title: An adolescent suicide cluster and the possible role of electronic communication technology.
abstract: BACKGROUND
  Since the development of Centers for Disease Control's (CDC) guidelines for the management of suicide clusters, the use of electronic communication technologies has increased dramatically.
  
  
  OBJECTIVE
  To describe an adolescent suicide cluster that drew our attention to the possible role of online social networking and SMS text messaging as sources of contagion after a suicide and obstacles to recognition of a potential cluster.
  
  
  METHODS
  A public health approach involving a multidisciplinary community response was used to investigate a group of suicides of New Zealand adolescents thought to be a cluster. Difficulties in identifying and managing contagion posed by use of electronic communications were assessed.
  
  
  RESULTS
  The probability of observing a time-space cluster such as this by chance alone was p = .009. The cases did not belong to a single school, rather several were linked by social networking sites, including sites created in memory of earlier suicide cases, as well as mobile telephones. These facilitated the rapid spread of information and rumor about the deaths throughout the community. They made the recognition and management of a possible cluster more difficult.
  
  
  CONCLUSIONS
  Relevant community agencies should proactively develop a strategy to enable the identification and management of suicide contagion. Guidelines to assist communities in managing clusters should be updated to reflect the widespread use of communication technologies in modern society.
authors.affiliation: Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Robertson
authors.forename: Keren
authors.initials: K
authors.lastname: Skegg
authors.forename: Marion
authors.initials: M
authors.lastname: Poore
authors.forename: Sheila
authors.initials: S
authors.lastname: Williams
authors.forename: Barry
authors.initials: B
authors.lastname: Taylor
mesh_terms: D000293:Adolescent; D016000:Cluster Analysis; D003142:Communication; D005260:Female; D006801:Humans; D007100:Imitative Behavior; D008297:Male; D009520:New Zealand; D060756:Social Networking; D013405:Suicide / Q000706:statistics & numerical data; D060145:Text Messaging; D000092864:Suicide Prevention