e Morbidity and Mortality Weekly Report is prepared by the Centers for Disease Control, Atlanta, and available on a paid subscription basis from the Superintendent of Documents, U.S. Government es Office, Washington, D.C. 20402, (202) 783-3238. data in this report are provisional, based on weekly reports to CDC by state health departments. The * week concludes at close of business on Friday; compiled data on a national basis are officially to the public on the succeeding Friday. The editor welcomes accounts of interesting cases, », environmental hazards, or other public health problems of current interest to health officials. Such d any other matters pertaining to editorial or other textual considerations should be addressed to: ABoardridity and Mortality Weekly Report, Centers for Disease Control, Atlanta, Georgia 30333. Ceritera for Disease Control Editor Michael B. Gregg, M.D. Managing Editor Gwendolyn A. Ingraham US Government Printing Office 1988-530-111/60070 Region IV 221ATES GOVERNMENT PRINTING OFFICE BULK RATE POSTAGE & FEES PAID GPO Permit No. G-26 NANGAN SAYOSER LIBRARY BOOKMAN'S CENTER 40300 48109 Secistibution using indicia is illegal. On March 11, 1987, four teenagers from a suburban New Jersey community committed suicide by locking themselves inside a 13-car garage and sitting in a car with a running engine. Two of the young people were males aged 18 and 19, and two were females aged 16 and 17. The young women were sisters; the young men were not related. The two men died of a synergism of carbon monoxide poisoning, cocaine, and alcohol; the two young women, of a synergism of carbon monoxide and cocaine. The 19-year-old male had a history of alcohol abuse. Both males had evidence of recent, nonfatal cuts on their wrists. All four teenagers had had trouble in school: three had dropped out of high school, and one had recently been suspended. Both males had been friends of an 18-year-old youth who had died after falling from a cliff 6 months earlier (Table 1). One had witnessed this fall. Within days after these suicides, the community responded with a number of efforts, coordinated mainly by the municipal government, to prevent other suicides. School officials identified students they thought might be at high risk, such as close friends of the victims or students with a history of suicide attempts, and provided counselors for these students and any others who wanted help. A local suicide hotline was started, and a walk-in center was opened and staffed 24 hours a day. Local police also assisted in locating anyone reported to have threatened suicide or who was thought to be at imminent risk of suicide. The garage where the suicides occurred was locked and put under periodic police surveillance. Despite these measures, a 20-year-old female and a 17-year-old male attempted suicide together in the same garage by the same means 6 days after the simultaneous suicides. A policeman found them unconscious in a car after noticing that the lock on the garage had been broken. Both were successfully resuscitated. The garage door was removed. During the following months, the municipal government developed a mental health emergency response plan in cooperation with school officials clergy, and family guidance and mental health professNIVERSITYng a APR 25 1988 Documents Center U.S. DEPARTMENT OF HEALTH AND HUMAN APR 25 1988 SERVICES/PUBLIC HEALTH SERVICE UNITED STATES OF AMERICA The Morbidity and Mortality Weekly Report is prepared by the Centers for Disease Control, Atlanta, Georgia, and available on a paid subscription basis from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402, (202) 783-3238. The data in this report are provisional, based on weekly reports to CDC by state health departments. The reporting week concludes at close of business on Friday; compiled data on a national basis are officially released to the public on the succeeding Friday. The editor welcomes accounts of interesting cases, outbreaks, environmental hazards, or other public health problems of current interest to health officials. Such reports and any other matters pertaining to editorial or other textual considerations should be addressed to: Editor, Morbidity and Mortality Weekly Report, Centers for Disease Control, Atlanta, Georgia 30333. On March 11, 1987, four teenagers from a suburban New Jersey community committed suicide by locking themselves inside a 13-car garage and sitting in a car with a running engine. Two of the young people were males aged 18 and 19, and two were females aged 16 and 17. The young women were sisters; the young men were not related. The two men died of a synergism of carbon monoxide poisoning, cocaine, and alcohol; the two young women, of a synergism of carbon monoxide and cocaine. The 19-year-old male had a history of alcohol abuse. Both males had evidence of recent, nonfatal cuts on their wrists. All four teenagers had had trouble in school: three had dropped out of high school, and one had recently been suspended. Both males had been friends of an 18-year-old youth who had died after falling from a cliff 6 months earlier (Table 1). One had witnessed this fall. Within days after these suicides, the community responded with a number of efforts, coordinated mainly by the municipal government, to prevent other suicides. School officials identified students they thought might be at high risk, such as close friends of the victims or students with a history of suicide attempts, and provided counselors for these students and any others who wanted help. A local suicide hotline was started, and a walk-in center was opened and staffed 24 hours a day. Local police also assisted in locating anyone reported to have threatened suicide or who was thought to be at imminent risk of suicide. The garage where the suicides occurred was locked and put under periodic police surveillance. Despite these measures, a 20-year-old female and a 17-year-old male attempted suicide together in the same garage by the same means 6 days after the simultaneous suicides. A policeman found them unconscious in a car after noticing that the lock on the garage had been broken. Both were successfully resuscitated. The garage door was removed. During the following months, the municipal government developed a mental health emergency response plan in cooperation with school officials clergy, and family guidance and mental health profesNIVERSITY OF CHIGAN a APR 25 1988 Documents Conter APR 25 1988 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES/PUBLIC HEALTH SERVICE DEPOSITED BY UNITED STATES OF AMERICA Suicides Continued community response team to coordinate the crisis response through four sectors of the community: the municipal government, the school system, mental health agencies, and the clergy. The plan was divided into precrisis planning, crisis operations, and postcrisis programs. For each phase, specific protocols were developed to address such issues as 1) the responsibilities of various community agencies during a mental health crisis, 2) implementation of programs, 3) identification of persons at high risk of suicide or otherwise in need of acute mental health services, and 4) provision of timely information to the public and the media. An epidemiologic investigation of the suicides and suicide attempts was also carried out. Investigators assessed the comparative magnitude of background suicide mortality for the period 1980-1984* in the community by calculating 5-year suicide rates for residents of the community, the county in which the community lies, New Jersey, and the United States. Local health department and state medical examiner records for January 1, 1986, through March 11, 1987, were also reviewed for all deaths from nonnatural causes among residents of the community. For this community, the 5-year crude suicide rate was 7.0/100,000 per year (Table 2). The county rate was 6.5 overall and 5.2 for persons 15-24 years of age. These community and county suicide rates are lower than those for both New Jersey and the United States as a whole. From 1980 through 1986, one or two suicide deaths occurred annually among the residents of this community, for a total of 12 suicides over the 7-year period. Two of these 12 persons who committed suicide were between the ages of 15 and 24. For all of 1987, six persons committed suicide; five of these were between 15 and 24 years old. However, the number of suicides in 1987 would not have been unusually high had it not been for the cluster of four suicides on March 11. *Population estimates for later years were not available. TABLE 1. Nonnatural deaths in a suburban community - New Jersey, January 1, 1986-March 11, 1987 12 11-Mar-87 18 13 11-Mar-87 19 male Suicide (synergism: cocaine, alcohol, and carbon monoxide) *"Manner of death" is a medicolegal term referring to the circumstances under which a death occurs, while "cause of death" refers to the injury or illness responsible for the death. When a death occurs under accidental circumstances, the preferred term within the public health community for the cause of death is "unintentional injury." |