Youth Suicides Continue to Rise in U.S.
One reason may be reluctance to prescribe antidepressants, study suggests
By Steven Reinberg, HealthDay Reporter
One reason may be reluctance to prescribe antidepressants, study suggests.
TUESDAY, Sept. 2 (HealthDay News) -- Suicides among U.S. children appear to be on the rise after a 15-year decline, and the trend may owe, in part, to fewer teens being prescribed antidepressants, a new study suggests.
Researchers thought a spike in youth suicides in 2004 may have been an anomaly. But the new study found the increase in suicides continued during 2005.
Looking at suicide trends among youngsters over a 15-year period, Jeff Bridge, from Nationwide Children's Hospital in Columbus, Ohio, found the rates of suicide among youths aged 10 to 19 were higher in 2004 and 2005 than would have been expected, based on suicide rate trends from 1996 to 2003.
"This is significant, because pediatric suicide rates in the U.S. had been declining steadily for a decade until 2004, when the suicide rate among U.S. youth younger than 20 years of age increased by 18 percent, the largest single-year increase in the past 15 years," said Bridge, an investigator in the Center for Innovation in Pediatric Practice.
"We now need to consider the possibility that this increase is an indicator of an emerging public health crisis. Studies to identify causal factors are important next steps," he added.
Bridge, whose findings were published in the Sept. 3 issue of the Journal of the American Medical Association, said several factors could be contributing to the increase in youth suicides. They include the influence of Internet social networking sites; an increase in the suicide rate among U.S. troops returning from Iraq and Afghanistan; and higher rates of untreated or undiagnosed depression.
One possible explanation for the increase could be that antidepressant use among children has been the subject of intense controversy in recent years, making doctors and parents more reluctant to use them.
In October 2003, the U.S. Food and Drug Administration issued a public health advisory, warning of an increased risk of suicide attempts or suicide-related behavior among children and teens taking antidepressants called SSRIs, or selective serotonin reuptake inhibitors.
One year later, the FDA directed manufacturers of antidepressants to revise their labeling to include a "black-box" warning. The warning alerts health-care providers about an increased risk of suicide and suicidal thoughts in children and teens.
This warning may have had a dampening effect on the drugs' use among children. A recent study found that the number of U.S. children being prescribed antidepressants has dropped since the warnings. Some experts have said this trend could be worrisome if it means that young patients who might benefit from SSRIs aren't getting them.
In a previous study, Bridge found that treating children with antidepressants was beneficial. "Our study shows that, at least in the short-term, treatment benefits appear to outweigh the risks," he said.
Diana Zuckerman, president of the National Research Center for Women & Families, agreed that the increase in youth suicides is now a trend, but the reasons for it are multi-faceted.
The increase among older teens may be due, in part, to the languishing economy. "When the economy is bad, and jobs are harder to find, it's a tough time for kids who are trying to get a job," she said.
It's also harder to get into college and afford it, Zuckerman said. "So, for kids who are college-bound, there are those stressors," she said.
Zuckerman also thinks that untreated depression may play a role in the increase suicide rate.
But overall, she thinks that children are more isolated, even from their families, than ever before.
"Kids and family members are spending more and more time apart," she said. "Apart might mean being on the computer. Kids and their families are not watching TV together, they're not eating meals together, they are not talking to each other nearly as much."
"There is a lot of data that shows when families don't eat together, kids get into trouble. And trouble means drug use, alcohol use, sex and suicide," she said. "Parents need to be more involved in the decision-making process about what their kids are doing."
For more on suicide, visit the National Institute of Mental Health.
SOURCES: Jeff Bridge, Ph.D., Nationwide Children's Hospital, Columbus, Ohio; Diana Zuckerman, Ph.D., president, National Research Center for Women & Families, Washington, D.C.; Sept. 3, 2008, Journal of the American Medical Association
Copyright (c) 2008 ScoutNews, LLC. All rights reserved.
Youth suicide rate is still high
Though suicides among U.S. adolescents drop a bit after a sharp escalation, the overall trend is upward, a study suggests.
By Denise Gellene, Los Angeles Times Staff Writer
September 3, 2008
Suicides among U.S. adolescents dropped in 2005 after a sharp rise the previous year, but the number still remained high compared with historical trends, researchers said Tuesday.
The youth suicide rate had been falling steadily for a decade, but shot upward by 18% in 2004, boosted, according to some experts, by a government warning about antidepressants that led patients to stop taking the drugs.
The latest study, published in the Journal of the American Medical Assn., suggests that the reaction triggered by the warning has subsided and patients are being treated with antidepressants or other therapies.
Despite the decrease in suicides, researchers cautioned that the trend was still clearly upward. "It is certainly cause for concern," said Robert D. Gibbons, a biostatistician at the University of Illinois at Chicago who was not involved in the report.
Researchers at Nationwide Children's Hospital in Columbus, Ohio, and Carnegie Mellon University in Pittsburgh analyzed data from the National Center for Injury Prevention and Control.
They used suicide reports dating back to 1996 to establish a trend line. A key year was 2003, when widespread publicity linked antidepressants, such as Prozac and Zoloft, to suicidal thoughts and behaviors in teenagers.
In 2004, the Food and Drug Administration required that the drugs carry a "black box" warning, the strongest possible. Prescriptions for antidepressants for teens and adolescents subsequently fell by more than 20%. The black-box warning calls for close monitoring of patients but does not discourage use of the medications.
After the 2004 jump in suicides, the researchers report, the rate among 10- to 19-year-olds in 2005 was 4.5 per 100,000, down 5.3%. The trend line indicated that the suicide rates per 100,000 should have been between 3.5 and 4.2 in 2005.
Based on those figures, researchers estimated there were 292 more suicides than expected in 2005.
Patterns were similar in males and females, said lead author Jeffrey A. Bridge, a pediatric researcher at Nationwide Children's Hospital.
Gibbons said the latest study showed that the increase in 2004 was not an anomaly.
"This was the first time that antidepressant use in children decreased and the first time that suicide rates increased anywhere near this amount," he said.
Vol. 300 No. 9, September 3, 2008 TABLE OF CONTENTS
Suicide Trends Among Youths Aged 10 to 19 Years in the United States, 1996-2005
Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.
To the Editor: Following a decade of steady decline, the suicide rate among US youth younger than 20 years increased by 18% from 2003 to 2004, the largest single-year change in the pediatric suicide rate over the past 15 years.1 Federal health officials have urged caution in interpreting this 1-year apparent spike in youth suicide until data from additional years are available for comparison.1 We examined available national fatal injury data to assess whether the increase in suicide rates among US youth persisted from 2004 to 2005, the latest year for which data are available.
Data on deaths for which suicide (coded E950-E959 for International Classification of Diseases, Ninth Revision [ICD-9] [1996-1998] and X60-X84, Y87.0, and U03 for ICD-10 [1999-2005]) was listed as the underlying cause of death among 10- to-19-year-olds were obtained from the National Vital Statistics Systems using WISQARS (Web-based Injury Statistics Query and Reporting System; National Center . . . [Full Text of this Article]
Jeffrey A. Bridge, PhD
The Research Institute at Nationwide Children's Hospital
Joel B. Greenhouse, PhD
Department of Statistics
Carnegie Mellon University
Arielle H. Weldon, MS; John V. Campo, MD; Kelly J. Kelleher, MD, MPH
The Research Institute at Nationwide Children's Hospital
Suicide in the U.S.: Statistics and Prevention
* What are the risk factors for suicide?
* Are women or men at higher risk?
* Is suicide common among children and young people?
* Are older adults at risk?
* Are Some Ethnic Groups or Races at Higher Risk?
* What are some risk factors for nonfatal suicide attempts?
* What can be done to prevent suicide?
* What should I do if I think someone is suicidal?
* For More Information About Suicide
Suicide is a major, preventable public health problem. In 2004, it was the eleventh leading cause of death in the U.S., accounting for 32,439 deaths.1 The overall rate was 10.9 suicide deaths per 100,000 people.1 An estimated eight to 25 attempted suicides occur per every suicide death.2
Suicidal behavior is complex. Some risk factors vary with age, gender, or ethnic group and may occur in combination or change over time.
If you are in a crisis and need help right away:
Call this toll-free number, available 24 hours a day, every day: 1-800-273-TALK (8255). You will reach the National Suicide Prevention Lifeline, a service available to anyone. You may call for yourself or for someone you care about. All calls are confidential.
What are the risk factors for suicide?
Research shows that risk factors for suicide include:
* depression and other mental disorders, or a substance-abuse disorder (often in combination with other mental disorders). More than 90 percent of people who die by suicide have these risk factors.2
* stressful life events, in combination with other risk factors, such as depression. However, suicide and suicidal behavior are not normal responses to stress; many people have these risk factors, but are not suicidal.
* prior suicide attempt
* family history of mental disorder or substance abuse
* family history of suicide
* family violence, including physical or sexual abuse
* firearms in the home,3 the method used in more than half of suicides
* exposure to the suicidal behavior of others, such as family members, peers, or media figures.2
Research also shows that the risk for suicide is associated with changes in brain chemicals called neurotransmitters, including serotonin. Decreased levels of serotonin have been found in people with depression, impulsive disorders, and a history of suicide attempts, and in the brains of suicide victims. 4
Are women or men at higher risk?
* Suicide was the eighth leading cause of death for males and the sixteenth leading cause of death for females in 2004.1
* Almost four times as many males as females die by suicide.1
* Firearms, suffocation, and poison are by far the most common methods of suicide, overall. However, men and women differ in the method used, as shown below.1
Suicide by: Males (%) Females (%)
Firearms 57 32
Suffocation 23 20
Poisoning 13 38
Is suicide common among children and young people?
In 2004, suicide was the third leading cause of death in each of the following age groups.1 Of every 100,000 young people in each age group, the following number died by suicide:1
* Children ages 10 to 14 ― 1.3 per 100,000
* Adolescents ages 15 to 19 ― 8.2 per 100,000
* Young adults ages 20 to 24 ― 12.5 per 100,000
As in the general population, young people were much more likely to use firearms, suffocation, and poisoning than other methods of suicide, overall. However, while adolescents and young adults were more likely to use firearms than suffocation, children were dramatically more likely to use suffocation.1
There were also gender differences in suicide among young people, as follows:
* Almost four times as many males as females ages 15 to 19 died by suicide.1
* More than six times as many males as females ages 20 to 24 died by suicide.1
Are older adults at risk?
Older Americans are disproportionately likely to die by suicide.
* Of every 100,000 people ages 65 and older, 14.3 died by suicide in 2004. This figure is higher than the national average of 10.9 suicides per 100,000 people in the general population. 1
* Non-Hispanic white men age 85 or older had an even higher rate, with 17.8 suicide deaths per 100,000.1
Are Some Ethnic Groups or Races at Higher Risk?
Of every 100,000 people in each of the following ethnic/racial groups below, the following number died by suicide in 2004.1
* Highest rates:
o Non-Hispanic Whites ― 12.9 per 100,000
o American Indian and Alaska Natives ― 12.4 per 100,000
* Lowest rates:
o Non-Hispanic Blacks ― 5.3 per 100,000
o Asian and Pacific Islanders ― 5.8 per 100,000
o Hispanics ― 5.9 per 100,000
What are some risk factors for nonfatal suicide attempts?
* As noted, an estimated eight to 25 nonfatal suicide attempts occur per every suicide death. Men and the elderly are more likely to have fatal attempts than are women and youth.2
* Risk factors for nonfatal suicide attempts by adults include depression and other mental disorders, alcohol abuse, cocaine use, and separation or divorce.5,6
* Risk factors for attempted suicide by youth include depression, alcohol or other drug-use disorder, physical or sexual abuse, and disruptive behavior.6,7
* Most suicide attempts are expressions of extreme distress, not harmless bids for attention. A person who appears suicidal should not be left alone and needs immediate mental-health treatment.
What can be done to prevent suicide?
Research helps determine which factors can be modified to help prevent suicide and which interventions are appropriate for specific groups of people. Before being put into practice, prevention programs should be tested through research to determine their safety and effectiveness.8 For example, because research has shown that mental and substance-abuse disorders are major risk factors for suicide, many programs also focus on treating these disorders.
Studies showed that a type of psychotherapy called cognitive therapy reduced the rate of repeated suicide attempts by 50 percent during a year of follow-up. A previous suicide attempt is among the strongest predictors of subsequent suicide, and cognitive therapy helps suicide attempters consider alternative actions when thoughts of self-harm arise.9
Specific kinds of psychotherapy may be helpful for specific groups of people. For example, a recent study showed that a treatment called dialectical behavior therapy reduced suicide attempts by half, compared with other kinds of therapy, in people with borderline personality disorder (a serious disorder of emotion regulation).10
The medication clozapine is approved by the Food and Drug Administration for suicide prevention in people with schizophrenia.11 Other promising medications and psychosocial treatments for suicidal people are being tested.
Since research shows that older adults and women who die by suicide are likely to have seen a primary care provider in the year before death, improving primary-care providers' ability to recognize and treat risk factors may help prevent suicide among these groups.12 Improving outreach to men at risk is a major challenge in need of investigation.
What should I do if I think someone is suicidal?
If you think someone is suicidal, do not leave him or her alone. Try to get the person to seek immediate help from his or her doctor or the nearest hospital emergency room, or call 911. Eliminate access to firearms or other potential tools for suicide, including unsupervised access to medications.
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