Teenage Suicide Clusters

Madelyn S. Gould, PhD, MPH
JAMA. 1990;263(15):2051. doi:10.1001/jama.1990.03440150055023.
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To the Editor.—  Davidson et al1 recently concluded that direct or indirect exposure to suicide was not associated significantly with suicide. However, the nature of the control group employed in their study limits the examination of the association of suicide with exposure to suicide as a risk factor. Given the amount of media coverage that surrounded the suicide clusters under study, the control group was inevitably exposed to the reports of the suicide cases. Indeed, the control subjects had a greater opportunity than the case subjects to be exposed to suicide stories that occurred during and after the cluster because the controls, by definition, survived the entire period of the cluster, whereas the case subjects obviously did not. This likelihood is highlighted in the finding that the case subjects were less likely than the control teenagers to have talked about death or suicide. Unless the identical assessment period


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