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Guidance counselor Jacquelyn Indrisano embraces ninth grader Arianna Troville, 16, outside her office at East Boston High School. | Craig F. Walker/Boston Globe via Getty Images A new book on youth suicide clusters offers perspective on prevention. Between 2000 and 2015 in an affluent, predominately white community in the US, 19 young people died by suicide through what’s known as suicide clusters. These clusters refer to an unusually high rate of suicide for a community over a short period of time, often at least two deaths and one suicide attempt, or three deaths. Suicide clusters are an extreme example of youth mental health struggles — an issue that’s been getting more attention since the pandemic and one that’s at the center of an increasingly charged national conversation around social media and phones. Anna Mueller, a sociologist at Indiana University Bloomington, and Seth Abrutyn, a sociologist at the University of British Columbia, recently published Life Under Pressure: The Social Roots of Youth Suicide and What to Do About Them, which explores why these clusters happened and how to prevent more. The researchers embedded themselves within the community (which goes by the pseudonym Poplar Grove) to understand the social conditions that preceded and followed the teenagers’ deaths. Senior policy reporter Rachel Cohen spoke with Mueller and Abrutyn about the youth mental health crisis, the crucial role and responsibility of adults, and how kids take behavioral cues from those around them. This conversation has been lightly edited and condensed for clarity. Rachel Cohen There’s been a lot of confusing and often conflicting reports about youth suicide trends, especially since the pandemic. Can you outline for readers what we know? Anna Mueller Since 2007, rates of youth suicide in the United States have been increasing pretty significantly and substantially. Not all countries around the world are experiencing this, though some others are. With the pandemic, I feel like I have to plead the fifth since the suicide data is still sort of inconclusive. For some kids, the pandemic was really hard in terms of mental health. For others, it actually took some pressures away. Rachel Cohen Do we know why youth suicide in the US started going up in 2007? What are the best theories? Seth Abrutyn It’s a complicated question. As you’re probably aware, there’s been some recent very public academics like Jonathan Haidt and Jean Twenge who have been studying the relationship between social media and mental health, especially among adolescent girls. So there’s some argument that that’s part of it. Of course, that wouldn’t explain why it started in 2007, when social media and smartphones were not really ubiquitous in the way they are now, but it probably plays a role in accelerating or amplifying some of the underlying things that were happening prior. Another part of the explanation might be that efforts to destigmatize mental health have given people greater license to talk about their mental health. So things that may have been hiding are now out there more, though that doesn’t necessarily explain why suicide rates have gone up, but it may help understand the context. Kids today are growing up in an extremely destabilized environment, and the economy is extremely precarious. Add that to the fact that since 2007, LGBTQ kids have been able to be more freely out, which also then causes more attention to them and invites more backlash. Anna Mueller Everybody asks us that, and I’ll be honest with you, it’s my least favorite question because we just don’t have great data to assess any of these theories. A lot of this really just remains speculation. Social media is something important to consider, but I take a little bit of an issue with the theory that it’s what we should solely be focused on. It’s sort of an excuse to ignore other social problems, like the fact that over that same period, rates of school shootings have increased substantially, and now make things like lockdown drills a normal part of our children’s lives. There’s also been increasing awareness that climate change is a fundamental threat to everyone’s ability to survive and that the cost of college has wildly increased. So we have a lot of pretty challenging things going on. Rachel Cohen I was going to ask you about phones — since as you note there’s a ton of debate right now about their role contributing to worsening mental health, but they didn’t really come up in your book. What role did you see phones play in your research on teen suicide? Anna Mueller Phones facilitated kids talking privately and in spaces that adults couldn’t access. And they meant kids had access to information that their parents weren’t aware they received, like kids would often find out a friend had died by suicide by text. I think that’s something adults need to be really aware of — it means the burden is on us to have meaningful conversations with kids about mental health, suicide, and how to get help because we may not be aware when our kid gets hit with some information that’s going to be relevant. Rachel Cohen But did it seem like the smartphones were causing the mental health problems? Seth Abrutyn Social media didn’t even really come up in the book. When we were in the field [back in 2013–2016], Instagram was out, but it was really more a photographic, artistic thing. Instagram wasn’t about influencers, and Facebook, Vine, and Snapchat were around but kids didn’t all have smartphones yet. Flip phones were still quite available. I think in our original fieldwork, a lot of the young adults were far more impacted by the internet, like they sat at home on a laptop or something like that. In our new fieldwork, what we see are kids who carry the internet on their phones wherever they go. Quickly we’ve habituated to the ubiquity of smartphones and social media. Rachel Cohen In your research, some of the teenagers who died by suicide had loving parents, friends, romantic partners. They didn’t necessarily have mental illness. Can you talk about what you learned with respect to risk factors and protective factors? Anna Mueller In the community where we were working, it was a lot of popular kids who had seemingly perfect lives who were dying by suicide. Some of them probably did have undiagnosed mental illnesses, you know, there was some evidence that they were struggling with things like deep depression or eating disorders or other things. But it was never visible. And so what the community saw was this perfect kid just gone for no reason. It is tough, because on the one hand, what we learned was that this community had really intense expectations for what a good kid and a good family and a good life looked like. And so for kids who didn’t have a lot of life experience to know that there are a lot of options out there for how else to be in this world — they really struggled. Things that helped were having family or other adult mentors who could put things in perspective. Rachel Cohen Life Under Pressure is about youth suicide clusters, and I wanted to ask if you could talk more about this idea of “social contagion,” which comes up several times in your book. It seems community leaders were really nervous about saying or doing the wrong thing in the wake of a youth suicide for fear of contributing to another teenager deciding to take their own life. What does the research on social contagion in this context look like? Anna Mueller Exposure to suicide, either the attempt or death of somebody that a kid cares about — whether they admire them, identify with them, or really love them — can be a pretty painful experience. Suicide is often about escaping pain, and so seeing people role model suicide can increase that vulnerability for kids. Our work suggests that it’s not just pre-existing risk factors, there’s something uniquely painful about exposure to suicide that can introduce suicide as a new way to cope. Seth Abrutyn If we take a step back, suicide is just like almost anything else. Smoking cigarettes, watching television, all the things that we end up doing and liking — a lot of it we’re learning from the people around us. And people are exceptionally vulnerable to influential others. That could be someone that’s very high status that we look up to like a popular kid in school, or it could just be a really close friend that we trust a lot. In the community, where there are these high-status popular kids dying by suicide, if the messaging is not done correctly by adults, if we don’t have adults who can actually help talk through what’s going on and help kids grieve appropriately, the story can easily become, well, for kids who are under pressure and feel distressed, suicide is an option. Rachel Cohen The idea of social contagion has been coming up a lot in debates around youth gender transition too. Some adults say kids are being unduly influenced by their friends and social media regarding things like taking puberty blockers or pursuing gender-affirming surgeries. Other research contests the idea that social contagion is a factor, and some advocates say even the suggestion that gender identity may be susceptible to peer influence is offensive. Does your research in this area offer us any insights here, any more nuanced ways to think about this? Anna Mueller I’m not answering this. We can’t answer this. Sorry. We have ongoing work, and we can’t go there. And I don’t know the literature and we can’t go there. Rachel Cohen Okay, so you don’t think it’s applicable — the social contagion research you’ve studied in the youth suicide context — to other contexts? Seth Abrutyn The only thing I would say is I think the word “contagion” is the word that’s problematic. We’ve tried to actually change that in our own research, and there’s pushback because it’s relatively accepted. It has a sort of folk meaning that everybody can kind of grasp on. The problem is it sounds like how people get the flu in a dormitory, right? But just because everyone shares a heating system and air conditioning system doesn’t mean it will spread like wildfire. Sociologists don’t think of it that way. When behaviors and beliefs spread, it’s usually because people talk about them with each other, or watch people do something and then talk about it. And then they can text that to their friends and talk about it with each other, and in that sense it is contagious, if you want to call it that. I would call it more like diffusion. Rachel Cohen Part of your book is about the need to talk more openly about mental health issues. There’s been this public conversation recently about whether there’s been inadvertent consequences in the push to destigmatize mental illness, with one being that young people may now have become so familiar with the language and frameworks of psychiatric illness that youth can get locked into seeing themselves as unwell. Oxford professor Lucy Foulkes coined the term prevalence inflation to describe the way that some people consume so much information about anxiety disorders that they begin to interpret normal problems of life as signs of decline in mental health, and she warned of self-fulfilling spirals. Psychology professor Darby Saxbe also noted that teenagers, who are still developing their identities, may be particularly susceptible to taking psychological labels to heart. I wanted to invite you to weigh in on these questions and debate. Anna Mueller I’m not sure that I find that idea to be really useful. One of the problems with adults right now is that we’re not listening to the pain that kids are experiencing, or taking it seriously. If I were to advocate for something, I would advocate for seriously listening to kids about their struggles and sources of pain, and working to build a world where kids feel like they matter. Obviously, helping kids build resiliency is incredibly important. We can do a better job at helping our kids navigate challenges, and I’m an advocate of letting kids fail, the road shouldn’t just be perfectly smooth. But I’m pretty fundamentally uncomfortable with not listening to kids’ voices. Rachel Cohen I don’t think anyone’s saying don’t listen to kids, but they’re saying that if you encourage kids to think of themselves as anxious, and if you give kids those certain frameworks to diagnose or understand their problems, and as you noted earlier a lot of this information is coming from social media — Anna Mueller We think of frames as ways for kids to express themselves. As adults, it’s our job to dig deeper into how they’re framing their lives. Can suicide be an idiom of distress? Yes. Research has shown that some kids use the language of suicide as a way to express themselves to the adults in their lives. Similar things with anxiety, but then our job is to unpack that and discover what does that mean. Seth Abrutyn I think what Anna is trying to say, and what our book is trying to say, is that adults are really responsible for the worlds these youth inhabit. And these anxiety frames maybe are something that spreads around on TikTok, but it’s also something that’s being generated by adults, and it’s actually something being generated from real things in their lives, like school shootings. The way that we talk about them, and the way that we don’t listen to them, is maybe not helpful to kids. As a sociologist, we’re sitting there thinking how do we make schools better places? Well, what are adults doing? How are we making schools safer spaces so that this anxiety frame is not something kids are talking about? Rachel Cohen What are the big questions researchers are still grappling with when it comes to youth suicide? Anna Mueller I know one thing that emerged for me and Seth after our book is how can we look at how suicide prevention is enacted in the school building, so that we’re catching kids before they get to that? Since we did the fieldwork for Life Under Pressure, our research has involved working collaboratively with schools to strengthen kids’ ability to get meaningful care. We have begun to see some differences in how schools approach suicide prevention that are actually really salient to whether the school experiences an enduring suicide problem or recurring suicide clusters. Seth Abrutyn Most schools know that trusted adults are a really important part of the school building. And so thinking about how do we get teachers to do little things, like one school building made sure every teacher between classes was outside of their room for five minutes, just standing in the hallway, just saying hi, smiling, and pointing out that you were there. We often think those things don’t make a big impact, but it does. If a kid is not having a good day, maybe they’re not the most popular kid, but if they see that someone remembers them, someone knows them, it makes a real difference.

Franco Zacha for Vox Your neighborhood watering hole is more important than you think. Meng Liu spent years ping-ponging around the world looking for community. It was her dream to live in New York City, but after she found it difficult to make friends, Liu moved to Los Angeles, where she faced similar social roadblocks. Loneliness followed her across the globe to Shanghai, where she again chased a sense of belonging that never came. Thinking back on a comment a friend had made years ago, Liu had an epiphany. “Belonging isn’t some magical place that you can find in your next destination,” she recalled the friend saying. “It is where you feel most connected with the people around you, and that you have people who love you and that you love.” So Liu decided to give New York a second chance. She moved back in 2019 and made a commitment to fostering relationships. Inspired by her own difficulty making friends and the country’s epidemic of loneliness, in 2022 she founded a social club, Wowza Hangout, that brings people together around shared interests and activities. Wowza Hangout has hosted gatherings where people ranging in age from early 20s to late 50s play games, watch movies, sing karaoke, and picnic. All events are free, though Wowza Hangout is experimenting with a subscription model ($14.99 a month for unlimited hangouts, as opposed to monthly organized get-togethers). A crucial component of these hangouts are their settings: board game cafés, bars, museums, parks. They’re venues that populate a vibrant city like New York, but where attendees might feel awkward approaching someone they don’t know. Wowza Hangout not only provides the location but gives people permission to transform each of these physical spaces into a hub for connection — in other words, a third place. First defined by sociologist Ray Oldenburg in his 1989 book The Great Good Place, third places are settings a person frequents beyond their home (the first place) and work (the second place). Third places can include more traditional settings like places of worship, community and recreation centers, parks, and social clubs, but also encompass bars, gyms, malls, makeshift clubhouses in neighborhoods, and even virtual settings like Nextdoor. As Oldenburg described them, third places are great equalizers, spots where regulars of different backgrounds and perspectives can mingle in a location that is comfortable, unpretentious, and low-cost. Even prior to the pandemic, these institutions were shuttering, according to research. As Americans spend more time alone and practice individualized forms of leisure, like marathoning television series on streaming services and passively scrolling on social platforms, they aren’t gathering communally as often as they were in decades past — a shift the political scientist Robert Putnam observed a quarter century ago in his formative book Bowling Alone. You don’t need to take on the herculean task of making new friends to be less lonely. You may just need a third place. High rent and disinvestment in low-income neighborhoods could be drivers in the closure of third place businesses, according to Jessica Finlay, an assistant professor in the Institute of Behavioral Science and the department of geography at the University of Colorado Boulder. (Finlay doesn’t yet have data to support this hypothesis, but this summer she hopes to study exactly where third places are closing and how the trends differ by neighborhood.) On a planning level, zoning laws preventing commercial spaces like bars and cafés from building in residential areas further drive the wedge between families and communities. This isn’t to say Americans don’t value third places. “I think that people both wish they had more of them,” says Katherine Giuffre, a professor emerita of sociology at Colorado College, “and at the same time, overlook them or take them for granted.” With some intentionality, experts believe we can recommit to — and reimagine — third places. They may look exactly as we’ve always experienced them. They may not be physical spaces at all. The benefits of third places If one of the many crises that befall our society is loneliness, third places offer a solution. These environments are where the community gathers, where you can be either actively engaged in conversation or passively taking in the bustle around you. At their very best, third places allow people of differing backgrounds to cross paths — to develop what are known as bridging ties. As opposed to our closest connections, bridging social networks encompass people who have varying identities, social and economic resources, and knowledge. “Studies have shown that just having a diversity of folks in your life … more informal and infrequent and unplanned, can be really protective for health and well-being,” Finlay says. “Classically, third places were sites where you could build up these bridging ties.” As a result, third places are trust and relationship builders: You encounter a person frequently enough that you naturally graduate from a polite smile to small talk to perhaps deeper conversation. “You start to get the feeling that maybe I can trust that person if they say hello to me,” Giuffre says. “It’s not the beginning of some scam.” According to a 2007 study, even employees in these places, like bartenders and hairdressers, can provide emotional support to patrons looking for a sympathetic ear. You don’t need to take on the herculean task of making new friends to be less lonely. You may just need a third place. Simply developing acquaintance-like relationships is enough to foster feelings of belonging, studies show. Without third places, “Americans may be losing access to key services, goods, and amenities, in addition to community sites that help buffer against loneliness, stress, and alienation,” Finlay wrote in her 2019 paper detailing the loss of third places. Why we aren’t getting the most out of third places While teaching a master’s level course about building community at Viterbo University, ethics professor Richard Kyte observed students’ piqued interest when discussing third places. Even if they hadn’t heard the term before, Kyte says, they could easily identify these communal relationship breeding grounds. “It would be the kind of place they used to visit, or a place they remembered from their childhood,” says Kyte, the author of Finding Your Third Place: Building Happier Communities (and Making Great Friends Along the Way). “Or a place that they see other people frequenting, and they wish they had in their lives. But not that many people who say, ‘I have a third place and I go to it on a regular basis.’” Aside from the obvious — the pandemic — there are a multitude of reasons why third places aren’t being frequented, supported, or funded. In her study of third place closures, Finlay and colleagues found that between 2008 and 2015, stores selling sporting goods, hobby items, musical instruments, and books decreased by 27 percent, while barbershops, beauty salons, and laundromats dropped by nearly 23 percent. Declining church membership suggests organized religion is no longer the community builder it once was. According to a 2023 Pew Research Center survey, over half of Americans say they would rather live in a larger house where schools, stores, and restaurants are miles away. Despite the fact that most of the country lives near a bar, movie theater, restaurant, or park, the Survey Center on American Life found that 56 percent of Americans in 2021 said they had a third place they frequent, down from 67 percent in 2019. According to Kyte, the separation of residential and commercial real estate means people must rely on cars to access bars and fitness studios. Food- and beverage-focused locations also encourage patrons to purchase their items and leave to make room for the next customer. If you do hope to stay, expect to keep spending. The low-cost luxuriating necessary for healthy third places isn’t considered profitable. Restaurants aren’t the only environments becoming untenable for lingering. Parks with hostile architecture and a lack of bathrooms and water fountains send the signal that they are spaces just for passing through. “They’re meant to be hostile to people who are without homes,” Giuffre says. “But it ends up being hostile to the whole community.” And some third places are increasingly difficult to access at all for certain populations. With fewer hangout options for teens (what spots do exist might require them to be chaperoned), they lack time for unstructured socializing. Older and immunocompromised people are vulnerable to illnesses like Covid-19, flu, and RSV circulating in indoor environments that are not well ventilated. Community- and health-focused efforts implemented during the height of the pandemic, like streeteries, expanded patio areas, and pedestrian-only street closures, have been pared back or abandoned, denying many an opportunity to safely engage with their cities and towns. (On the contrary, some cities, like Los Angeles, have made outdoor dining measures permanent.) When people don’t feel safe in specific contexts, they won’t engage with them. Recently, third places have become a monolith of experience, Finlay says. People are self-segregating based on specific interests, hobbies, or ideologies that tend to skew toward a particular demographic. Interacting with people who look and see the world similarly may deepen our existing connections but don’t facilitate bridging social networks. “We need to facilitate more of these bridging ties and bridging encounters,” Finlay says, “so that we’re not just spending time in an echo chamber, whether it’s online or in person, of people who already think the same way that we do.” However, opting to spend time with people who share similar experiences and backgrounds can be a matter of safety. If you suspect other patrons in a community book club will judge you — or worse, harass you — based on your views or how you present yourself, you’ll avoid those spaces. In her research looking at young people with histories of housing instability and homelessness, Danielle Littman found that this population doesn’t always feel welcomed in modern third places. People who don’t appear as if they “belong” might face questions like “Why is this person here?” or “Are they supposed to be here right now?” says Littman, an assistant professor in the College of Social Work at the University of Utah. The person might be asked to leave. “Even worse,” she says, is “criminalization of just existing in a space. I see some of those practices and policies as inequitable enforcement of third places.” By nature, third places should be diverse, Giuffre says. Everyone has a responsibility to act inclusively so the space is safe and welcome to all. “That can be a lot easier said than done,” she says. “Because the teenagers are loud and the old people don’t want to hear them. But we have to open ourselves up to embracing difference.” How to reimagine third places Experts agree communities are in a collective state of rethinking third places. But how might those places look? In response to the housing affordability crisis, people are moving into smaller homes they can afford, says Jorge González-Hermoso, a research associate at the Urban Institute. In these smaller homes, people might lack leisure amenities, like a backyard or space for a home gym, pushing them into third spaces to seek those services elsewhere. In order to signal that these places are lively and in demand, González-Hermoso says, there must be some form of engagement and activation, whether through exercise classes in a park or kids’ skate nights at a roller rink. This public commitment often comes naturally when the community’s needs are taken into consideration. When the nonprofit Better Block plans public space transformations in cities and towns worldwide, its team first solicits the community’s feedback, says the organization’s executive director, Krista Nightengale. “Valuing the community’s input and not only listening, but watching what they do and how they respond to a space,” she says, “is a huge thing.” In the parking lot outside of Better Block’s offices, for instance, four parking spaces were transformed into a small basketball court where students from a nearby school now organically gather. “Our parking lot has now become a third place for many of those students,” Nightengale says, “where they’ll bring their basketballs, they’ll play after school, or they’ll just simply sit in the patio furniture that we’ve put out there and hang out.” In her research, Littman says people are looking for third places to meet basic needs — amenities like a safe place to nap or free snacks — especially if they are not getting those needs met at home or work or school. To make third places as inclusive as possible, Better Block ensures park signs reflect the diverse languages spoken by members in the community or use images like emojis to convey messages, Nightengale says. The organization also aims to make the spaces ADA accessible. Comfortable seating and shade are also integral to making a space comfortable for all. Despite fears that the furniture may be stolen or vandalized, those incidents almost never transpire, Nightengale says. “When you show a space is loved and taken care of, people tend to treat it the same way.” Perhaps the most accessible third place of all isn’t necessarily a physical one. Online platforms can offer people in rural communities, people with limited mobility, and people with marginalized identities safe and affirming ways to connect. While many potential benefits of online third places haven’t been studied, Finlay has spoken with study participants who say online concerts, for instance, have allowed them to enjoy an event they wouldn’t have experienced otherwise. She has also heard from people who use Nextdoor because, despite it being online, they can still interact with locals. Younger generations may prefer apps like Pokémon Go, she says, another platform that filters reality through the screen — and gets people outside. Chat rooms and social media sites centered around specific interests and hobbies are also popular online third places, Finlay says. However, these online forums come with their own complications, including harassment from other, sometimes anonymous, users and less welcoming attitudes toward people with differing perspectives. When it comes to established environments that serve the needs of as many people as possible, experts agree that public parks are the closest we have to an ideal third place. Parks are preferably welcoming to all members of the community for a variety of activities; they ideally have bathrooms, water fountains, and cooling tree cover; they’re free and open daily. It might be easier for parents of children playing to chat with one another than for a picnicker to approach a jogger, but events — like concerts, art installations, and farmers markets — can help bring more people together, Giuffre says. But funding and support for parks isn’t always a given. “It’s a policy decision to say we’re going to have money put into these public spaces from our tax dollars so that everyone can participate,” Giuffre says. How to find your own third place To get the most out of third places, you’ve got to find one you enjoy frequenting. Mine your interests, Littman says, to discover a location that fulfills your needs. For instance, if you love books but don’t necessarily want to discuss them with others, find a bar or café that offers silent reading nights for people who want to read communally. See what public and commercial spaces are in your community: Do any of them offer classes you’d want to take? Are they spots you’d want to hang out and become a regular? Invite a friend, coworker, or family member to check it out with you. Immersing yourself in the culture of the space requires intentionality, consciously caring for your, and your community’s, social health. This might require some actionable changes, like dedicating time each week to spend an hour or so in a neighborhood hangout, going into a restaurant or coffee shop instead of picking up, leaving your phone in your pocket while waiting in line, engaging with people in small but meaningful ways. Don’t become discouraged if an interaction isn’t as successful as you hoped, says Liu, the founder of meetup group Wowza Hangout. To be a part of something, you must consistently show up. Soon enough you’ll naturally braid into the fabric of the third place; you’ll become a familiar face, a driver of conversation, a person to say hello to. In an age of loneliness, that might be one of the most powerful tools of all.

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