Dramatic Increase in Teen Suicide

CDC Reports Largest Spike in Teen Suicide Rate in 15 Years

From the WebMD Archives

Sept. 6, 2007 -- There is a sharp rise in suicides across the board in teens, says the CDC.

They are up 76% in girls aged 10-14, up 32% in girls aged 15-19, and up 9% in boys aged 15-19. It's the biggest spike in 15 years, the CDC's latest teen-suicide statistics show.

"This is a dramatic and huge increase" in pre-teen and teen suicide, Ileana Arias, PhD, director of the CDC's National Center for Injury Prevention and Control, said at a news conference. "We are seeing this increase in significantly younger Americans than we have seen in the past."

The data cover the year 2004, the latest year for which numbers are available. The CDC collects the information from death certificates. Because coroners and medical examiners don't always have enough information to conclude that a death was a suicide, the actual number of suicides is likely to be higher than the official number.

The new numbers reverse a decade-long downward trend in teen and youth suicide. It's too soon to know whether 2004 was an unusual year, or whether it marks the beginning of an upward trend. But the data suggest disturbing changes.

One disturbing change is the uptick in girls and young women committing suicide. The other disturbing change is that hanging or asphyxiation is becoming much more common -- particularly among 10- to 14-year-old girls.

The rate of suicide by hanging/asphyxiation more than doubled to 68 per 1,000 girls aged 10 to 14. Since 1990, when the CDC began keeping records, this rate was never higher than 35 per 1,000 girls in the same age group.

It's possible that this new trend toward hanging and asphyxiation is linked to a choking game that has recently become popular among schoolchildren.

As its name implies, the "game" usually involves using the hands, rope, or fabric to choke another child until he or she loses consciousness. The payoffs appear to be the brief "high" achieved during the loss and regain of oxygen to the brain, and the amusement derived from seeing a peer become disoriented.

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As might be expected, this game has resulted in deaths. However, 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 antidepressant prescriptions for teens. This is due to concerns that the drugs may increase suicide risk for a subset of young people. Some psychiatrists feel this drop in prescribing is behind the surge in teen suicides, but Arias says this isn't the only issue involved.

"It is important to recognize that suicide is a multidimensional and complex problem. As much as we would like to attribute it to a single source, we cannot do that," she said. "So while antidepressant medication may have role in suicidal ideation, it not the only factor."

"It is possible that some subgroups of patients do become worse when given antidepressants, but the larger population benefits," Thomas Laughren, MD, head of the FDA's psychiatric products division, said at the news conference. "It is possible for two different things to be happening at the same time. We will continue to monitor suicide rates and antidepressant prescribing and take whatever regulatory steps are necessary."

The new teen suicide statistics appear in the Sept. 7 issue of the CDC's Morbidity and Mortality Weekly Report.

Is Your Child or Teen Suicidal?

The increased risk of suicide in young girls presents problems for prevention efforts. In the past, when three out of four suicides were male, suicide prevention focused on boys and young men. Prevention efforts also focused on firearms, which had been the most common method of suicide.

The September issue of the Journal of Pediatrics carries an updated review of teen suicide by Benjamin N. Shain, MD, PhD, of the American Academy of Child and Adolescent Psychiatry, and colleagues from the American Academy of Pediatrics committee on adolescence.

"Unfortunately, no one can accurately predict suicide, so even experts can only determine who is at high risk," Shain and colleagues note.

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Examples of high-risk teens include:

  • Teens with a plan or recent attempt to commit suicide
  • Teens who say they are going to kill themselves
  • Teens who talk about killing themselves and who become agitated or hopeless
  • Impulsive teens who become profoundly sad and who suffer conditions such as bipolar disorder, major depression, psychosis, or substance use disorders

Signs of major depression include:

  • Cranky mood
  • Preoccupation with song lyrics suggesting life is meaningless
  • Loss of interest in sports and usual activities
  • Failure to gain normal weight
  • Frequent complaints of physical illness such as headache and stomach ache
  • Excessive late-night TV watching
  • Refusal to wake for school in the morning
  • Talk of running away from home, or attempts to do so
  • Persistent boredom
  • Oppositional and/or negative behavior
  • Poor performance in school or frequent school absences
  • Recurrent talk of or writing about suicide
  • Giving away toys or belongings

Signs Not Always Obvious

Unfortunately, absence of high risk does not necessarily mean low risk. Kids who seem to be at low risk, but who joke about killing themselves or who repeatedly seek treatment for physical complaints, "may be asking for help the only way they can," Shain and colleagues suggest.

Any teen who suffers significant loss of function or distress due to emotional or behavioral symptoms should be closely observed, referred for a mental health evaluation, or both.

A brief psychological intervention may be all teens need if they have a responsive and intact family, good relationships with their peers, hope for the future, and a desire to resolve conflicts.

Hospitalization and long-term psychiatric care may be needed for teens who:

  • Have made previous suicide attempts
  • Show a strong intent to commit suicide
  • Have serious depression or other major psychiatric disorders
  • Abuse alcohol or drugs
  • Have low impulse control

If a teen has made a suicide attempt, it's crucial to keep up continuous psychological care after hospital discharge. It's important to continue treatment of underlying psychiatric illnesses, to remove firearms from the home, and to lock up potentially lethal medications. Getting the teen to agree to a "no suicide" contract has not been proven effective.

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"Suicide risk can only be reduced, not eliminated," Shain and colleagues warn. "Risk factors can provide no more than guidance."

The national suicide hotline -- 800-273-TALK -- connects callers to one of 120 local suicide crisis centers.

WebMD Health News Reviewed by Louise Chang, MD on September 06, 2007

Sources

SOURCES: CDC, Morbidity and Mortality Weekly Report, Sept. 7, 2007; vol 56: pp 905-908. News conference, CDC, with Ileana Arias, PhD, director, CDC National Center for Injury Prevention and Control (NCIPC); Keri Lubell, PhD, behavioral scientist and MMWR study author, NCIPC; Richard McKeon, PhD, special advisor on suicide prevention, Substance Abuse and Mental Health Services Administration (SAMHSA); and Thomas Laughren, MD, director, psychiatric products division, FDA. Shain, B.N. Pediatrics, September 2007; vol 120: pp 669-676.

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