by Kevin Caruso
September 6, 2007
The U.S. suicide rate for 10- to 14-year-old girls rose 76 percent from 2003 to 2004, according to a report by the Centers for Disease Control and Prevention (CDC).
Additionally, the CDC reported a 32.3 percent increase among 15- to 19-year-old girls, and a 9 percent increase among 15- to 19-year-old boys.
And the overall youth suicide rate rose 8 percent.
The dramatic increase sharply contrasts with the 28.5 percent decrease in youth suicide rates since 1990, thus causing alarm in the suicide prevention community.
“Our news today is sobering. This is a dramatic and huge increase and it raises great concern for us, but we don't yet know if this is a short-lived increase or if it's the beginning of a trend ” said Dr. Ileana Arias, director of the CDC's National Center for Injury Prevention and Control, which produced the new report. “Suicide is the third leading cause of death among people ages 10 to 24, surpassed only by car crashes and homicides.”
The cause for the increased rate may be attributed to the 20 percent decrease in teen antidepressant prescriptions since “black box” warnings were mandated by the FDA in 2004. These warnings ordered manufacturers of antidepressants, such as Prozac and Zoloft, to print its strictest, “black box” warning on the boxes to inform doctors and patients that the medicines could increase the risk of suicidal thoughts or actions in children and teens.
Bottom line: Some young people who may need antidepressants are not getting them.
Dr. Mark Riddle, director of child and adolescent psychiatry at the Johns Hopkins Children's Center, said, “There's been concern that the black box would lead to a reduction in prescribing and therefore an increase in suicides, and my guess is that's what's happening. Some doctors are reluctant to prescribe an antidepressant to a child if it comes with the FDA's most stringent warning label.”
And Dr. Benjamin N. Shain, an associate professor of psychiatry at Northwestern University and a liaison to the American Academy of Child and Adolescent Psychiatry, said, “One major factor that changed was the prescribing of antidepressant medications. Most likely, that’s what was responsible for the decrease in suicide rates.”
And several recent studies suggest that antidepressants are more likely to reduce suicide risk than increase it.
One such study, which was published in The American Journal of Psychiatry on September 5, 2007, found that a decrease in antidepressant prescriptions for young people in the U.S. of just a few percentage points coincided with a 14 percent increase in suicides; and in the Netherlands, the suicide rate spiked almost 50 percent in young people when prescription rates declined.
“There is a lot of evidence to believe the black box warnings have led to decreases in prescriptions, and there is also evidence that the number of suicides was on the rise as those prescriptions dropped. The highest risk period for suicide is right before treatment is started, and the risk actually comes down once pharmacotherapy or psychotherapy is started,” said Robert Gibbons, a professor of biostatistics and psychiatry at the University of Illinois in Chicago and the lead author of the study.
But Ileana Arias from the CDC said, “There is a wide range of factors that may be accounting for the increase, and we’re not aware of anyone who has done an analysis to account for those. In addition to changes in prescribing habits, other changes might include increased rates of mental health disorders or increased rates of alcohol or drug use.”
And Dr. Thomas Laughren, director of the division of psychiatry products at the F.D.A., said that the CDC would need to see more data over time, linking declines in prescriptions to suicide risk before revisiting any of its decisions.
“It is true that antidepressant prescribing in pediatric patients has gone down, and that coincides with this one-year uptick in adolescent suicide, and that is a concern for us,” said Laughren, “We do have an obligation to alert prescribers and patients of risks we find with drugs, [but] you simply cannot reach causal conclusions from the new CDC data.”
The CDC found that in 2004 there were 4,599 suicides in Americans ages 10 to 24, up from 4,232 in 2003, for a rate of 7.32 per 100,000 people that age. But the rate had dropped to 6.78 per 100,000 in 2003 from 9.48 per 100,000 in 1990.
The CDC also reported that 161,000 youths between the ages of 10 and 24 went to an emergency room because of a self-inflicted injury in 2004 – so the number of attempted suicides is extremely high.
The CDC report also indicated that hanging was the most common method for 10- to 14-year old girls, with 71 percent using that method.
Clearly, the one-year spike could be an aberration, but immediate action needs to be taken to ensure that the rate is reduced. Suicide.org and ProjectCare.com have been working diligently with young girls and youths to help prevent suicides as well as offer assistance and support for mental disorders, rape, molestation, eating disorders, self-injury, drug consumption, and other serious issues.
“Young people are particularly vulnerable to depression,” said Kevin Caruso, executive director of Suicide.org. “And untreated depression is the number one cause for suicide. So we need to do all that we can to reach these young people who are suicidal and ensure that they receive immediate, effectual treatment as well as long-term loving, caring support.”
If you or someone you know is suicidal, please go to the Home Page of this website for immediate help.
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