Suicide contagion: What we know and what we don't

The apparent suicide of star chef, author and TV host Anthony Bourdain comes just days after another celebrity, designer Kate Spade, killed herself.

With suicide having a known “contagion effect,” the incidence of two celebrity suicides in one week raises the question of whether that could have been at play here: Did news coverage of the fashion designer’s death have any influence on Bourdain’s? And could more suicides follow his?

In the month after Marilyn Monroe died from a barbiturates overdose in 1962, there was bump in suicide deaths by as much as 12 percent, according to the Center for Suicide Prevention. The movie star's death was initially ruled a suicide but later accounts have raised questions about that conclusion.

In another famous case, after the media reported on people in Vienna, Austria, killing themselves by throwing themselves in front of trains, more people did the same thing. National guidelines were implemented on suicide coverage in the media, after which suicide rates plummeted by as much as 81 percent, according to studies.

What is suicide contagion?

Suicide contagion refers to the phenomenon of indirect exposure to suicide or suicidal behaviors influencing others to attempt to kill themselves.

But the question of whether this effect even exists remains controversial among researchers; suicidal thoughts and behaviors, after all, are not a contagious condition, like a virus.

There is agreement on many researchers, however, that publicity around a suicide can increase the risk of other suicides.

Three main areas of research are attempting to unravel suicide contagion: How does a suicide affect the person's peers or family? What impact might news coverage of a suicide have on other people's trying or committing suicide? What possible influence might there be from fictional suicides in movies or television shows like “13 Reasons Why,” or from music lyrics.

Any potential increase in suicides following media stories is nicknamed the “Werther effect,” dating back to fears of contagious suicides after publication of Goethe's novel, "The Sorrows of Young Werther," which detailed a character’s suicide. That was close to 250 years ago, in 1774.

Suicide contagion accounts for at least 5 percent of youth suicides each year, according to Madeyln Gould, professor of epidemiology and psychiatry at Columbia University, who specializes in suicide-prevention strategies.

A study by the American Foundation for Suicide Prevention found that news coverage of suicide likely plays a role in approximately 10 percent of the suicide deaths of people younger than 25.

What is a suicide cluster?

A cluster is when multiple suicides or attempted suicides happen around the same time -- typically within a three-month period -- and sometimes around a certain location, such as in one town or high school.

Clusters occur mainly among teenagers and young adults. Gould of Columbia University has studied at least 50 suicide clusters around the U.S., and in her book, “The Contagion of Suicidal Behavior,” says the only connecting threads in each case is that those committing suicide are close in age.

What factors increase the risk of suicide?

Risk of suicide increases when media stories use more dramatic or graphic headlines or images, repeatedly report on the same suicide, explicitly describe the suicide method, and dramatize the death through romanticized headlines or by showing the site of the suicide and pictures of those who are grieving, the American Foundation for Suicide Prevention says.

Suicides by celebrities are more likely than those by the not famous to spur imitation. One meta-analysis looking at 10 studies of the aftermath of 98 celebrity deaths found a 0.26 percent rise in suicide rates in the months after celebrities kill themselves.

What can be done to minimize contagion?

Owing to concerns about the possibility of suicide contagion, the Centers for Disease Control and Prevention and others such as the American Foundation for Suicide Prevention have issued media guidelines on how to report on someone's taking their own life.

Guidelines call for avoiding reporting that describes death as an “escape” for a troubled person or that gives sensational or morbid details about the suicide.

Reporting should also not avoid focusing on community expressions of grief and instead highlight suicide warning signs and prevention resources.

All these practices can help minimize any effect from news coverage of suicide.

A key method to try to reduce suicides is to increase screening for those at risk, which can lead to referrals for mental health services. Don’t be afraid to discuss suicide with those at risk – it can help. And many groups advise that media reports should do exactly what we’re about to do here – offer a resource for help:

The National Suicide Prevention Lifeline, 1-800-273-TALK (8255) is a free, 24-hour service that can provide support, information and resources to suicidal persons or those around them.