These facts demonstrate likelihoods, not fates. Neither a contagion nor a protection may be predicted in any individual case.

1. Contagion facts

Contagion was only proved after the suicide of a parent or after certain ways of revealing suicides in the media.

After the suicide of a parent

In order to compare how many were informed of a suicide among those who took their lives and those who did not not, J.A. Mercy, M. Kresnow and P. O?Carroll 2001 focused on nearly lethal suicide attempts. They compared 513 control subjects with 153 victims of such attempts aged 13-34 years.

The odds-ratio of nearly lethal attempts after the suicide of a parent was 2.4; it reached seven when this suicide was recent (less than one year).

Confounding factors, significantly more frequent among suicide attempters, were raised by the authors: depression, alcoholism and moving the year before.

If these factors were introduced into a multivariable analysis, the odds-ratio was no more significant.

This interpretation is questionable. The nine authors omitted to examine if the "confounding factors" were earlier or later than the suicide of the relative. Depression and alcoholism were recorded as present at the time of the attempt. Then, these events could neither be regarded as independent of the bereavement nor as confounding factors . The author, J. Mercy, agreed immediately.

His data were worth being rescued from his own suicidal discussion.

In youth exposed to suicide

The friends and acquaintances of suicide victims suffered of post-traumatic stress disorders and of depression more often than unexposed controls. The suicidal behaviours appeared more frequent, especially in previously depressive adolescents, but the number of the cases was not enough to reach the threshold of significance (Brent 1993, 1994)

Epidemics in special environments

In jails and in psychiatric hospitals, imitation of suicides is frequent (Velting 1997)

The role of media: television, newspapers, books, Internet

- Television.

In 1981, German television broadcasted a series of six episodes, each one starting by the ficticious suicide of a teenager under a train. During the 70 following days, among people aged 15-29, 35 railway suicides were added to an average of 41. In persons aged 15-19, the incidenc of railway suicides increased almost threefold. Until then, no relationship could be clearly demonstrated.

Fortunately, so to speak, the series was repeated 21 months later, followed by 25 additional suicides, in proportion to the audience (12% vs. 19%). The suicides by other means did not decrease. There was no pit after the peaks. Both recrudescences were statistically significant and had the same timing, demonstrating the causal relationship (Schmidtke 1988).

The German study was enough to prove that television induced a contagion of suicides; and that the youngsters were more vulnerable than others to the display of youngsters taking their life. However, it did not prove that all the televised suicides are contagious.

For instance, in United States, three such films of were not followed by contagion in teenagers (Phillips 1987, Berman 1988, Kessler 1988). Perhaps were the American shows less violent than the German ones. Moreover, the broadcasting corporations were much more numerous in USA than in Germany, so that the films were viewed by a lesser part of the population.

No matter whether the actual suicide victims saw the television series: facts are one thing, explanations another one.

"If television did not modify behaviors, there would be no television" acknowledge the television professionals in other circumstances.

Being limited to people under twenty, the German demonstration valorizes the presumptions accumulated since the antiquity.

Contagion is a factor of suicides among others, but never the only one.

- Newspapers.

In Vienna, the newspapers gave dramatic descriptions of the suicides in the subway. Then the suicides expanded without any increase in the traffic (Etzersdorfer 1992).

"We are no more than the mirror of society" repeat the media.

The facts related above lead to answer :

"The media turn society into their mirror".

- Books

After the publication of Final Exit, the suicide procedures were influenced, but not the annual incidence of suicides (Velting 1997).

- The Internet.

On the web, the prevention-oriented documents concerning suicide are a small minority among three million websites mentioning suicide.

The Internet promoted suicide pacts, a form of contagion (Baume 1997, Mehlum 2000).

The publications demonstrate likelihoods, not fates.

Neither a contagion nor a protection may be predicted in any individual case.

Of course, contagion is not an exclusive factor.

For instance, a genetic propensity to depression is frequent.

2. Protective disclosures and preventive implications.

Being informed of the suicide of another than a parent was no more "contagious" but "protective" when the "emotional and temporal distance" was great enough (Mercy et al., 2001). The odds-ratio significantly fell to .5. Did survivors "more fully appreciate the negative consequences of suicide" (Mercy), or their own reasons for living?

People at large seem to be more exposed to protection than to contagion because most suicides about which people are informed don't involve parents.

Does such a protection happen in the AAS survivors support groups (Dunne 1992), as each member listens to suicides of others than his parents and appreciates the negative consequences in other survivors?

However, the risk of contagion is not far. Suicidal ideas and alcoholism may be contra-indications of support groups.

In Vienna, after an agreement was made among journalists about prefering moderate reports, the suicides in the subway fell from nine to two every half-year (Etzersdorfer 1992). This demonstrated the influence of the way suicide was reported about. Moreover, suicides by other means fell by 13%, maybe due to a protective effect of the newspapers.

This allows a good prognosis to the AAS "Recommendations for the media" (Centers for Disease control and prevention 2002, Cotter 1999), especially:

- Ask if the victim received treatment for depression or other mental disturbance.

- Ask if the victim had a problem with substance abuse.

- Know that most suicides had multiple causes.

- Instead of referring to suicide in the headline, consider phrasing such as "Marilyn Monroe   dead at 36". In the body of the story, consider "having died by suicide".

- Avoid glamorizing.

- Relate stories of people who overcame despair without attempting suicide.

- Relate actions that individuals can take to prevent suicide by others.

CONCLUSION

Either a contagion or a protection is to be expected according

to whether the deceased was a parent or not,

to whether the suicide was recent or not,

to whether the person informed is a youngster or not

and finally according to the way the suicide was revealed.

Preventive implications concerning the survivors support groups and the newspapers are discussed.

REFERENCES

Baume P, Cantor CH, Rolfe A: Cybersuicide: the role of interactive suicide notes on the   Internet. Crisis 1997; 18 (2): 73-79

Berman AL: Fictional depiction of suicide in television films and imitative effects. Am J   Psychiatry 1988; 145 (8): 982-986

Brent DA, Perper J, Moritz G et al. Adolescent witnesses to a peer suicide. J Am Acad   Child Adolesc Psychiatry 1993; 32 (6): 1184-1188

Brent DA, Perper J, Moritz G et al. Major depression or uncomplicated bereavement? A   follow-up of youth exposed to suicide.. J Am Acad Child Adolesc Psychiatry 1994; 33 (2):   231-239

Centers for Disease control and prevention: Suicide contagion is real. Suicide and

   Life-Threatening Behaviors 2002; 32 (2): vii-xiii

Cotter M: Suicide in the media. Translating research into practice. 20° Congrès de   l?International Association for Suicide Prevention, Athènes 1999: 213-214

Dunne E : Survivors of Suicide, Support Group Guidelines. Washington, American   Association of Suicidology, 1992

Etzersdorfer E, Sonneck G, Nagel-Kuess S: Newspapers reports and suicide. New Engl J   Med 1992; 327: 502-503

Kessler RC, Downey G, Milavsky JR, Stipp H: Clustering of teenage suicides after   television new stories about suicides: a reconsideration. Am J Psychiatry 1988; 145: 1379-   1383

Mehlum L: The Internet, suicide and suicide prevention. Crisis 2000; 21 (4): 186-188

Mercy JA, Kresnow M, O?Carroll P, Lee RK, Powell K, Potter LB, Swann AC

   Frankowski RF, Bayer TL: Is suicide contagious? A study of the relation between

   exposure   to the suicidal behavior of others and nearly lethal suicide attempts. Am J

   Epidemiol 2001;   154 (2): 120-127

Phillips DP, Paight DJ: The impact of televised movies about suicide: a replicative study.   New Engl J Med 1987; 317 (13): 809-811

Schmidtke A, Häfner H: The Werther effect after television films : new evidence for an old   hypothesis. Psychol Med 1988; 18: 665-676

Velting DM, Gould MS. Suicide contagion. In Maris RW, Silverman MM. Review of   suicidology (pp. 96-137). New York, The Guildford Press 1997

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