Associations Between Social Media and Suicidal Behaviors During a Youth Suicide Cluster in Ohio

Elizabeth A Swedo; Jennifer L Beauregard; Sietske de Fijter; Luke Werhan; Kirkland Norris; Martha P Montgomery; Erica B Rose; Corinne David-Ferdon; Greta M Massetti; Susan D Hillis; Steven A Sumner

doi:10.1016/j.jadohealth.2020.05.049

Associations Between Social Media and Suicidal Behaviors During a Youth Suicide Cluster in Ohio

J Adolesc Health. 2021 Feb;68(2):308-316. doi: 10.1016/j.jadohealth.2020.05.049. Epub 2020 Jul 7.

Authors

Affiliations

¹ Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia. Electronic address: eswedo@cdc.gov.
² Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
³ Ohio Violence and Injury Prevention Program, Ohio Department of Health, Columbus, Ohio.
⁴ Stark County Health Department, North Canton, Ohio.
⁵ Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Ohio Violence and Injury Prevention Program, Ohio Department of Health, Columbus, Ohio.
⁶ Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
⁷ Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
⁸ Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; Office of the Global AIDS Coordinator, Washington, District of Columbia.

Abstract

Purpose: Youth suicide clusters may be exacerbated by suicide contagion-the spread of suicidal behaviors. Factors promoting suicide contagion are poorly understood, particularly in the advent of social media. Using cross-sectional data from an ongoing youth suicide cluster in Ohio, this study examines associations between suicide cluster-related social media and suicidal behaviors.

Methods: We surveyed 7th- to 12th-grade students in northeastern Ohio during a 2017-2018 suicide cluster to assess the prevalence of suicidal ideation (SI), suicide attempts (SAs), and associations with potential contagion-promoting factors such as suicide cluster-related social media, vigils, memorials, news articles, and watching the Netflix series 13 Reasons Why before or during the cluster. Generalized estimating equations examined associations between potential contagion-promoting factors and SI/SA, adjusting for nonmodifiable risk factors. Subgroup analyses examined whether associations between cluster-related factors and SI/SA during the cluster varied by previous history of SI/SA.

Results: Among participating students, 9.0% (876/9,733) reported SI and 4.9% attempted suicide (481/9,733) during the suicide cluster. Among students who posted suicide cluster-related content to social media, 22.9% (267/1,167) reported SI and 15.0% (175/1,167) attempted suicide during the suicide cluster. Posting suicide cluster-related content was associated with both SI (adjusted odds ratio 1.7, 95% confidence interval 1.4-2.0) and SA during the cluster (adjusted odds ratio 1.7, 95% confidence interval 1.2-2.5). In subgroup analyses, seeing suicide cluster-related posts was uniquely associated with increased odds of SI and SA during the cluster among students with no previous history of SI/SA.

Conclusions: Exposure to suicide cluster-related social media is associated with both SI and SA during a suicide cluster. Suicide interventions could benefit from efforts to mitigate potential negative effects of social media and promote prevention messages.

Keywords: Social media; Suicide; Suicide cluster.

Published by Elsevier Inc.

Publication types

Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adolescent
Cross-Sectional Studies
Humans
Ohio / epidemiology
Risk Factors
Social Media*
Suicidal Ideation*
Suicide, Attempted

Grants and funding

CC999999/ImCDC/Intramural CDC HHS/United States