BACKGROUND: Suicide is a significant global public health concern. However, previous studies have predominantly focused on individual-level risk factors. Against this backdrop, microsystem suicide propinquity, which encompasses suicidal thoughts and behaviors (STB) within families and peer groups, is significant in elucidating the development and perpetuation of STB in adolescents.
METHODS: This study utilized data from the National Longitudinal Study of Adolescent to Adult Health (Add Health, 1994-2018). Adolescents who reported instances of suicide attempts among their friends and family members during Wave 1 were selected (N = 4826). Generalized estimation equations (GEE) and structural equation models (SEM) were employed.
RESULTS: GEE analyses indicated that individuals with friends who had attempted suicide exhibited higher risks for suicidal ideation (OR [95 % CI] = 2.57 [2.13, 3.11]) and suicide attempts (OR [95 % CI] = 2.47 [1.78, 3.42]). Also, individuals with family members who had attempted suicide exhibited higher risks for suicidal ideation (OR [95 % CI] = 2.37 [1.62, 3.46]) and attempts (OR [95 % CI] = 2.27 [1.17, 4.41]). However, friends\' and family members\' suicide attempts failed to show significant interactive effect. Besides, SEM analyses indicated that friends\' and family members\' suicide attempts were associated with one\'s long-term suicidal ideation and attempts via depressive symptoms.
CONCLUSIONS: Suicide attempts of friends and family during adolescence were long-term risk factors for suicidal ideation and attempts from adolescence to young adulthood. Moreover, depressive symptoms served as long-term mechanisms in these associations.

Although research on neighborhood effects has shown positive outcomes of collective efficacy in mental health, few studies have examined whether its protective role is universally applicable to all residents or the vulnerable population. Building on a stress-buffering model, this study examines whether or not neighborhood collective efficacy serves as a stress buffer to ameliorate the deleterious effects of exposure to stressful events across different population groups. Analyses are conducted based on a city-wide representative sample in Hong Kong linked to suicide events through spatial and temporal information. Neighborhood-level collective efficacy is constructed by the aggregated mean score of individual perceived collective efficacy within the same residential neighborhoods. Results from the logistic regression models show that individuals exposed to suicide in the residential surroundings have a higher risk of mental distress symptoms. Moreover, neighborhood-level collective efficacy tends to alleviate the mental distress upon exposure, but such a stress-buffering effect is only observed in older adults. Our findings provide a new perspective informed by the variation of stress-buffering effect across population groups. Thus, this study contributes to the understandings of neighborhood collective by demonstrating the stress-buffering effects among the vulnerable population.

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Current research indicates that exposure to suicide is a risk factor for suicidality; however, we know little about the mechanisms through which exposure confers this risk. In this study, we address this gap by examining the role of meaning-making after a suicide death in moderating individual\'s vulnerability to suicide. We draw on interview data with suicide bereaved individuals in the USA (N = 48), the majority of whom engaged in intense meaning-making processes after their loss. Many reported an increased awareness of suicide as a \'something that actually happens,\' a realization that impacted their lives and relationships with others (N = 37). For 7 participants, all women, their loss appeared to trigger increased suicidality, as they not only felt overwhelmed by grief, but also came to see suicide as something they, too, could do. However, for 19 participants, witnessing the profound impact of suicide on others made them feel that suicide was something they could never do. Thus, in our data, how exposure impacted vulnerability was tied to how individuals made sense of and experienced their loss. For some, suicide was re-framed as more of an option, while for others it was re-framed as not just the killing-of-oneself, but as the harming-of-others through grief and trauma, which in turn diminished their view of suicide\'s acceptability. Collectively, our findings suggest that exposure to suicide itself is not inherently risky, though it may be inherently distressing; instead, whether it results in increased vulnerability depends on the meaning an individual makes of the experience and likely the context surrounding the death. We discuss the implications of our findings for theories of suicide contagion, suicide itself, and suicide prevention.