Children's Hospitals Today - Spring 2017 - 25

SUICIDE / FEATURE

students in the town of 125,000 people
surrounding the psychiatric hospital.
Two juniors at "School B" committed suicide eight days apart. The same week,
officials ruled the death of a 20-year-old
local graduate as a suicide. The next
month, Shands Psychiatric Hospital admitted 13 students from the high school,
more than double the average.
Many health care professionals are
familiar with the known risk factors
for suicide in children and adolescents,
which include a previous suicide attempt, family history of suicide attempts, family discord and the availability of lethal means. But "suicide
clusters," an emerging risk factor, are
rare and infrequently documented.
These clusters are groups of suicides, attempts or both that occur close together
in time and space than what would be
normally expected in a given community. Clusters of completed suicides occur predominantly among adolescents
and young adults, and these clusters
account for approximately 1 percent to 2
percent of all suicides in this age group,
but may be as high as 5 percent.
In 2011, suicide jumped from the third
to the second leading cause of death in
Americans ages 15 to 24, and suicide
in this age group has been increasing every year since 2007. In 2015, the
CDC reported 16 percent of U.S. high
schoolers thought about suicide, and 8
percent made a suicide attempt. More
than 157,000 youth receive medical care
for self-inflicted injuries at emergency
departments across the U.S. each year.
This far exceeds the number of adolescents who have been diagnosed with
depression, indicating many cases are
still not being diagnosed.

Finding a cause
One prevailing thought is that suicide
clusters are caused by "suicide contagion." Based on the infectious disease
model, this is the theory that suicidal

behavior of one person may facilitate
a suicide in other individuals. Experts
say extensive media coverage of such
events can play a role in suicide contagion, with data suggesting a link
between media coverage and the intensity of suicide contagion.
According to social learning theory,
most human behavior is learned from
observing, modeling or imitating others. This is more likely to occur if the
observer can identify with the model
through shared experiences or characteristics. Social learning theory also
says individuals are driven by peer
pressure and a sense of belonging to
a group, with peer pressure being the
most important factor in decision-making for adolescents compared to others.
An alternative hypothesis for suicide
clusters is that like-minded adolescents, including those prone to depression and thoughts of suicide, are more
likely to form relationships and be in
the same peer group. The occurrence
of or exposure to suicide may foster
familiarity and acceptance of suicide as
a natural outcome, rather than pathologic. Recently, this is most evident as
a response to bullying, where a publicized suicide as a response to being
bullied led to a predetermined outcome
that bullying leads to suicide.
Neurobiology also explains the lack
of impulse control and future-oriented
thinking in the adolescent brain. The
ability to control impulsiveness and
inhibit inappropriate behavior is not
fully developed in the adolescent brain.
This leads to the idea that the lack of
a fully formed executive functioning
system in the brain predisposes teenagers to suicide contagion. Several areas
of research support this hypothesis,
including neuroimaging.
Regardless of the theory, there is ample research to suggest that exposure
to peers' suicidal behavior increases
the risk for children and adolescents to
attempt suicide.

KEY LESSONS

4 must-do's
After its experience with
two suicide clusters, UF
Shands critically evaluated its
response and assessed what it
could do better. Here are some
key lessons learned:

1

Be aware of unusual events.
If a string of adolescent
deaths are observed, even
if they aren't ruled suicides,
these situations mandate
heightened awareness. Look
to physician leaders to direct
protocols proactively.

2

Communicate with other
behavioral health facilities.
An organization can cast a
wide net to help the community
if there's collaboration with
other institutions.

3

Coordinate and collaborate
with local pediatricians and
general practitioners. One
study indicated that as many
as 70 percent of youth who had
committed suicide were seen
by their primary care physician
within the previous month.

4

Coordinate with schools.
Due to HIPAA and privacy
constraints, schools may
have to initiate contact with
mental health programs in
the area to provide guidance
and assistance.

CHILDREN'S HOSPITAL S TODAY Spring 2017

25



Table of Contents for the Digital Edition of Children's Hospitals Today - Spring 2017

Contents
Children's Hospitals Today - Spring 2017 - Cover1
Children's Hospitals Today - Spring 2017 - Cover2
Children's Hospitals Today - Spring 2017 - Contents
Children's Hospitals Today - Spring 2017 - 2
Children's Hospitals Today - Spring 2017 - 3
Children's Hospitals Today - Spring 2017 - 4
Children's Hospitals Today - Spring 2017 - 5
Children's Hospitals Today - Spring 2017 - 6
Children's Hospitals Today - Spring 2017 - 7
Children's Hospitals Today - Spring 2017 - 8
Children's Hospitals Today - Spring 2017 - 9
Children's Hospitals Today - Spring 2017 - 10
Children's Hospitals Today - Spring 2017 - 11
Children's Hospitals Today - Spring 2017 - 12
Children's Hospitals Today - Spring 2017 - 13
Children's Hospitals Today - Spring 2017 - 14
Children's Hospitals Today - Spring 2017 - 15
Children's Hospitals Today - Spring 2017 - 16
Children's Hospitals Today - Spring 2017 - 17
Children's Hospitals Today - Spring 2017 - 18
Children's Hospitals Today - Spring 2017 - 19
Children's Hospitals Today - Spring 2017 - 20
Children's Hospitals Today - Spring 2017 - 21
Children's Hospitals Today - Spring 2017 - 22
Children's Hospitals Today - Spring 2017 - 23
Children's Hospitals Today - Spring 2017 - 24
Children's Hospitals Today - Spring 2017 - 25
Children's Hospitals Today - Spring 2017 - 26
Children's Hospitals Today - Spring 2017 - 27
Children's Hospitals Today - Spring 2017 - 28
Children's Hospitals Today - Spring 2017 - 29
Children's Hospitals Today - Spring 2017 - 30
Children's Hospitals Today - Spring 2017 - 31
Children's Hospitals Today - Spring 2017 - 32
Children's Hospitals Today - Spring 2017 - Cover3
Children's Hospitals Today - Spring 2017 - Cover4
https://www.nxtbook.com/nxtbooks/cha/cht_winter_2024
https://www.nxtbook.com/nxtbooks/cha/cht_fall_2023
https://www.nxtbook.com/nxtbooks/cha/cht_summer_2023
https://www.nxtbook.com/nxtbooks/cha/cht_spring_2023
https://www.nxtbook.com/nxtbooks/cha/cht_winter_2023
https://www.nxtbook.com/nxtbooks/cha/cht_fall_2022
https://www.nxtbook.com/nxtbooks/cha/cht_summer_2022
https://www.nxtbook.com/nxtbooks/cha/cht_spring_2022
https://www.nxtbook.com/nxtbooks/cha/cht_winter_2022
https://www.nxtbook.com/nxtbooks/cha/cht_fall_2021
https://www.nxtbook.com/nxtbooks/cha/cht_2018spring
https://www.nxtbook.com/nxtbooks/cha/cht_2018winter
https://www.nxtbook.com/nxtbooks/cha/cht_2017fall
https://www.nxtbook.com/nxtbooks/cha/cht_2017summer
https://www.nxtbook.com/nxtbooks/cha/cht_2017spring
https://www.nxtbook.com/nxtbooks/cha/cht_2017winter
https://www.nxtbook.com/nxtbooks/cha/cht_2016fall
https://www.nxtbook.com/nxtbooks/cha/cht_2016summer
https://www.nxtbook.com/nxtbooks/cha/cht_2016spring
https://www.nxtbook.com/nxtbooks/cha/cht_2016winter
https://www.nxtbook.com/nxtbooks/cha/cht_2015fall
https://www.nxtbook.com/nxtbooks/cha/cht_2015summer
https://www.nxtbook.com/nxtbooks/cha/cht_2015spring
https://www.nxtbook.com/nxtbooks/cha/cht_2015winter
https://www.nxtbook.com/nxtbooks/cha/cht_2014fall
https://www.nxtbook.com/nxtbooks/cha/cht_2014summer
https://www.nxtbook.com/nxtbooks/cha/cht_2014spring
https://www.nxtbook.com/nxtbooks/cha/cht_2014winter
https://www.nxtbookmedia.com