The Story Behind the Increase in Teen Suicide Rates

[David Baxter PhD]

The Story Behind the Increase in Teen Suicide Rates
By John M. Grohol, Psy.D.

On Monday, February 12 2007, the U.S. Center for Disease Control and Prevention released its Annual Summary of Vital Statistics. Inside the report, suicide rates for children ? and especially teens ? appeared to have rose dramatically over a one-year time period, 2003 to 2004.

And like moths drawn to a flame, every news outlet in the U.S. dutifully reports the supposed link between this increase in suicide rates to a decrease in antidepressant prescriptions in 2004.

The problem is ? like most mainstream medical reporting done on tight deadlines with virtually no time to fact check and get the story right ? every news outlet was dead wrong.

But it?s not like we could only blame the news outlets (such as ABC News, whose story was typical reporting on this issue).

Experts in the field, including researchers and university professors, were quick to make pronouncements about the cause of this increase. The report is simply an annual tabulation of data ? it is not a study and does not propose any hypotheses to test. Yet researchers, who supposedly should know better, instantly created a causal relationship between two variables where only a correlational relationship exists.

What did these experts blame on the rise in suicide in children?

An FDA label on certain antidepressant medications.

For instance, Dr. Charles Nemeroff, chairman of the department of psychiatry and behavioral sciences at the Emory University School of Medicine, was quoted by ABC News as saying, ?I have no doubt that there is such a relationship.? That is a bold, unsupported statement.

The ABC News article continues?

?This is very disturbing news,? said Dr. David Fassler, clinical professor of psychiatry at the University of Vermont College of Medicine. ?The adolescent suicide rate has been declining steadily since the early 1990s.

?The sudden increase in the adolescent suicide rate,? Fassler continued, ?corresponds to the significant and precipitous decrease in the use of SSRI antidepressants in this age group.?​

I can see why these researchers feel this way, because the data seem to support a decline in SSRI prescriptions to teens and children in 2004.

But, as others are making clear, the data and the datatrends about childhood prescriptions is not at all clear for 2004.

Correlation does not equal causation. Without a specific study examining causative factors in this increase, one simply cannot make factually-based claims. The rise in the child suicide rate could?ve been caused by a multitude of equally plausible other factors.

It also looks like researchers are quick to blame the FDA making the ?wrong? decision with regard to the black box label. The FDA website has a detailed page about the controversy.

As any scientist will tell you, though, the data don?t support this conclusion. Without an empirical study that examines this specific hypothesis, all we have is a possible correlational relationship. We shouldn?t make public policy decisions ? or research or treatment decisions ? based upon such a thin relationship.

Read more over at Clinical Psychology and Psychiatry: A Closer Look: SSRI?s and Suicide: Update.

 

[just mary]

Hi,

I was trying to download the report that these statistics came from but "there was a problem" (according MicroSoft) and it didn't work. I wanted more information, more data, I wanted to see how large the increase was. I wanted to learn more about the study itself but I couldn't, which is too bad.

However, this is a good article, and I think they hit the nail on the head when it says:

like most mainstream medical reporting done on tight deadlines with virtually no time to fact check and get the story right

There is so much information/knowledge out there, that it's virtually impossible to get the story right in a short timeframe - unless you're just reporting the basic facts.

jm

 

[David Baxter PhD]

I also get a page error, JM. It may be temporary.

 

[HA]

Teen Suicide Spike Linked to SSRI Black Box
By Michael Smith, Senior Staff Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
February 06, 2007

Explain to interested patients that a statistical picture of the U.S. shows that teen suicides spiked sharply upwards in 2004 -- a time that coincided with increased concern about the use anti-depressants by youngsters.

Caution that the statistical survey does not draw any conclusions about the cause of the increase, and note that other factors -- such as lack of access to care -- may also play a role.

Review

ATLANTA, Feb. 6 -- Teen and childhood suicides rose sharply in 2004, for the first time in more than 10 years, and some are linking this to a reduced use of antidepressants that year because of black box label warnings mandated by the FDA.

According to figures compiled by the CDC there were 1,985 suicides among those ages 10 through 19 in 2004, compared with 1,737 in 2003.

That's a rate of 2.6 per 100,000, up from 2.2 per 100,000 the year before, according to the Annual Summary of Vital Statistics, published in the February issue of Pediatrics.

Overall, the death rate from suicide increased by 18.2% -- a change that was deemed "unacceptable" by David Shern, Ph.D., president of Mental Health America.

Dr. Shern said it's premature to draw conclusions about the cause of the increase, but noted that it coincided with the FDA's warning that selective serotonin reuptake inhibitors (SSRIs) had been linked to suicidal thoughts in young people.

The warnings created a barrier to treatment "by scaring young people and parents away from care" that may be linked to the rise in suicide, Dr. Shern said in a statement.

Charles Nemeroff, M.D., Ph.D., of Emory University School of Medicine here told reporters he has no doubt that the warning contributed to the suicide increase.

"The concerns about antidepressant use in children and adolescents have paradoxically resulted in a reduction in their use, and this has contributed to increased suicide rates," Dr. Nemeroff said.

Noting that the adolescent suicide rate had been falling, David Fassler, M.D., of the University of Vermont in Burlington, Vt., called the new data "very disturbing."

"The sudden increase in the adolescent suicide rate," Dr. Fassler told reporters, "corresponds to the significant and precipitous decrease in the use of SSRI antidepressants in this age group."

He said there are no data showing that SSRIs increase the risk of suicide and "the current data suggest that the decreased use of these medications is, in fact, associated with an increase in actual deaths attributable to suicide."

But the warnings may not be the only reason for the spike, according to Bernadette Melnyk, Ph.D., R.N., of Arizona State University in Phoenix. She told reporters the U.S. is short about 30,000 child psychiatrists "so the gaps in mental health services for those children and youth who need them are huge."

She said that one in four teens has a mental health problem and only about a quarter of them are treated. Aside from the teen suicide numbers, the survey presented a statistical grab-bag, including:

• A record high life expectancy. The expectation of life at birth reached 77.8 years for all gender and race groups combined.
• Declining death rates for nine of the 15 leading causes, including heart disease (down by 6.6%), cancer (down by 2.3%), strokes (down by 6.5%), and influenza and pneumonia (down by 10.0%).
• The statistical survey noted that most of the causes of death among youngsters remained unchanged, with the exceptions of suicide and of influenza and pneumonia, which fell by 40%.

Overall, 25,325 children and adolescents died in 2004, 44% of them from unintentional injuries, according to Brady Hamilton, Ph.D., of the CDC.

The death rate for youngsters was 32.7 per 100,000 populations, slightly lower (0.9%) compared with the 33.0 in 2003.

Over all age groups, the death rate was 816.5 per 100 000 population, a 3.0% decrease from the final 2003 rate of 841.9. All told, 2,397,615 Americans died in 2004.

As for births, the survey found, the excess of birth over deaths in 2004, was slightly more than 1.7 million, while the preliminary data for 2005 show 4,140,419 births, an increase of about 1%.

The survey also found:

• The general fertility rate in 2005 was 66.7 births per 1,000 women ages 15 to 44, which is the highest level since 1993.
• The birth rate for teen mothers -- those 15 to 19 years -- fell by 2% between 2004 and 2005 to 40.4 births per 1,000 women, the lowest seen in the 65 years for which there are good data.
• The birth rate for women 30 years old rose in 2005 to levels not seen in almost 40 years.
• Pronounced differences in infant mortality rates by race and Hispanic origin continue, with non-Hispanic black newborns more than twice as likely as non-Hispanic white and Hispanic infants to die within one year of birth.
• Childbearing by unmarried women also surged to historic record levels for the United States in 2005 -- to 1,525,345, compared with 1,470,189 in 2004.
• The caesarean-delivery rate rose by 4% in 2005 to 30.2% of all births, another record.

The authors reported they have no relevant financial relationships.

Source reference: Hamilton BE et al. Annual Summary of Vital Statistics: 2005 Pediatrics 2007;119:345-60.

 

[just mary]

Thanks HeartArt. This article gives some good/more information.

I'm still going to try downloading the whole report though, and if anyone's interested, I'll let you know if I was successful.

Thanks again,

jm

 

[SoSo]

I have been reading on the SSRI meds and teens. I adopted my grandson who was born a 'drug' baby due to bad streets drugs his birth mother used. He had it rough right from day one but was never out of control. He was a little slow and could not learn as quickly as some but on the 'normal' low end of test scales. He was put on Dexidrine after a 15 minute visist to a doctor who said he was ASHD. Then some doctor decided because he talked to himself and his toys he had split personality, put him on SSRI meds and many others. He became psychotic, tried to kill me, tortured our pets till they had to be put down, set fire to our home, etc. etc. Then she put him on a stronger dose of a different SSRI med and he tried to kill himself a few times. I then got cancer so moved back to the city to get him help as I just couldn't deal anymore. I lied to doctors, would say I fell and broke my wrist myself, etc. but one day realized I was not qualified to help my son, he needed help and fast. I went for months trying to get him into a program in this city but no one would listen or help. Finally I took myself off my thyroid replacement hormone meds and refused to take them till they got him help and I could have died from doing that but figured he was worth it even if no one else seemed to care. I took him off the SSRI meds, finally got him into a teen residential group home where he lived for 6 months and got help. He has improved, still has problems but it is nothing compared to what I saw when he was on the meds. I don't know if it was the meds, can only say I feel it was. I just wish the gov. would support and supply more group homes or places for these kids to get help rather than have doctors give them those pills. If they really need them, then that is different. He is now living with his birth mother for the first time in his life. It hurt like hell when he made the choice to live with her but she is his mother and I respect his choice. Now, I can work on me, getting my life together after the past 8 years of going through hell with him on meds. I feel sad for all the lonely scared teens out there today. I know so many of my sons friends that are 'cutting' etc. Wish someone could give them all a hug and make whatever it is that hurts them go away, life, sucks sometimes but we keep on going.
feisty4me