The Influence of Suggestibility, Positive Expectancy, and Identification on Resilience (INSPIRE) Model.

Since the early 2010s, increasing rates of youth self-harm and suicide-related behavior in many high-income countries have raised urgent questions about underlying drivers. One well-recognized yet incompletely understood factor is social transmission (contagion). Here we posit the influence of suggestibility, positive expectancy, and identification on resilience (INSPIRE) model and propose that suggestibility, expectancy, and identification drive both harmful (Werther effect) and protective (Papageno effect) social transmission in youth. Building on established frameworks including Durkheim's social integration theory, social learning theory, cultivation theory, identification processes, and susceptibility-based models of media effects, the model highlights how pervasive media portrayals, peer dynamics, and social media environments can shape youths' beliefs, norms, and behaviors around suicide. Importantly, while these mechanisms can promote imitative suicide, they offer opportunities to foster resilience, adaptive coping, and help-seeking through positive modeling. The paper argues that cultivating virtuous circles of healthy coping and resilience - rather than vicious spirals of despair - can reduce suicide risk. The model suggests practical avenues for interventions within media, education, and peer settings to promote life-affirming behaviors. Although hypothetical, the INSPIRE model provides a testable framework for guiding research and public health efforts to address youth suicide through a nuanced understanding of social transmission dynamics.