title: Epidemiological investigation of a youth suicide cluster: Delaware 2012.
abstract: In the first quarter of 2012, eight youth (aged 13-21 years) were known to have died by suicide in Kent and Sussex counties, Delaware, twice the typical median yearly number. State and local officials invited the Centers for Disease Control and Prevention to assist with an epidemiological investigation of fatal and nonfatal youth suicidal behaviors in the first quarter of 2012, to examine risk factors, and to recommend prevention strategies.
  
  
  METHODS
  Data were obtained from the Delaware Office of the Medical Examiner, law enforcement, emergency departments, and inpatient records. Key informants from youth-serving organizations in the community were interviewed to better understand local context and perceptions of youth suicide.
  
  
  RESULTS
  Eleven fatal and 116 nonfatal suicide attempts were identified for the first quarter of 2012 in Kent and Sussex counties. The median age was higher for the fatalities (18 years) than the nonfatal attempts (16 years). More males died by suicide, and more females nonfatally attempted suicide. Fatal methods were either hanging or firearm, while nonfatal methods were diverse, led by overdose/poisoning and cutting. All decedents had two or more precipitating circumstances. Seventeen of 116 nonfatal cases reported that a peer/friend recently died by or attempted suicide. Local barriers to youth services and suicide prevention were identified.
  
  
  CONCLUSIONS
  Several features were similar to previous clusters: Occurrence among vulnerable youth, rural or suburban setting, and precipitating negative life events. Distribution by sex and method were consistent with national trends for both fatalities and nonfatalities. References to the decedents in the context of nonfatal attempts support the concept of 'point clusters' (social contiguity to other suicidal youth as a risk factor for vulnerable youth) as a framework for understanding clustering of youth suicidal behavior. Recommended prevention strategies included: Training to identify at-risk youth and guide them to services; development of youth programs; monitoring trends in youth suicidal behaviors; reviewing evidence-based suicide prevention strategies; and continued implementation of CDC media guidelines for reporting on suicide.
authors.affiliation: Division of Violence Prevention, Centers for Disease Control and Prevention, USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Fowler
authors.forename: Alexander E
authors.initials: AE
authors.lastname: Crosby
authors.forename: Sharyn E
authors.initials: SE
authors.lastname: Parks
authors.forename: Asha Z
authors.initials: AZ
authors.lastname: Ivey
authors.forename: Paul R
authors.initials: PR
authors.lastname: Silverman
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D003625:Data Collection; D003691:Delaware / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000706:statistics & numerical data*; D055815:Young Adult