An outbreak of suicide and suicidal behavior in a high school.

In a high school of 1,496 students, two students committed suicide within 4 days. During an 18-day period that included the two suicides, seven students attempted suicide and an additional 23 manifested suicidal ideation. Compared to expected rates, the rates of both completed and attempted suicide were markedly elevated. Seventy-five percent of the members of the cluster had at least one major psychiatric disorder antedating their exposure. One hundred ten students thought to be at high risk were psychiatrically screened on site. Within this group, students who became suicidal after exposure were more likely than their nonsuicidal counterparts to be currently depressed and to have had past episodes of depression and suicidality. Close friends of the victims manifested suicidality at a lower psychopathological threshold than those who were less close to the victims. Students who are friends of a victim or who have a history of affective disorder and/or previous suicidality should be screened for suicidality after exposure.