An adolescent suicide cluster and the possible role of electronic communication technology.

Background: Since the development of Centers for Disease Control's (CDC) guidelines for the management of suicide clusters, the use of electronic communication technologies has increased dramatically. Aims: To describe an adolescent suicide cluster that drew our attention to the possible role of online social networking and SMS text messaging as sources of contagion after a suicide and obstacles to recognition of a potential cluster. Methods: A public health approach involving a multidisciplinary community response was used to investigate a group of suicides of New Zealand adolescents thought to be a cluster. Difficulties in identifying and managing contagion posed by use of electronic communications were assessed. Results: The probability of observing a time-space cluster such as this by chance alone was p=.009. The cases did not belong to a single school, rather several were linked by social networking sites, including sites created in memory of earlier suicide cases, as well as mobile telephones. These facilitated the rapid spread of information and rumor about the deaths throughout the community. They made the recognition and management of a possible cluster more difficult. Conclusions: Relevant community agencies should proactively develop a strategy to enable the identification and management of suicide contagion. Guidelines to assist communities in managing clusters should be updated to reflect the widespread use of communication technologies in modern society.