A recent rise in teen suicides recently ended a long, steady decline in
The rate of suicides among youngsters and young adults aged 10 to 24
increased by 8 percent from 2003 to 2004 to total of 4,599 deaths. The jump in
deaths among this age group, announced in September by the Centers for Disease
Control and Prevention (CDC), was particularly pronounced among girls aged 10
to 14, among whom the number of suicides jumped by 76 percent. Suicides were
also up 32 percent among girls aged 15 to 19, and 9 percent among boys aged 15
The CDC found that the spike occurred after 14 years of declines in youth
suicide. The suicide rate dropped 19 percent from 1990 to 2003 before the
sharp rise in 2004, which was the most recent year data were collected.
"This is the biggest annual increase that we've seen in 15
years," said Ileana Arias, Ph.D., director of CDC's National Center for
Injury Prevention and Control. "We do not yet know if this is a
short-lived increase or if it's the beginning of a trend."
The method many young girls use to commit suicide also has changed. In 2004
hanging or suffocation was the most common method among girls in all age
groups and accounted for 71 percent of suicides among girls aged 10 to 14, 49
percent of suicides in girls aged 15 to 19, and 34 percent of suicides among
young women aged 20 to 24.
A particularly dramatic jump in the rate of suicide by hanging or
asphyxiation was found in girls aged 10 to 14. In 2004 the rate was 6.8 per
1,000,000 population, but in the years since the CDC began keeping records on
suicides in 1990, this rate was never higher than 3.5 per 1,000,000 girls in
the same age group, according to the report in the September 7 Morbidity
and Mortality Weekly Report.
"So while we can't say this is a trend, we are confident that that is
definitely an usually high number in 2004," said Keri Lubell, Ph.D., one
of the study authors in comments at a press conference.
The report's authors theorized that the trend toward hanging and
asphyxiation is linked to a choking game that has recently become popular
among youngsters. Although the CDC does not believe that a significant number
of these deaths have been misclassified as suicides, it remains unclear
whether the game is linked to the growing acceptability of hanging and
asphyxiation as a suicide method.
The surge in teen suicide also coincides with a drop in prescribing of
antidepressant medications after the Food and Drug Administration mandated the
addition of warning language to the labels of antidepressants about possible
links between their use and suicide among children, adolescents, and young
adults (see Suicide Data Prompt Call for Black Box Review).
Reported prescriptions of antidepressants for children and adolescents
decreased by 19 percent in the third quarter of 2004 and 16 percent in the
fourth quarter of 2004, compared with the year before, according to an article
in the September Pediatrics that cited data from pharmacy benefit
manager Medco Health Systems.
Some psychiatrists and other researchers believe that the decline in
antidepressant prescribing is responsible for the surge in teen suicides.
A growing body of research bolsters the position that antidepressants
effectively treat depression. An example of the effectiveness of such
medications in adolescents was documented in a study by John March, M.D., and
others in the August 18, 2004, Journal of the American Medical
Association that found that a combination of an antidepressant and
cognitive-behavioral therapy led to significant clinical improvement in 71
percent of adolescents with major depression. That outcome was compared with
improvement of 61 percent for the medication alone, 43 percent for
cognitive-behavioral therapy alone, and 35 percent for placebo, according to
the study (Psychiatric News, September 3, 2004).
Regardless of the data on the benefits of antidepressants outweighing the
risks, the FDA will need to see more evidence over time before the agency will
consider linking declines in prescriptions to a growth in suicide risk and
revisiting any of its previous warnings, said Thomas Laughren, M.D., director
of the Division of Psychiatry Products at the FDA, in a September 6 conference
call with reporters. "It's true that antidepressant prescribing in
pediatric patients has come down. And that coincides with this one-year uptick
in adolescent suicide, so obviously that's a concern," Laughren said."
On the other hand, we do, as a regulatory agency, have an obligation to
alert prescribers and patients of risks that we find with drugs that are being
used. So it's a dilemma for us, but clearly it's a concern."
In December 2006, an FDA advisory committee urged antidepressant medication
product labeling to reflect the apparent beneficial effect of antidepressants
in older adults and to remind health care professionals about the danger of
untreated depression (Psychiatric News, January 19). As a result,
this past summer the FDA required manufacturers of antidepressants to include
on their labeling the statement, "Anyone considering the use of [name of
antidepressant] or any other antidepressant in a child, adolescent, or young
adult must balance this risk with the clinical need.... Depression and certain
other psychiatric disorders are themselves associated with increases in the
risk of suicide."
It is possible that some subgroups of patients become more suicidal when
given antidepressants, Laughren said, while the larger population
Thomas Anders, M.D., president of the American Academy of Child and
Adolescent Psychiatry (AACAP), urged physicians, educators, parents, and teens
to learn the signs of suicidal behavior and to take action and seek help when
they see those signs.
The significant increase in adolescent suicides demonstrates the need for
more information on how to prevent violent deaths, including suicide,
according to Sean Gerow, chair of the board of directors of the Suicide
Prevention Action Network USA (SPAN USA).
The CDC suicide data, which federal health officials describe as likely
underestimating the extent of the problem, are based on the National Violent
Death Reporting System (NVDRS), which collects data from medical examiners,
coroners, police, crime labs, and death certificates to understand the
circumstances around violent deaths, including suicides. The system's data,
however, come from only 17 states.
SPAN USA has urged a $1.5 million federal expansion of the NVDRS.
The CDC "Morbidity and Mortality Weekly Report" is
AACAP's "Practice Parameter for the Assessment and Treatment of Children
and Adolescents With Suicidal Behavior" is posted at<www.aacap.org/galleries/PracticeParameters/Suicide.pdf>.▪