Caring for those touched by suicide behaviour

It is estimated that as many as one in every five of us will know someone, a loved one or friend perhaps, who has been lost to suicide.

For every suicide death it is estimated that 135 people are affected, and these people left behind have been linked to a range of adverse physical and mental health outcomes – including subsequent suicidal behaviour.

It is a huge public health concern that exposure to suicide behaviour can put people at greater risk of actual suicide, attempted suicide or suicidal thoughts. It also raises concerns about the risk of suicidal behaviours clustering in exposed groups.

Our recently published research has now confirmed that this risk of suicidal behaviour following exposure to suicide is real – and for the first time we’ve been able to quantify it.

We’ve reviewed and analysed the data on 13 million people across 34 previously completed studies and found that exposure to actual suicide increases the odds of subsequent suicide or attempted suicide by about three times.

Previously, efforts to quantify the risk associated with exposure to suicide have been complicated by most research not being clear about whether exposure to suicidal behaviour had in fact occurred before the suicidal behaviour observed in others.

But we only included studies which showed that exposure had occurred before any suicidal behaviour in others.

Our findings underline the importance of interventions targeted at people exposed to suicide, but when we further examined the data we also found important evidence suggesting that we also need to take more account of the type of suicide behaviour people may have been exposed to.

For example, while exposure to a death by suicide does increase the risk of subsequent suicide or attempted suicide, exposure to a suicide attempt (as opposed to death) didn’t increase the risk of subsequent suicide death, though it did increase the risk of a subsequent suicide attempt.

This an important finding for public health interventions because frameworks for preventing suicide or self harm clusters have focused largely on responding to exposure to suicide death.

Including exposure to attempts may therefore be beneficial.

It also provides evidence suggesting that when someone attempts suicide after being exposed to a suicide attempt, they are imitating the actual behaviour they have been exposed to.

An imitation model is consistent with previous studies that have shown that increased risk of suicide-related behaviour following exposure to both suicide and suicide attempt isn’t significantly moderated by pre-existing risk factors like depression, anxiety and hospital admissions for mental health.

We believe the nuances in analysing the data may suggest that composite measures of suicidal behaviour maybe too blunt, at least in the context of understanding the potential transmission of suicidal behaviour.

The results are based on the general population – in other words, those who were not necessarily receiving treatment from clinical services.

However, we don’t yet know what individual level factors, such as the type of support structures an individual has, may increase or protect individuals against the association between exposure to suicidal behaviour and subsequent suicide and suicide attempt.

Findings from our study pave the way for future studies to investigate what these individual factors are so that the person-to-person transmission of suicide and suicide attempt can be better understood and prevented.

Interventions that target the general population are typically referred to as ‘universal’ or upstream interventions.

As a first line response, universal interventions have the potential to improve the mental health literacy, help seeking behaviour and response to those who may be at risk of suicide. These may be particularly relevant for communities and organisations which have experienced a suicide or suicide attempt.

A list of some programs that are available can be found here.

The way in which suicidal behaviour is discussed can also play a role in the potential person-to-person transmission of suicidal behaviour.

For example, previous studies have shown that news reports that sensationalise suicide and include information that details the way someone died have been linked increased suicidal behaviour in others.

Terms that describe suicide as ‘contagious’ can also be stigmatising and harmful to those with lived experience of suicidal behaviour.

In contrast, the way that we talk about suicide can also be protective, especially when the message portrays stories of hope and recovery and addresses some of the myths associated with suicide.

To address some of these issues, our team recently developed #chatsafe guidelines to help young people safely communicate about suicide online. Guidelines for safe media reporting of suicidal behaviour are also available.

We suggest these resources are consulted when communicating about both suicide and suicide attempt.

Finally, examples of suicide postvention toolkits (designed to assist school communities following a student suicide) are available. There are also many examples of cluster response frameworks in New Zealand, the UK and the US.

We recommend that these frameworks also be adapted to assist communities prevent further suicidal behaviour during the aftermath of a suicide attempt.

If you or anyone you know needs help or support, you can call Lifeline on 13 11 14.

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