One in 25 youth attempt suicide: U.S. study
By Genevra Pittman
NEW YORK | Wed Jan 9, 2013 3:25pm EST
(Reuters Health) - About one in 25 U.S. teens has attempted suicide, according to a new national study, and one in eight has thought about it.
Researchers said those numbers are similar to the prevalence of lifetime suicidal thinking and attempts reported by adults - suggesting the teenage years are an especially vulnerable time.
"What adults say is, the highest risk time for first starting to think about suicide is in adolescence," said Matthew Nock, a psychologist who worked on the study at Harvard University in Cambridge, Massachusetts.
The results are based on in-person interviews of close to 6,500 teens in the U.S. and questionnaires filled out by their parents. Along with asking youth about their suicidal thinking, plans and attempts, interviewers also determined which teens fit the bill for a range of mental disorders.
Just over 12 percent of the youth had thought about suicide, and four percent each had made a suicide plan or attempted suicide.
Nock and his colleagues found that almost all teens who thought about or attempted suicide had a mental disorder, including depression, bipolar disorder, attention deficit hyperactivity disorder (ADHD) or problems with drug or alcohol abuse.
More than half of the youth were already in treatment when they reported suicidal behavior. Nock said that was both "encouraging" and "disturbing."
"We know that a lot of the kids who are at risk and thinking about suicide are getting (treatment)," he told Reuters Health. However, "We don't know how to stop them - we don't have any evidence-based treatments for suicidal behavior."
WHO IS AT RISK?
Amy Brausch, a psychologist who has studied adolescent self-harm and suicide at Western Kentucky University in Bowling Green, said the finding shouldn't be interpreted to mean mental health treatment doesn't work for teens.
"We don't know from this study if they even told their therapist they were having these thoughts, we don't know if it was a focus of the treatment," Brausch, who wasn't involved in the new research, told Reuters Health.
The findings were published this week in JAMA Psychiatry. But they still leave many questions unanswered.
Because most youth who think about suicide never go on to make an actual plan or attempt, doctors need to get better at figuring out which ones are most at risk of putting themselves in danger, according to Nock.
Once those youth are identified, researchers will also have to determine the best way to treat them, he said - since it's clear that a lot of current methods aren't preventing suicidal behavior.
According to the U.S. Centers for Disease Control and Prevention, suicide is the third leading cause of death for people between age 10 and 24, killing about 4,600 young people annually.
Although girls are more likely to attempt suicide - a pattern confirmed by Nock's study - boys have higher rates of death by suicide because they typically choose more deadly methods, such as guns.
For parents, Brausch advised keeping open communication with their adolescent and not being afraid to ask about things like depression. They should also pay attention to changes in mood or behavior, she added.
Nock agreed. "For parents, if they suspect their child is thinking about suicide… or talking about death, I would have that child evaluated," he said.
Prevalence, Correlates, and Treatment of Lifetime Suicidal Behavior Among Adolescents
Results From the National Comorbidity Survey Replication Adolescent
Matthew K. Nock, PhD; Jennifer Greif Green, PhD; Irving Hwang, MA; Katie A. McLaughlin, PhD; Nancy A. Sampson, BA; Alan M. Zaslavsky, PhD; Ronald C. Kessler, PhD
JAMA Psychiatry. 2013;():1-11. doi:10.1001/2013.jamapsychiatry.55.
Published online January 9, 2013
Context Although suicide is the third leading cause of death among US adolescents, little is known about the prevalence, correlates, or treatment of its immediate precursors, adolescent suicidal behaviors (ie, suicide ideation, plans, and attempts).
Objectives To estimate the lifetime prevalence of suicidal behaviors among US adolescents and the associations of retrospectively reported, temporally primary DSM-IV disorders with the subsequent onset of suicidal behaviors.
Design Dual-frame national sample of adolescents from the National Comorbidity Survey Replication Adolescent Supplement.
Setting Face-to-face household interviews with adolescents and questionnaires for parents.
Participants A total of 6483 adolescents 13 to 18 years of age and their parents.
Main Outcome Measures Lifetime suicide ideation, plans, and attempts.
Results The estimated lifetime prevalences of suicide ideation, plans, and attempts among the respondents are 12.1%, 4.0%, and 4.1%, respectively. The vast majority of adolescents with these behaviors meet lifetime criteria for at least one DSM-IV mental disorder assessed in the survey. Most temporally primary (based on retrospective age-of-onset reports) fear/anger, distress, disruptive behavior, and substance disorders significantly predict elevated odds of subsequent suicidal behaviors in bivariate models. The most consistently significant associations of these disorders are with suicide ideation, although a number of disorders are also predictors of plans and both planned and unplanned attempts among ideators. Most suicidal adolescents (>80%) receive some form of mental health treatment. In most cases (>55%), treatment starts prior to onset of suicidal behaviors but fails to prevent these behaviors from occurring.
Conclusions Suicidal behaviors are common among US adolescents, with rates that approach those of adults. The vast majority of youth with suicidal behaviors have preexisting mental disorders. The disorders most powerfully predicting ideation, though, are different from those most powerfully predicting conditional transitions from ideation to plans and attempts. These differences suggest that distinct prediction and prevention strategies are needed for ideation, plans among ideators, planned attempts, and unplanned attempts.
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