than one third of suicide behavior scores explained by the following predictors: the main predictor was suicide ideation scores ; stressful events after the war; and active coping and planning coping mechanism factor. By entering the suicidal ideation in regression model as a predictor variable, the result was that suicide ideation is an important predictor of the suicide behavior of Kosovar adolescents. The findings from this study inform a tentative model for suicide ideation and behavior for Kosovar adolescents and define further steps for the suicide prevention. Key words: suicide ideation; suicide behavior; self-esteem; negative life events; wellbeing; happiness; post-war. Subject terms: Kosova; adolescents; suicide.
... Akbaba et al. [60] a survey conducted in Turkey showed that suicides were 2.4% of hospital admissions (ICU and clinics). Although, the international literature supported that suicide is one of the leading causes of adolescent death [61]. As far as that concern the gender and specifically for men, the main reason for admission to the ICU was car accidents (64.4%), followed by the pathology problems (12%), postoperative monitoring (6.2%), work accidents (5.6%), crimes (5.3%), drugs (3.6%), and finally the suicide attempt (2.9%) [62]. ...
... Akbaba et al. [60] a survey conducted in Turkey showed that suicides were 2.4% of hospital admissions (ICU and clinics). Although, the international literature supported that suicide is one of the leading causes of adolescent death [61]. As far as that concern the gender and specifically for men, the main reason for admission to the ICU was car accidents (64.4%), followed by the pathology problems (12%), postoperative monitoring (6.2%), work accidents (5.6%), crimes (5.3%), drugs (3.6%), and finally the suicide attempt (2.9%) [62]. ...
Article
Full-text available
Abstract Background: The most powerful of instincts is that of survival. The primary concern of human being is staying alive in every way. Many times it is characteristic the agonizing, people attempt survival when they faced with risks to life, serious illness, old age, even when death seems inevitable. But in all cultures and in all historical periods have been and there are still cases of people who at some point decide to terminate their existence. The purpose of this special article is to examine the risk factors such as age, race, marital status and religion-related suicides. Understanding these factors associated with suicide are deemed useful and necessary. Methods: Literature review studies, articles have been recovered for review of computer searches. No time limit was set. Used those articles written in Greek and English. Conclusion: The involvement of risk factors such as age, race, marital status and religion-related suicides play an important role in suicide event. Future efforts must focus on the development, prevention and treatment protocols of suicide in Primary Care. Medical and nursing staff in the Intensive Care Units must be aware of their attitudes towards the patients that have committed suicide as part of their therapeutic role. Keywords: Suicide; Risk factors; Primary care; Intensive care unit
... Suicidologists recommend that effective schoolbased suicide prevention programs should use evidence-based screening tools to identify youth at risk, and linkage screening program to effective management and referral system. (Moskos et al., 2004). Early identification of suicidal adolescents is a priority in suicide prevention (Zhang et al., 2014)and suicide assessment measures represent a way of quantifying suicide risk (Warden et al., 2014). ...
... Capuzzi (2002) cautioned that the actions of school counsellors are sometimes shaped by misinformation and myths about suicide. Common myths include the belief that talking to youths about suicide may increase its incidence (Kalafat, 2003;Leenaars and Wenckstern, 1999), that suicide is caused by social and familial stressors rather than mental illness (Moskos, Achilles and Gray, 2004), and that little can be done to prevent suicide once an individual decides to complete suicide (King et al., 1999). The risk factor model is a common approach to conceptualising suicide (Sanchez, 2001). ...
Article
Full-text available
Youth suicidal behaviour poses a significant public health concern. Mental health care professionals working in schools have an important role to play in youth suicide prevention initiatives, although little is known of the experiences of this group of professionals in low and middle income countries (LMIC’s). The aim of this study was to explore the experiences of mental health professionals working in South African schools and to document their insights, attitudes and beliefs regarding youth suicidal behaviour. In-depth semi-structured interviews were conducted with seven school-based mental health care professionals and data were analysed using Thematic Analysis. Participants reported that they relied on a reactive strategy by responding to youths who were in crisis. They were challenged by a lack of support from faculty staff, a lack of access to resources, and heavy caseloads. Findings highlight the need for a proactive and collaborative approach to suicide prevention among mental health care professionals, teachers and parents in South African schools and improved training and supervision.
Article
Full-text available
India is having highest suicide ratein the world the reason is lack of economic social or emotional resource to combatit. Suicide is a desperate attempt to escape suffering, it is blinded by the feelings of hopelessness and isolation and it is a serious adolescent problem.The paper tries to analyze the reasons for Teenage suicides and suggests ways and means to overcome it.Teenagers are emotionally turbulent and the face stress and turmoil to succeedin their life and this is a resulting to suicides.Academic pressure, workplace stress, social pressures, modernization, breakdown of family support, urbanization and breakdown of the traditional family support system relationship concerns,Generation gap issues coupled with the class of values within the family are few of the causes.Despite the high number of the adolescent victims, suicide prevention has not been discussed as a major social problem in our country. EmileDurkheim (1966) describes suicide as oneof thecrudest expression of the social phenomena and women are more likely to make and attempt over men.Suicidalbehavior is a result of the socio-culture developmentalpsychological circumstances.In recent days online education has put the students to extreme stress and depression especially in the rural areas where there is a digital divide.The paper highlights how stress management and counseling can prevent suicides.Aquestionnaire with the 10 questions was given to over 120 students studying in the degree college of Mahabubabad district as a part of our case study and the © 2022 IJNRD | Volume 7, Issue 4 April 2022 | ISSN: 2456-4184 | IJNRD.ORG IJNRD2204010 International Journal of Novel Research and Development (www.ijnrd.org) 96 findings and perceptions of the students with the regard to suicide and counseling are submitted through this paper. Objective: Suicide rates in young people have increased during the past three decades, particularly among youth, and there is alarming public and policy concern about the issue of youth suicide in India. This paper summarizes current knowledge about risk factors for suicide and suicide attempts in young people. The paper also discusses how parents, teachers, and friends can act as supporting network to prevent suicides. It emphasizes the importance of establishing counseling centres in the colleges. It also discusses how Stress and Depression can be managed in adolescent age. Introduction:
Article
Youth suicidal behavior continues to be a significant national problem in need of urgent attention by school personnel. The purpose of this introductory article to the special series is to provide an overview of youth suicidal behavior, including research-based information on demographic data; risk factors and warning signs; and where, when, and how youth suicidal behavior typically occurs. Common myths and current controversies about youth suicide are also discussed, as are the implications of youth suicidal behavior for school-based practice. A brief discussion of current research gaps and needs is provided, as well as an introduction to the other articles in the special series on school-based suicide prevention.
Article
Adolescents who kill themselves invariably have an underlying psychiatric disorder. Biological markers are not yet clinically useful for identifying adolescents at risk, and there is a paucity of research data on the effectiveness of behavioral intervention for suicidal teenagers. A case of a 16-year-old scholar and athlete is presented to illustrate how multiple risk factors and a family diathesis often go undetected, resulting in tragic consequences. Psychiatric, familial, genetic, and social risk factors of adolescent suicide are reviewed, and the efficacy of lithium and antidepressant pharmacotherapy in reducing suicide rates is discussed. The importance of screening adolescent patients for depression is emphasized. Although teenage suicide is rare and hard to predict, identifying and treating adolescents at risk is essential to further reduce teenage suicide.
Article
Background: The age, sex, and ethnic distribution of adolescents who commit suicide is significantly different from that of the general population. The present study was designed to examine psychiatric risk factors and the relationship between them and demographic variables.Methods: A case-control, psychologic autopsy study of 120 of 170 consecutive subjects (age, <20 years) who committed suicide and 147 community age-, sex-, and ethnic-matched control subjects who had lived in the Greater New York (NY) area.Results: By using parent informants only, 59% of subjects who committed suicide and 23% of control subjects who met DSM-III criteria for a psychiatric diagnosis, 49% and 26%, respectively, had had symptoms for more than 3 years, and 46% and 29%, respectively, had had previous contact with a mental health professional. Best-estimate rates, based on multiple informants for these parameters, for suicides only, were 91%, 52%, and 46%, respectively. Previous attempts and mood disorder were major risk factors for both sexes; substance and/or alcohol abuse was a risk factor for males only. Mood disorder was more common in females, substance and/or alcohol abuse occurred exclusively in males (62% of 18-to 19-year-old suicides). The prevalence of a psychiatric diagnosis and, in particular, substance and/or alcohol abuse increased with age.Conclusion: A limited range of diagnoses—most commonly a mood disorder alone or in combination with conduct disorder and/or substance abuse—characterizes most suicides among teenagers.
Article
• The characteristics of adolescent suicide victims (n = 27) were compared with those of a group at high risk for suicide, suicidal psychiatric inpatients (n = 56) who had either seriously considered (n = 18) or actually attempted (n = 38) suicide. The suicide victims and suicidal inpatients showed similarly high rates of affective disorder and family histories of affective disorder, antisocial disorder, and suicide, suggesting that among adolescents there is a continuum of suicidality from ideation to completion. However, four putative risk factors were more prevalent among the suicide victims: (1) diagnosis of bipolar disorder; (2) affective disorder with comorbidity; (3) lack of previous mental health treatment; and (4) availability of firearms in the homes, which taken together accurately classified 81.9% of cases. In addition, suicide completers showed higher suicidal intent than did suicide attempters. These findings suggest a profile of psychiatric patients at high risk for suicide, and the proper identification and treatment of such patients may prevent suicide in highrisk clinical populations.
Article
• Suicide appears to cluster in fanmilies, suggesting that genetic factors may play a role in this behavior. We studied 176 twin pairs in which one or both twins had committed suicide. Seven of the 62 monozygotic twin pairs were concordant for suicide compared with two of the 114 dizygotic twin pairs (11.3% vs 1.8%). The presence of psychiatric disorder in the twins and their families was examined in a subsample of 11 twin pairs, two of whom were concordant for suicide. Eleven of these 13 twin suicide victims had been treated for psychiatric disorder, as had eight of their nine surviving cotwins. In addition, twins in 10 pairs had other first- or second-degree relatives who had been treated for psychiatric disorder. Thus, these twin data suggest that genetic factors related to suicide may largely represent a genetic predisposition for the psychiatric disorders associated with suicide. However, they leave open the question of whether there may be an independent genetic component for suicide.
Article
Background: Epidemiologic studies have reported disturbingly low rates of treatment for major depression in the United States. To better understand this phenomenon, we studied the prevalence and predictors of antidepressant treatment in a national sample of individuals with major depression. Method: Between 1988 and 1994, 7589 individuals, aged 17-39 years and drawn from a national probability sample, were administered the Diagnostic Interview Schedule as part of the National Health and Nutrition Examination Survey. Interviewers asked about prescription drug use and checked medication bottles to record the name and type of medications. Results: A total of 312 individuals, or 4.1% of the sample, met DSM-III criteria for current major depression. Only 7.4% of those with current major depression were being treated with an antidepressant. Among individuals with current major depression, being insured and having a primary care provider each predicted a 4-fold increase in odds of antidepressant treatment; telling the primary provider about depressive symptoms predicted a 10 fold increase in treatment. Conclusion: The study's findings support the notion that a serious gap exists between the established efficacy of antidepressant medications and rates of treatment for major depression in the "real world." Underreporting of depressive symptoms to providers and problems with access to general medical care appear to be 2 major contributors to this problem.
Article
Around 100 studies have been conducted to examine the ‘Werther effect’ – the phenomenon whereby there is an increased rate of completed or attempted suicide following the depiction of an individual’s suicide in the media. These ‘media influence studies’ provide strong evidence for the existence of the Werther effect in the news media, and equivocal evidence for its existence in the entertainment media. Having established this, there is now a need to complement these media influence studies with inter-related studies that draw on approaches from a range of disciplines, particularly that of communication. The studies can be thought of as investigating the full spectrum of news and entertainment media processes and content, from how suicide stories are produced (news/entertainment production studies), to what information they contain and how this is framed (content analysis studies), to how this information is received and perceived (audience reception studies). This will assist in explicating the mechanisms by which the Werther effect might operate, and in designing and evaluating interventions to improve the practices of news and entertainment media professionals.