By age 17, a quarter of U.S. students have experienced a peer suicide. Using linked administrative data from South Carolina and a matched difference-in-differences design, we find that exposure to a peer’s self-harm death increases the probability of a self-harm diagnosis by nearly 50% and both the incidence and frequency of mental health visits. Effects on care use and criminal behavior are concentrated among white boys, and responses diverge by prior mental health history: students without a prior diagnosis increase felony offending rather than care-seeking. Deaths from assault and transportation accidents produce no comparable rise in self-harm, consistent with contagion.
