An increasing youth suicide rate may point toward an emerging public health crisis, necessitating national efforts to develop effective interventions, experts recently warned. Some efforts are already under way. Researchers are reporting significant findings from new studies on suicidal adolescents, particularly those who make multiple attempts.
In a recently published trend analysis, Bridge and colleagues1 found that after a decade-long decline in the suicide rate among youths aged 10 to 19 years in the United States, there was an 18% increase in suicide rates in 2004. This upward trend persisted in 2005 (Figure).
The analysis showed 326 more deaths than would have been expected in 2004 and 292 more deaths than expected in 2005 when compared with the number of deaths predicted by the regression model.
Concerned about an emerging crisis, Bridge and associates recommend studies on possible factors that have contributed to the increase in youth suicides.
These include the influence of Internet social networking sites, the effects of combat in Iraq and Afghanistan on soldiers returning home, untreated depression in the wake of recent boxed warnings on antidepressants, and access to firearms. Those studies, they added, should involve comprehensive assessment of individual-level exposure and outcome data, because “aggregate data alone cannot establish causal links.”
In another measure, the CDC’s national Youth Risk Behavior Surveillance Survey of 2007 (www.cdc.gov/ mmwr) showed that 6.9% of US high school students (grades 9 through 12) had attempted suicide at least once during the 12 months before the survey and 14.5% had seriously considered suicide. Overall, the prevalence of attempted suicides was highest among females, black and Hispanic students, and 9th and 10th graders.
Burns and coworkers2 studied treatment compliance in adolescents after attempted suicide. They found that up to 50% of adolescents who attemptsuicide may reattempt it. Up to 11% of those who attempt suicide eventually die by suicide.2 David Shaffer, MD, Irving Philips Professor of Child Psychiatry and professor of psychiatry and pediatrics at Columbia University Medical Center, explained that differences occur in reattempt statistics—depending on whether the source is a survey or clinical sample. Dr Shaffer is a strong proponent of suicide prevention efforts through screening.
According to Shaffer, about 10% of attempters identified in large anonymous surveys of high school students report having made more than 1 previous attempt. The rate in clinical samples is higher: approximately one-third of attempters seen in a clinic repeated their attempt within 3 years. Our research on youth identified as being at risk for suicide (after screening in the general population), Shaffer added, shows that teens who make multiple attempts are more likely to be girls and to have an associated psychiatric disorder than teens who make a single attempt.
Studies of inpatients show that a reattempt at suicide is most likely within a year after discharge. The peak incidence occurs between 3 and 6 months after the original attempt, said Shaffer.
Predictors of future attempts, Burns told Psychiatric Times, include greater intent to die; lethality of first attempt; general psychopathology, particularly depressive symptoms; the intensity, number, and range of life stressors experienced by the adolescent following the initial suicide attempt; negative perceptions of the family function (eg, high levels of family conflict); and feelings of hopelessness and helplessness. Prior attempts also serve as a major predictor, Shaffer reported.
Miranda and colleagues3 recently published a study of 228 teens who reported a lifetime suicide attempt or suicidal ideation during a 2-stage high school screening done in the mid- 1990s in the New York metropolitan area. These teens were contacted 4 to 6 years later as young adults and asked whether they had made any further suicide attempts.
According to Shaffer, results suggest that psychiatrists should be asking teenagers who present to the emergency department not only whether they have ever attempted suicide but also how many times they have made such attempts.
“Knowing whether teens had ever made more than 1 suicide attempt when we first interviewed them gave us more information about how likely they were to make another suicide attempt during the ensuing 4 to 6 years than even knowing whether they had a history of a psychiatric disorder,” he said.
1.Bridge JA,Greenhouse JB,Weldon AH,et al. Suicide trends among youths aged 10 to 19 years in the United States,1996-2005.JAMA. 2008;300:1025-1026.
2. Burns CD, Cortell R,Wagner BM.Treatment compliance in adolescents after attempted suicide: a 2-year follow-up study. J Am Acad Child Adolesc Psychiatry. 2008;47:948-957.
3. Miranda R, Scott M, Hicks R, et al. Suicide attempt characteristics,diagnoses,and future attempts:comparing multiple attempters to single attempters and ideators. J Am Acad Child Adolesc Psychiatry. 2008; 47:32-40.