title: Teenage suicide cluster formation and contagion: implications for primary care.
abstract: 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 Umeå, 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Section of Forensic Medicine, Dept. of Community Medicine and Rehabilitation, Umeå University, Sweden. lars.johansson@formed.umu.se
authors.forename: Lars
authors.initials: L
authors.lastname: Johansson
authors.forename: Per
authors.initials: P
authors.lastname: Lindqvist
authors.forename: Anders
authors.initials: A
authors.lastname: Eriksson
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001344:Autopsy / Q000706:statistics & numerical data; D002423:Cause of Death; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010290:Parents / Q000523:psychology; D011320:Primary Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D017678:Sex Distribution; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D000092864:Suicide Prevention