title: Newspaper coverage of suicide and initiation of suicide clusters in teenagers in the USA, 1988-96: a retrospective, population-based, case-control study.
abstract: BACKGROUND
  Public health and clinical efforts to prevent suicide clusters are seriously hampered by the unanswered question of why such outbreaks occur. We aimed to establish whether an environmental factor-newspaper reports of suicide-has a role in the emergence of suicide clusters.
  
  
  METHODS
  In this retrospective, population-based, case-control study, we identified suicide clusters in young people aged 13-20 years in the USA from 1988 to 1996 (preceding the advent of social media) using the time-space Scan statistic. For each cluster community, we selected two matched non-cluster control communities in which suicides of similarly aged youth occurred, from non-contiguous counties within the same state as the cluster. We examined newspapers within each cluster community for stories about suicide published in the days between the first and second suicides in the cluster. In non-cluster communities, we examined a matched length of time after the matched control suicide. We used a content-analysis procedure to code the characteristics of each story and compared newspaper stories about suicide published in case and control communities with mixed-effect regression analyses.
  
  
  RESULTS
  We identified 53 suicide clusters, of which 48 were included in the media review. For one cluster we could identify only one appropriate control; therefore, 95 matched control communities were included. The mean number of news stories about suicidal individuals published after an index cluster suicide (7·42 [SD 10·02]) was significantly greater than the mean number of suicide stories published after a non-cluster suicide (5·14 [6.00]; p<0·0001). Several story characteristics, including front-page placement, headlines containing the word suicide or a description of the method used, and detailed descriptions of the suicidal individual and act, appeared more often in stories published after the index cluster suicides than after non-cluster suicides.
  
  
  CONCLUSIONS
  Our identification of an association between newspaper reports about suicide (including specific story characteristics) and the initiation of teenage suicide clusters should provide an empirical basis to support efforts by mental health professionals, community officials, and the media to work together to identify and prevent the onset of suicide clusters.
  
  
  BACKGROUND
  US National Institute of Mental Health and American Foundation for Suicide Prevention.
authors.affiliation: Division of Child and Adolescent Psychiatry, Department of Epidemiology, Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA. Electronic address: gouldm@nyspi.columbia.edu.
authors.forename: Madelyn S
authors.initials: MS
authors.lastname: Gould
authors.affiliation: New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Marjorie H
authors.initials: MH
authors.lastname: Kleinman
authors.affiliation: New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Lake
authors.affiliation: New York State Psychiatric Institute, New York, NY, USA; Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Forman
authors.affiliation: New York State Psychiatric Institute, New York, NY, USA; Office of Advanced and Graduate Education, Tufts University School of Dental Medicine, Boston, MA, USA.
authors.forename: Jennifer Bassett
authors.initials: JB
authors.lastname: Midle