Improving our understanding of youth suicide clusters.

The study by Madelyn S Gould and colleagues 1 reported in The Lancet Psychiatry provides strong evidence to suggest that media reporting about suicide in the days after the suicide of a young person might have a ripple eff ect within a community, and be a factor in subsequent suicides that constitute a cluster. Gould and colleagues did a sophisticated case-control study that showed signifi cantly more newspaper stories about suicide were published between the fi rst and second deaths in a cluster of suicides than after suicides that were not part of a cluster. These stories were also more likely to be prominent (ie, published on the front page) and to describe the suicide in considerable detail. Gould and colleagues' study brings together two related research streams that have not been well integrated until now. The fi rst of these is on the eff ect of media reporting of suicide on subsequent suicidal acts. The research published about this topic is sizeable and consists of many studies (predominantly ecological in design) that show peaks in suicide rates or temporal clustering of suicides after publication of suicide stories. 2 These peaks have been referred to as temporal clusters or mass clusters, and the suicides in these clusters are not necessarily spatially related. 3 The second research stream brings in a geographical element, and is concerned with spatiotemporal clusters or point clusters, which are presumed to occur because members of the cluster have some connection. 3 This research focuses on suicide clusters that occur within communities over a defi ned time period and has a particular emphasis on clusters involving young people. It comprises quantitative studies 4 and qualitative studies. 5 The quantitative studies use techniques that are similar to those employed by Gould and colleagues and involve identifi cation of groups of suicides that occur in greater numbers in given space–time windows than would be expected by chance. The qualitative studies tend to map the relationships between individual members of given clusters. We have reviewed both of these groups of research 2,6 and have concluded that they are both largely atheoretical (ie, not driven by testable hypotheses that might explain clustering behaviour) and rarely intersect. Gould and colleagues' study prompts the reader to think about how mass clusters and point clusters might be related, and whether they are underpinned by similar mechanisms. Both mass clusters and point clusters can be …