By Lawrence Harmon

Teen suicide’s tragic lure

By Lawrence Harmon

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KAYANA SZYMCZAK FOR THE BOSTON GLOBE

Lila McCain and Brian Douglas, parents of suicide victim Karen Douglas, attended Tuesday’s community meeting at Newton South High School about teen suicide.

IS IT CATCHY?
That question was on the minds of many parents who gathered Tuesday in the auditorium of Newton South High School where they struggled to make sense of the suicides of three teenagers since October. Twenty-seven years ago, almost to the day, an earlier group of parents assembled at Newton North High School to discuss the suicides in close proximity of two local students. Back then, as now, they worried over what is known as “suicide contagion.’’
Many mental health experts reject the notion of suicide contagion. Dr. Susan Swick, chief of child and adolescent psychiatry at Newton-Wellesley Hospital, tried to calm parents’ fears at the assembly. “Suicide is not contagious,’’ she said, while acknowledging it certainly can feel that way. “It’s not like the flu. It’s not norovirus. You can’t catch it,’’ she said. “It doesn’t travel through a community in that way.’’
Still, there is something about dismissing the concept that doesn’t add up. Newton school and health officials have enough on their minds right now. And they are doing a good job of ensuring that counselors are on hand to help anyone who needs it. But after the crisis abates, it may be worth digging deeper into the subject of suicide contagion.

A longitudinal study of students ages 12 to 17 published last year in the Canadian Medical Association Journal concluded that a teen’s suicide can and does prompt suicidal thoughts and behaviors in the student body at large, even two years later. Thirteen-year-old students exposed to a suicide at school were five times more likely to be thinking about suicide or to say they had made an attempt. By age 17, the risk was reduced. But those older students were still twice as likely to think about or attempt suicide. Surprisingly, the effects on the teens were the same regardless of their relationship to the suicide victim.

“Knowing the person does not change the effect,’’ wrote study author Dr. Ian Colman. “It therefore suggests that just hearing about someone their own age dying of suicide may introduce suicidal thoughts or actions.’’ At the other end of the spectrum, Canadian teens who had no exposure to suicide rarely contemplated or attempted it.
Suicide contagion could explain some startling statistics in the United States. The Centers for Disease Control and Prevention identify suicide as the third leading cause of death for ages 15 to 24. One in five teenagers in the United States seriously contemplates suicide annually, according to its data. About 1 million adolescents — 8 percent — make an attempt. Nearly a third of those require medical attention. And about 1,800 die annually.
In Newton and elsewhere, a teen suicide prompts immediate attention on students who are deemed vulnerable due to a diagnosable mental illness. Mental health experts worry especially that a depressed student might misinterpret glowing memorials to a dead student as a message that suicide is an acceptable or even desirable path. To parents and outsiders, such warnings also sound like efforts to get out in front of suicide contagion by the same experts who deny its existence. It’s just confusing.
Dr. Douglas Jacobs, a Harvard-affiliated psychiatrist and national expert on suicide, stressed that teen suicide occurs primarily among a small subset of young people who suffer an underlying psychiatric illness — usually depression. And such illnesses, he said, are often treatable. His excellent advice for friends and family members of young people who express suicidal thoughts: Respond as they would to a choking victim by doing everything in their power to summon medical help.
That’s so sensible on its face. But the Canadian study found no evidence that vulnerable groups of students, including the mentally ill, were affected by a suicide at school to any greater or lesser degree than other students. Might it make more sense or save more lives for health officials to respond to a suicide at a high school by establishing an immediate presence in the middle school, where word of the death will quickly filter down? The Canadian study, after all, made clear that 12- and 13-year-olds are the group at greatest risk of suicide contagion.
The instincts, training, and experience of medical experts tell them to intervene first with depressed students in the event of a school suicide. But the fact that Newton officials are taking pains to provide schoolwide counseling and interventions also tells parents that medical experts recognize the risk to the larger student body. They just can’t seem to call that risk by its proper name: suicide contagion.