How to stop copycat suicides in students

Over the last two months three teenage students from the same Pune school have died by copycat suicide. 'Copycat’ suicides are frequent among adolescents aged 15-19 years. They occur more often than expected by chance alone. There has been an increase in teenage clusters in more recent years (Gould et al1990).

Patterns of ‘copycat’ suicide

There are two patterns of suicide clusters: point clusters, which are localised in both space and time (spatio-temporal), and mass clusters, which are localised in time only.

Point clusters

A point cluster is a temporary increase in the frequency of suicides within a small community or institution like a school or hospital. This differentiation is important as even limited resources can be effectively mobilised for prevention.

Mass cluster

A mass cluster is a temporary increase in the frequency of suicides within an entire population. Mass clusters are typically associated with high-profile celebrity suicides that are publicised and disseminated in the mass media. Prevention here is mainly by media restraint.

This article is concerned with point cluster copycat suicides that occur in schools.

Causes of ‘copycat’ suicide

Modelling

One of the causes of suicide is social learning. ‘Copycat’ suicides are caused at least in part by exposure to another individual's suicide and through the imitation of suicidal behaviour. Suicide modeling is a real phenomenon and there is ample evidence of its impact on suicide clusters (Mesoudi 2009, Insel and Gould 2003).

Homophily

Point clusters may also occur due to of homophily, the tendency for individuals with similiar interests and outlook to preferentially associate with one another. Students who are have poor academic performance, are delinquent or abuse drugs tend to associate together. These high-risk clusters may form suicide clusters due to each member's independently high risk of suicide (Joiner 1999).

Poverty

Community household poverty increases the risk of adolescent suicidal behavior. These communities place adolescents at a higher risk for associating with suicidal others. Adolescents brought up in poor communities would thus be subjected to the processes of both homophily and social modelling for suicide behaviour (Bernburg JG et al 2009 ).

Prevention of copycat suicide

One suicide in the school is tragic by itself. However, given the tendency for teenage suicides to occur in clusters urgent action needs to be taken to prevent further deaths. Successful suicide prevention programs have three general strategies - universal, selected and indicated. (Goldsmith et al 2002).

Universal approaches

These are strategies that target the entire school population. What the school does after the index suicide is important for prevention of point cluster suicides (Doan et al 2003).　
DO

• Respond within 24 hours of the suicide
• Show concern and empathy
• Inform all staff members about the suicide and provide a debriefing session where staff may voice their concerns, apprehensions, and any questions they may have.
• Inform school board members
• Ensure all teachers announce the death of the student by suicide to their first class of the day
• Provide counseling sites throughout the school for students
• Assign a school liaison to handle all media inquiries in order to avoid sensationalistic stories concerning the suicide
• Monitor the school’s emotional climate (Has there been an increase in fights or school delinquency following a death by suicide?).
• Evaluate all activities done following a death by suicide (How did your school respond? What worked and what did not work?).
• Utilize an established linkage system or community network in order to make referrals to the appropriate services as well to exchange information concerning the appropriate steps for treating those affected by the suicide.
• Utilize an established school response crisis team, which should include a diverse group of school professionals, such as the principal, counselor, teacher and possibly the school nurse.

DON'T

A major aspect of preventing cluster suicides lies in not glamourising or memorialising the act in any way. This would include attention to points as below.

• DON'T plant a tree or object in order to honor the student.
• DON'T hold a memorial service for the student at the school.
• DON'T describe in great detail the suicide (method or place).
• DON'T dramatise the impact of suicide through descriptions and pictures of grieving relatives, teachers or classmates.
• DON'T glamorise or sensationalise the suicide.

Selected approaches

Further specific strategies are for at-risk student groups. This would include screening and counselling of the student's known friends and group. Other at-risk children such as those with a previous history of attempted suicide, those known to have mood disorders, or substance use problems should also be specifically screened.

Indicated approaches

Students who show signs of suicidal potential should not be left alone. They should be given empathic support until they can be assessed by a psychiatrist, psychologist or counsellor and more definitive measures instituted. The signs of suicide potential include

• statements about suicide or that things would be better if the student was dead
• talking or writing about death, dying, or suicide

Every Pune school should have a mechanism in place to deal with the aftermath of student suicide to prevent copycat suicides in teenagers.

References

1. Bernburg JG, Thorlindsson T, Sigfusdottir ID. The spreading of suicidal behavior: The contextual effect of community household poverty on adolescent suicidal behavior and the mediating role of suicide suggestion.Soc Sci Med. 2009 Jan;68(2):380-9. Epub 2008 Nov 18.
2. Doan, J., Roggenbaum, S., & Lazear, K.J. (2003). Youth suicide prevention school-based guide (c/p/r/s)—Checklist 7a: Preparing for and responding to a death by suicide: Steps for responding. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute. (FMHI Series Publication #219-7a).
3. Goldsmith SK, Pellmar TC, Kleinman AM, Bunney WE, eds. Reducing suicide: a national imperative. Washington, DC: National Academy Press; 2002.
4. Insel BJ, Gould MS. Impact of modeling on adolescent suicidal behavior. Psychiatr Clin North Am. 2008 Jun;31(2):293-316.
5. Joiner JTE. The clustering and contagion of suicide. Current Directions in Psychological Science. 1999;8:89–92
6. Mesoudi A. The cultural dynamics of copycat suicide. PLoS One. 2009; 4(9): e7252. Published online 2009 September 30. doi: 10.1371/journal.pone.0007252.