As suicides hit record highs, what can we do about "contagion"?

Phrases like "break the stigma" and "start the conversation" have now long been associated with mental health movements, but when it comes to the occasional contagious elements of suicide, is it possible such matter has been destigmatized too much?

Some communities know this all too well; one suicide and the proceeding public grieving and validation of the late individual leads another community member, who identified in some manner with that person, to also consider suicidal thoughts and actions. This convoluted reality serves as a "double-edged sword" experts say, because in one right, no progress will be made around mental health if it's inundated with stigma or not discussed — but not all dialogue is productive and safe. 

"The long journey from sin to science failed to eliminate the stigma of suicide," Dr. Heather Stuart, the Bell Mental Health and Anti-Stigma Chair at Queen's University said referencing the long history of suicide stigma in Suicide From a Global Perspective: Public Health Approaches. If minimized, the stigma of suicide can reduce suicide deaths by way of earlier detection and care — however, it remains a barrier to care for now, she added.

While some societal progress around suicide stigma has been made since the time when insurance wouldn't pay out death by suicide and suicidal burials were forced to take place outside of a cemetery, advocates say the fight is only beginning.

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In August, the Centers for Disease Control and Prevention (CDC) released provisional data indicating the United States reached another record in its slow public health decline: nearly 50,000 deaths by suicide in 2022. Media headlines and news conversations were flooded with the topic. While experts say data and reporting on the latest figures are important to shape public health responses, they warn some language can be harmful to at-risk populations.

"If you think that something is happening frequently, it can normalize it for you," Stuart told Salon. "So, If you're a person with a mental illness, and you know that more and more people are using [suicide], then maybe you'll consider it, too."

However, silencing talk of suicide has proven to not be the answer either, since this fosters shame and hinders help-seeking measures, such as the use of helplines, therapy and safe conversations. The stigma shadowing suicide has long plagued the grueling timeline of suicidal ideation, from inception to the family's grieving, most involved have been stigmatized to not talk about what they're enduring, whether directly or indirectly.

"Talking about [suicidal ideation] with people is better than not, especially if you're talking about it in a way that you're trying to promote treatment seeking help and awareness," Stuart said. "Just simply talking about it is only going to be one small contributor to the overall problem."

To reduce both stigma and contagion, discussions of suicide should exclude any mention of method and include more context about the undercovered yet notable number of abortive suicidal attempts and considerations, not only confirmed deaths, according to Dr. Christine Yu Moutier, the American Foundation for Suicide Prevention's (AFSP) Chief Medical Officer. For every one person that dies by suicide, 316 people seriously consider suicide but don't kill themselves, according to the 988 Suicide and Crisis Lifeline, which recently marked its one year of operation.

The depth of social contagion from graphic depictions and talk of suicide can be seen in the aftermath of the popular and controversial 2017 Netflix Series "13 Reasons Why," the third most binge-watched show of 2017 that graphically detailed the suicide of an adolescent girl. The release of the show was associated with a 28.9 percent increase in the suicide rate among 10-to-17-year-olds in April 2017, the month following the show's release, according to a study by Carnegie Mellon University (CMU.) While other studies found similar results, many experts advise cautious interpretation of the findings as the direct link is hard to prove.

The character's suicide in '13 Reasons Why' was depicted as a cause-and-effect scenario — because she endured a sequence of traumatic life events, suicide was the ultimate outcome. This rhetoric of suicide being a cause-and-effect framework with an inevitable outcome is inaccurate and of utmost danger, as it neglects to factor in very real elements like heavy-weighing social determinants of health, Moutier said, language that only fuels potential contagion, which CMU found alongside suicide stigma.

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Although rare, estimates say approximately 100 to 200 preventable deaths occur annually due to suicide contagion, with nearly 135 people affected by every single suicide. Suicide can often billow well beyond an individual's immediate circle and into a vast network, according to Dr. Madelyn Gould of Columbia University, one of the earliest suicide contagion researchers.

Without normalizing the act itself, Moutier says that anything destigmatizing help-seeking and the experience of suicidal struggle is generally beneficial to suicide prevention, despite being a nuanced reality. However, messaging is still paramount when discussing suicide, unlike dialogue around non-contagious public health threats like heart disease and cancer. 

"It is helpful, not harmful to ask someone if they're having thoughts of suicide," Dr. Moutier said.

For Stuart, the double-edged sword comes into play here because those experiencing suicidal ideation often feel isolated and coverage of the matter lets them know they're not alone. This convoluted dynamic touches on the underlying reality that just because suicidal behavior can be contagious doesn't mean it will, no one should be further isolated because of a behavioral health experience, despite it's severity. If society is less willing to interact with suicidal individuals, that only spins the wheel of stigma while neglecting to respectfully understand the contagious elements of behavior.

To combat suicide contagion, Gould says society can start by following diligent media guidelines for reporting on suicides, screening advance individuals for suicide risk, and postvention/crisis intervention after a suicide to minimize and contain the effects of suicide contagion.

While each encounter with the wrenching realities of suicide is unique, and no grieving community should be faulted for their coping mechanisms, the aura encircling suicide must not neglect the threatening reality of contagion and snowballing stigma.  

If you are in crisis, please call the 988 Suicide and Crisis  Lifeline by dialing 988, or contact the Crisis Text Line by texting TALK to 741741.