Today this effect is referred to as either suicide contagion or suicide imitation/modeling. Although they are often used interchangeably, each is based on a different theoretical framework. Each theoretical framework is useful, but Schmidtke and Schaller (2000) propose that the language of imitation and modeling is preferable to the language of a contagious process because it relies on active learning processes that do not imply the exclusion of individual volitional factors.
Imitation and modeling, which play a role in other harmful behaviors such as drug use and bullying, occur with suicide in several circumstances, such as in the case of temporal clusters of suicides in a particular community or culture (see Chapter 2), suicide among family members (see Chapter 5), and suicide following exposure to a media1 presentation of a real or fictional suicide.
Research shows that suicide contagion through the media is real (for review, see Gould, 2001a; 2001b). Recent meta-analyses report that studies conducted by clinically oriented investigators yield the strongest support for suicide imitation (cited in Schmidtke and Schaller, 2000). However, many of the studies of suicide imitation are beset with methodological problems; for example, many are based on aggregate-level data, which preclude the possibility of ruling out the influence of other factors.
Imitation can be linked to newspaper accounts of suicide (for review, see Gould, 2001b; Hassan, 1995; Phillips, 1974; Stack, 1996). Newspaper coverage of suicide is related to an increase in the rate of suicide, and the magnitude of the increase is proportional to the duration, prominence and amount of media coverage (Gould, 2001a). There has been less conclusive research on the consequences of television news programs on suicide imitation. Kessler et al. (1988; 1989) found no association over an 11 year period in the United States, but recent studies suggest imitation in specific groups (e.g., in the elderly, see Stack, 1990).
The influence of fictional presentations of suicide on imitation is less clear. Research into fictional portrayals has examined attempts or other suicidal behavior (such as ideation) rather than just rates of completed suicides, which allows for actual measurement of exposure. Some studies indicate that imitation occurs (e.g., Gould et al., 1988; Hawton et al., 1999); others do not (e.g., Phillips and Paight, 1987); still others are inconclusive (Berman, 1988).
Aspects of both the media presentation and the individual interact to produce imitation. The person who is likely to imitate a suicidal behavior