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Teenage suicide cluster formation and contagion: implications for primary care
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
Division of Forensic Psychiatry, Dept. of Clinical Neuroscience, Karolinska Institute, Stockholm university, Sweden.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
2006 (English)In: BMC Family Practice, ISSN 1471-2296, Vol. 17, no 7, 32- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: We have previously studied unintentional as well as intentional injury deaths among teenagers living in the four northernmost counties, forming approximately 55% of Sweden with 908,000 inhabitants in 1991. During this work, we found what we suspected to be a suicide cluster among teenagers and we also suspected contagion since there were links between these cases. In this present study, we investigate the occurrence of suicide clustering among teenagers, analyze cluster definitions, and suggest preventive measures. METHODS: A retrospective study of teenager suicides autopsied at the Department of Forensic Medicine in Umea, Sweden, during 1981 through 2000. Police reports, autopsy protocols, and medical records were studied in all cases, and the police officers that conducted the investigation at the scene were interviewed in all cluster cases. Parents of the suicide victims of the first cluster were also interviewed. Two aggregations of teenager suicides were detected and evaluated as possible suicide clusters using the US Centers for Disease Control definition of a suicide cluster. RESULTS: Two clusters including six teenagers were confirmed, and contagion was established within each cluster. CONCLUSION: The general practitioner is identified as a key person in the aftermath of a teenage suicide since the general practitioner often meet the family, friends of the deceased, and other acquaintances early in the process after a suicide. This makes the general practitioner suitable to initiate contacts with others involved in the well-being of the young, in order to prevent suicide cluster formation and para-suicidal activities.

Place, publisher, year, edition, pages
2006. Vol. 17, no 7, 32- p.
National Category
Forensic Science
Research subject
Forensic Medicine
URN: urn:nbn:se:umu:diva-12797DOI: 10.1186/1471-2296-7-32PubMedID: 16707009OAI: diva2:152468
Available from: 2007-04-19 Created: 2007-04-19 Last updated: 2013-10-14Bibliographically approved
In thesis
1. Teenager fatalities: epidemiology and implications for prevention
Open this publication in new window or tab >>Teenager fatalities: epidemiology and implications for prevention
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A significant number of teenagers are killed each year by unintentional or intentional injuries. A teenager is in a vulnerable phase of her/his life, going from being a child to adult. This transition often includes testing the limits of their capabilities, which can include, e.g., high speed driving, testing alcohol and other drugs, including drinking and driving. The development from child to adult includes different psychological stress factors, such as, e.g., school problems, broken love affairs and bullying. The demands – perceived or real – also increases over time and vulnerable individuals can turn to self-harm and in the most extreme case suicide.

The aim of this thesis was to investigate teenager fatalities in the northern half of Sweden and to suggest preventive measures.

A survey of teenager fatalities during a twenty-year period revealed that the incidence of unintentional (n=248) deaths decreased, while intentional (n=102) deaths were unaffected over time. Most unintentional deaths were transportation related (n=204) while most of the intentional deaths were suicides (n=88). Twenty-eight percent of the decedents were test-positive for alcohol at autopsy.

In a series of three studies, teenager suicides were investigated in depth, firstly through an interview study with the investigating police officer in charge of the investigation of a teenager suicide. Most of the suicides occurred in rural and depopulated areas despite the fact that most teenagers live in the larger cities along the coastline. A majority of the suicides appeared to be planned. Females, contrary to males, often had a psychiatric history. One of the conclusions was that police officers provide essential information concerning the circumstances around a teenager suicide.

Parents who had lost a child through suicide, and in some cases siblings, were interviewed 15-25 months after the suicide. It was striking how the life of the surviving family members were still affected by the devastating trauma of the suicide; most parents testified that they were still struggling with the question “why?” and that they were thinking of their lost child every day. Post suicide support was often badly timed and insufficient, especially for the younger siblings. The family doctor has an important role as a co-ordinator of a long-term individually formulated support scheme for the bereaved.

Evidence of suicide contagion and suicide cluster formation, i.e., one teenager suicide led to another suicide, was found in these studies, and two suicide clusters were identified, with links between the victims in each cluster. Both clusters occurred within a geographical and timely proximity. Everyone involved in the well-being of the young should be aware of the risk of contagion and suicide cluster formation.

The fifth study concerned 12,812 teenagers who visited the Emergency Room at Umeå University Hospital due to an injury during 1993 through 2006. Sixty-one of these were found dead through 2007, 49 by unnatural (of which 38 were included) and 12 by natural causes. The standard mortality rate for unnatural death was calculated to 1.44 (1.02-1.98), confirming an increased risk of premature death. In many of these deaths, alcohol and drugs may have contributed. By increasing the awareness among health professionals that injury can predict a premature death - primarily among those who develop substance abuse - some premature deaths may be prevented by early intervention.

This thesis confirms that most teenagers die from unnatural causes, mostly in transportation-related events and by suicide. By studying these deaths, preventive measures that could save lives have been suggested.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2010. 56 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1371
Teenager, fatalities, injury, suicide, alcohol, drugs, intoxication, trends
National Category
Forensic Science
Research subject
Forensic Medicine
urn:nbn:se:umu:diva-36682 (URN)978-91-7459-063-0 (ISBN)
Public defence
2010-10-29, Betula, by 6M, Umeå, 15:05 (Swedish)
Available from: 2010-10-11 Created: 2010-10-07 Last updated: 2012-10-09Bibliographically approved

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