A Pilot Case-Control Study of the Social Media Activity Following Cluster and Non-Cluster Suicides in Australia

Social media may play a role in the “contagion” mechanism thought to underpin suicide clusters. Our pilot case-control study presented a novel methodological approach to examining whether Facebook activity following cluster and non-cluster suicides differed. We used a scan statistic to identify suicide cluster cases occurring in spatiotemporal clusters and matched each case to 10 non-cluster control suicides. We identified the Facebook accounts of 3/48 cluster cases and 20/480 non-cluster controls and their respective friends-lists and retrieved 48 posthumous posts and replies (text segments) referring to the deceased for the former and 606 for the latter. We examined text segments for “putatively harmful” and “putatively protective” content (e.g., discussion of the suicide method vs. messages discouraging suicidal acts). We also used concept mapping, word-emotion association, and sentiment analysis and gauged user reactions to posts using the reactions-to-posts ratio. We found no “putatively harmful” or “putatively protective” content following any suicides. However, “family” and “son” concepts were more common for cluster cases and “xx”, “sorry” and “loss” concepts were more common for non-cluster controls, and there were twice as many surprise- and disgust-associated words for cluster cases. Posts pertaining to non-cluster controls were four times as receptive as those about cluster cases. We hope that the approach we have presented may help to guide future research to explain suicide clusters and social-media contagion.

Identifying a probable suicide cluster in an acute care psychiatric hospital in the Eastern Cape, South Africa

Background: Two young male patients who were diagnosed with drug-induced psychosis committed suicide in a psychiatric hospital in South Africa within a month of each other. The psychiatric nurses working in the hospital had never before had to deal with a similar trauma of suicide cluster.Aim: To assess the psychiatric nurses’ experiences of suicide cluster in an inpatient psychiatric setting.Setting: A psychiatric hospital in the Eastern Cape, South Africa.Method: A qualitative design was used. The research population consisted of psychiatric nurses who were purposively selected. Data were gathered using in-depth interviews where the participants narrated their experiences of the incidents. The interviews were transcribed verbatim and the data was coded using descriptive and explanatory codes. Trustworthiness was ensured. Ethical principles of justice, autonomy, beneficence and non-maleficence were ensured.Results: An attempt was made to compare the suicides of two patients with the characteristics of cluster suicide to determine if clustering took place. Two young males committed suicide in an institutional setting within a month of each other. Other characteristics present included using the same method, in the same venue and in the same unit. They had similar educational and social backgrounds. The second victim knew the first victim and was aware of what happened.Conclusion: When the two events are analysed together it would seem as if clustering did occur. The suicide victims knew each other and victim number 2 was aware of the facts of the first suicide. They were in their early 20’s, were mentally ill and committed suicide in the same site, using the same method and were both institutionalised at the time. Members of the mental healthcare team should be made aware of the characteristics of clustering so that when a suicide attempt occurs in a place where mentally-ill individuals are cared for, measures can be put in place to prevent another patient from copying such an event.

A Content Analysis and Comparison of Two Peaks of Newspaper Reporting During a Suicide Cluster to Examine Implications for Imitation, Suggestion, and Prevention

Background: During 2007–2008, media attention focused on a cluster of youth suicides in the UK. There were two peaks (P1, P2) in the volume of newspaper reporting of the deaths. The number of possible suicides was greater than expected at the time of the first peak but not at the time of the second. Aims: To explore any differences in the content of the reporting peaks and to consider implications for imitation and prevention. Method: A content analysis of two peaks of newspaper reporting was conducted. Results: There were 204 articles in P1 (December 27, 2007 to February 19, 2008) and 157 in P2 (February 20, 2008 to March 15, 2008). Four main themes were identified: individual stories; possible causes; features of reporting of the cluster; and educating and informing the public. P1 articles more frequently contained: explicit details of method; photographs of the deceased, and contained more characterization of individuals. Limitations: The focus was on print media, future studies should incorporate online and social media content. Conclusion: The findings provide some support for the hypothesis of a process of suggestion initiated by sensationalist reporting in P1. This contributes to the evidence base of the role of the press in suicide imitation and prevention, highlighting the importance of care when reporting suicides.

A Community-Based Response to a Suicide Cluster

Background: A 45-month community-based suicide prevention program was launched in response to the emergence of a suicide cluster in 2010 in Hong Kong. Aims: This study aimed to evaluate the effectiveness of the program, document the implementation and outcomes of the project, and identify factors that contribute to the outcomes. Method: The program was delivered following the five key components of the public health approach: (a) community consensus building; (b) surveillance and monitoring; (c) development of coordinated action strategies; (d) interventions development and implementation at the universal, selective, and indicated levels; and (d) program evaluation. Results: A significant decreasing trend of suicide was found in the study site during the intervention period, whereas no changes were found in the three control sites. Spatial analysis also showed that the suicide cluster subsided after the intervention. Three impacts and one challenge of the program were identified from the qualitative feedback of the program stakeholders. Limitations: More investigations should be made to assess the sustainability of this community-based suicide prevention effort in the long run. Conclusion: A community-based suicide prevention program was successfully implemented to address the suicide cluster. A reduction in the suicide rate was observed after the intervention.

Post-suicide investigations

This chapter illustrates the series of post-suicide investigators, including the police, ombudsman and coroner. It examines the 2013-2016 suicide cluster at HMP Woodhill to illustrate these investigations, their value and their limitations. It concludes that the post-suicide investigations are broadly Article 2 compliant and offer no shortage of vigorous critique, but also explains that Article 2 does not require that lessons be learnt and does not direct accountability to those with the capacity to implement said lessons. This is a greater limitation in England and Wales than the more commonly recognised issues with family participation and independence. The discourse of lesson learning is shown to be unhelpful in many cases of prison suicide, manufacturing mystery where there is none. It is not a mystery when prisoners die with untreated mental health problems because the prison’s mental health team is severely understaffed and has been for years, as identified multiple times by multiple prison overseers. The discourse of lesson learning also obfuscates the role of deliberate political decisions in reducing staffing levels and increasing the prison population such that staff are set up to fail and cannot follow Prison Service Orders and Instructions.

CHERISH: Understanding Suicide Clusters tHrough ExploRIng Self Harm behaviours

ABSTRACTObjectivesIn Wales suicide accounts for 20% of deaths among men aged 15-24 years and almost 10% of deaths among women of that age. Up to 2% of suicides in young people are thought to occur in clusters. Yet, our understanding of the social and psychological determinants of suicide clusters is limited, with none of the cross-discipline theories proposed having been tested via in-depth research on an actual cluster. This HCRW funded mixed methods study had qualitative and quantitative data linkage work packages to explore here the factors that trigger a suicide cluster, cause it to continue and then eventually subside. ApproachThe data of 1866 individuals’ who attended the Princes of Wales Hospital emergency department (ED) with self harm between 1st January 2006 and 31st December 2013 was anonymously linked within the Secure Anonymised Information Linkage (SAIL) databank. We had a matching rate of 99.7. We performed both time-trend analysis on this data around the apparant suicide cluster in 2007-08, and a comparison across three defined populations: those attending ED at the time of the cluster; those attending during the same period, one year before; and those attending one year after. ResultsWe are able to present the characteristics of those who attend ED during a cluster with self harm compared to those who attend at other times and their long term outcomes. ConclusionTo inform the development of appropriate policy to respond to suicide clusters at an early stage.