Researchers--proceeding cautiously because of their uncertainty over whether public attention is causally linked to multiple suicides among adolescents--have only recently begun to study the phenomenon as a serious national health problem.
While the deaths in New York and Texas have attracted the most media attention, experts say such clusters have occurred in all parts of the country. The Centers for Disease Control in Atlanta, which began extensive research on suicide clusters about a year ago, plans to release some preliminary findings in mid-1985.
“Such clusters suggest that suicides among young people bear some sort of relationship to each other,” said James Mercy, assistant branch chief of the violence-epidemiology branch of the cdc The centers’ study poses “a very touchy situation,” he added, “because there is evidence that possibly people imitate suicides they view on televison or through other media sources. We are trying to arrive at a solution that will not also become part of the problem.”
New Focus
Traditionally, public-health institutes have not treated violent causes of death as a health problem, Mr. Mercy said. “But as we’ve had a greater and greater effect dealing with infectious diseases,” he noted, “these other problems--such as homicide and suicide--gained prominence as causes of premature death. We thought we had an obligation to focus on such health prob-lems, which are most important in terms of the costs to our society.”
According to research by the cdc, the overall increase in youth sucide is due primarily to the soaring rate among young males. From 1970 to 1980, the rate of male suicides increased by 50 percent, while that for females rose by only 2 percent. That translates into a ratio of five male suicides for every one female suicide.
Experts have found that boys more often choose a violent means of suicide--guns and explosives--while girls tend to use poison. The more violent the method used, the experts say, the greater the chance of death, so while there are more male suicides, there is a higher number of suicide attempts among females.
The cdc also found that 90 percent of all young male suicides are white, while there is no significant difference between races among young female suicides.
Research Projects
The National Institute for Mental Health is funding a number of research projects to try to understand and interpret such data. Dr. Susan Blumenthal, chief of the suicide-research unit at the nimh, said studies are being conducted on possible genetic and biological causes of suicide as well as on psychological disorders and family history.
“We found that young people who come from a family in which there was a suicide have a six-times-greater risk of committing suicide themselves,” she said. “We also found that the early detection and treatment of depression is the single most important preventive strategy for teen-age suicide.”
‘Impulsivity and Aggression’
Other studies have examined the relation of impulsiveness and aggression to suicide. Dr. Blumenthal said research has found that a brain chemical called serotonin may be related to aggression and violent suicide attempts or completions. A low level of serotonin seems to correspond with a high level of aggression, she said, and the level of serotonin is almost always lower in men than in women. These studies, which are continuing, began in the mid-1970’s.
“Research also suggests there may be other biological factors [related to aggression] as well, which need to be better understood,” Dr. Blumenthal said.
Studies have also found that genetic factors may play a much larger role in suicide than initially suspected. A 1979 study in Denmark found that suicidal tendencies seem to have a stronger genetic basis than either schizophrenia or depression, according to Dr. Frederick Goodwin, scientific director of the nimh
Suicide ‘Profile’
The nimh is also funding research under the auspices of David Shaffer, director of the division of child psychiatry of the New York State Psychiatric Institute and Columbia University, that will attempt to develop a profile of a teen-age suicide as a basis for treatment. The research will look at adolescent suicides in New York City’s five boroughs, New Jersey, and areas of Connecticut.
“We plan to examine every suicide as it occurs, conduct interviews with the families and see how that family functioned,” said Dr. Madelyn Gould, a co-investigator on the project. “We will collect data for three years, and expect to have information on 200 youths by the time it is completed.” Dr. Gould said the study would also compare the profiles of those who have committed suicide with those who have attempted it.
Medical Factors
Dr. Goodwin cautioned that the medical aspect of suicide is often overlooked by those primarily concerned with the psychological factors.
“We have to move from hoping to change things to really solid information,” he said. “We can’t just do well-intentioned things now; there are too many demands on public resources. We have to be careful how we spend them. My plea would be that public attention should be devoted to pressing legislative bodies to learn more about the problem instead of rushing off before we know what we’re doing.”
Dr. Goodwin also warned that those working in suicide prevention must be “exceedingly careful.”
“I think it’s not necessarily an unvarnished good that people talk about everything and know everything,” he said. “If people trivialize a serious subject, it could stimulate imitation behavior in a group that’s already vulnerable. I come down on the side of education and elucidation, but I think it would be extremely dangerous if suicide is made to seem like normal things people do for pretty normal reasons.”
“Taboos and stigmas,” Dr. Goodwin argued, may be necessary bar-riers to limit behavior. “The taboo against sex broke down, and we all know kids are now sexually active at a much earlier age,” he said. “The consequences of that can be argued, but nobody dies from it. There is a strong drive toward sex, and a strong drive toward suicide. One of the things that keeps it in check is a system of taboos.”
Warning Signs
All experts agree, however, that teachers and parents can help prevent a possible suicide attempt, by noting behavioral changes in children, for example. Such changes could include withdrawal, a drop in academic performance, and disruptions in sleeping or eating patterns. (See accompanying box.)
Robert Scherago, a resident of Burke, Va., whose son killed himself four years ago, testified before a Congressional hearing last month that parents must observe as well as listen.
“I would take very seriously the losses children have,” he said. “It may be something we feel is insignificant, but it’s not to them.”
Researchers in the field also say it is a myth that those who talk about suicide will not attempt it.
“My son asked if I ever considered suicide, but I wasn’t especially concerned,” Marcia Scherago said. “An appropriate response would be to encourage the child to talk about his or her feelings. The tendency is to run and hide from it--it’s very frightening.”
“Julie Smith,” a 16-year-old student, who also testified, said she had attempted suicide three times since the age of 13. She attributed her suicidal impulses to physical problems as a child and a recent move from Massachusetts to the Washington, D.C., area.
“Any time someone is feeling suicidal, they should seek out help,” she said. “When you speak about things, they tend to shrink in size. To anyone who is considering it, I would tell them it isn’t worth it.’'
Television Program
More attention will be focused on the problem of youth suicide this week, when CBS airs a televison movie called “Silence of the Heart,” which depicts the suicide of a high-school senior and the impact his death has on his family and friends. The network has scheduled the movie for prime time on Oct. 30.
CBS has distributed one million scripts of the program to schools, along with a guide about the program and ways that teachers might discuss the show and suicide with their students. The network also indicated it would print the script in local newspapers and air phone numbers of local mental-health services during the program.
“We are not turning teachers into mental-health professionals,” said Joanne Brokaw, vice president of educational and community services for the CBS broadcasting group. “The script may simply help teachers deal with the subject in a slightly more objective way.”
Ms. Brokaw, who helped develop the materials, said there has been some fear expressed that such a program may actually spark a rash of suicides across the country.
“I don’t believe someone who hasn’t seriously considered suicide will be influenced by this program,” she said. “There is an inevitability that the day this program airs, 18 young people will kill themselves. It happened the day before, and will happen the day after. But who knows how many will be prevented?”
