[Paleopsych] SW: Trends in Thoughts of Suicide in the US
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Public Health: Trends in Thoughts of Suicide in the US
http://scienceweek.com/2005/sw050805-4.htm
The following points are made by R.C. Kessler et al (J. Am. Med.
Assoc. 2005 293:2487):
1) Suicide is one of the leading causes of death worldwide. As a
result, the World Health Organization[1] and the US surgeon general[2]
have highlighted the need for more comprehensive data on the
occurrence of suicidal thoughts and attempts, according to the
assumption that such data would be useful for planning national health
care policy, as well as for evaluating efforts to reduce suicide and
suicide-related behaviors. The latter are among the official national
health objectives in the United States.[3] The assumption that
information on suicide-related behaviors, including thoughts, plans,
gestures, and nonfatal attempts, is important for understanding
completed suicides can be called into question because only a small
fraction of suicide attempters eventually complete suicide.[4]
However, suicide attempts are significant predictors of subsequent
completed suicide, as well as important in their own right as
indicators of extreme psychological distress.
2) Little is known about trends in suicidal ideation, plans, gestures,
or attempts or about their treatment. Such data are needed to guide
and evaluate policies to reduce suicide-related behaviors. The
objective of this study was to analyze nationally representative trend
data on suicidal ideation, plans, gestures, attempts, and their
treatment. Data came from the 1990-1992 National Comorbidity Survey
and the 2001-2003 National Comorbidity Survey Replication. These
surveys asked identical questions to 9708 people aged 18 to 54 years
about the past year's occurrence of suicidal ideation, plans,
gestures, attempts, and treatment. Trends were evaluated by using
pooled logistic regression analysis. Face-to-face interviews were
administered in the homes of respondents, who were nationally
representative samples of US English-speaking residents.
3) Results of the study: No significant changes occurred between
1990-1992 and 2001-2003 in suicidal ideation, plans, gestures, or
attempts, whereas conditional prevalence of plans among ideators
increased significantly, and conditional prevalence of gestures among
planners decreased significantly. Treatment increased dramatically
among ideators who made a suicidal gesture and among ideators who made
an attempt.
4) The authors conclude: Despite a dramatic increase in treatment, no
significant decrease occurred in suicidal thoughts, plans, gestures,
or attempts in the United States during the 1990s. Continued efforts
are needed to increase outreach to untreated individuals with suicidal
ideation before the occurrence of attempts and to improve treatment
effectiveness for such cases.[5]
References (abridged):
1. World Health Organization. Prevention of Suicide: Guidelines for
the Formulation and Implementation of National Strategies. Geneva,
Switzerland: World Health Organization; 1996
2. The Surgeon General's Call to Action to Prevent Suicide.
Washington, DC: US Public Health Service; 1999
3. US Department of Health and Human Services. Healthy People 2010,
2nd ed: With Understanding and Improving Health and Objectives for
Improving Health. Washington, DC: US Government Printing Office; 2000
4. Kuo WH, Gallo JJ. Completed suicide after a suicide attempt. Am J
Psychiatry. 2005;162:633
5. Centers for Disease Control and Prevention. Web-based Injury
Statistics Query and Reporting System (WISQARS) [Centers for Disease
Control and Prevention Web site]. Available at:
http://www.cdc.gov/ncipc/wisqars/default.htm. Accessed March 21, 2005
J. Am. Med. Assoc. http://www.jama.com
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Related Material:
PUBLIC HEALTH: ON SCHOOL-ASSOCIATED STUDENT SUICIDES
The following points are made by J. Kaufman et al (Morb. Mort. Wkly.
Rep. 2004;53:476):
1) During 1994-1999, at least 126 students carried out a homicide or
suicide that was associated with a private or public school in the
United States.(1) Although previous research has described students
who commit school-associated homicides, little is known about student
victims of suicide. To describe the psychosocial and behavioral
characteristics of school-associated suicide victims, the Centers for
Disease Control and Prevention (CDC) analyzed data from school and
police officials. The results of that analysis indicated that among
the 126 students who carried out school-associated homicides or
suicides, 28 (22%) died by suicide, including eight who intentionally
injured someone else immediately before killing themselves. Two (7%)
of the suicide victims were reported for fighting and four (14%) for
disobedient behavior in the year preceding their deaths; none were
associated with a gang. However, potential indicators of suicide risk
such as expressions of suicidal thoughts, recent social stressors, and
substance abuse were common among the victims. The authors suggest
these findings underscore the need for school staff to learn to
recognize and respond to chronic and situational risk factors for
suicide.
2) The need for safe schools has prompted considerable interest in
understanding and preventing all types of lethal school-associated
violence. The finding that 22% of students who carried out such
violence took their own lives indicates that a sizeable proportion of
lethal school-associated violence was self-directed. In addition, the
finding that approximately one in four suicide victims injured or
killed someone else immediately before their suicide suggests an
overlap between risk for committing school-associated homicide and
risk for suicide. Efforts to prevent incidents of lethal
school-associated violence should address youth suicidal ideation and
behavior.
3) Suicide-prevention efforts are needed not only to address the risk
for school-associated violence, but also to reduce the much larger
problem of self-directed violence among adolescents overall. In 2001,
suicide was the third leading cause of death in the United States
among youths aged 13-18 years, accounting for 11% of deaths in this
age group.(2) In 2003, approximately one in 12 high school students in
the US reported attempting suicide during the preceding 12 months.(3)
Data from Oregon indicate that approximately 5% of adolescents treated
in hospitals for injuries from a suicide attempt made that attempt at
school.(4)
4) The finding that the majority of students who were
school-associated suicide victims were involved in extracurricular
activities suggests that these students could be familiar to school
staff who might recognize warning signs. Although these students were
unlikely to stand out (e.g., by fighting or involvement in gangs) in
the manner of those who commit school-associated homicides,(1) other
established risk factors for suicidal behavior were common (e.g.,
expression of suicidal thoughts, recent household move, and romantic
breakup). These findings support the need for school-based efforts to
identify and assist students who describe suicidal thoughts or have
difficulty coping with social stressors. School-based prevention
efforts are likely to benefit from school officials working closely
with community mental health professionals to enhance the abilities of
school counselors, teachers, nurses, and administrators to recognize
and respond to risk factors for suicide.
5) The findings that one in four of the school-associated suicides
were preceded by a recent romantic breakup and nearly one in five
suicide victims were under the influence of drugs or alcohol at the
time of their deaths underscore the potential importance of
situational risk factors. Youth suicidal behavior often is an
impulsive response to circumstances rather than a wish to die. Efforts
to help students cope with stressors and avoid substance abuse are
important elements of suicide-prevention strategies.(5)
References (abridged):
1. Anderson M, Kaufman J, Simon TR, et al. School-associated violent
deaths in the United States, 1994-1999. JAMA. 2001;286:2695-702
2. CDC. Web-based Injury Statistics Query and Reporting System
(WISQARSTM). Atlanta, Georgia: U.S. Department of Health and Human
Services, CDC, National Center for Injury Prevention and Control,
2004.
3. CDC. Youth Risk Behavior Surveillance--United States, 2003. In: CDC
Surveillance Summaries (May 21). MMWR. 2004;53(No. SS-2)
4. CDC. Fatal and nonfatal suicide attempts among adolescents--Oregon,
1988-1993. MMWR Morb Mortal Wkly Rep. 1995;44:312-315, 321-323
5. Centers for Disease Control and Prevention. School health
guidelines to prevent unintentional injury and violence. MMWR Recomm
Rep. 2001;50(RR-22):1-73
Centers for Disease Control and Prevention http://www.cdc.gov
--------------------------------
Related Material:
PUBLIC HEALTH: METHODS OF SUICIDE AMONG ADOLESCENTS
The following points are made by Centers for Disease Control (MMWR
2004 53:471):
1) In 2001, suicide was the third leading cause of death among persons
aged 10-19 years.(1) The most common method of suicide in this age
group was by firearm (49%), followed by suffocation (mostly hanging)
(38%) and poisoning (7%).(1) During 1992-2001, although the overall
suicide rate among persons aged 10-19 years declined from 6.2 to 4.6
per 100,000 population,(1) methods of suicide changed substantially.
To characterize trends in suicide methods among persons in this age
group, CDC analyzed data for persons living in the US during
1992-2001.
2) The results of that analysis indicated a substantial decline in
suicides by firearm and an increase in suicides by suffocation in
persons aged 10-14 and 15-19 years. Beginning in 1997, among persons
aged 10-14 years, suffocation surpassed firearms as the most common
suicide method. The decline in firearm suicides combined with the
increase in suicides by suffocation suggests that changes have
occurred in suicidal behavior among youths during the preceding
decade. Public health officials should develop intervention strategies
that address the challenges posed by these changes, including programs
that integrate monitoring systems, etiologic research, and
comprehensive prevention activities.
3) Among persons aged 10-14 years, the rate of firearm suicide
decreased from 0.9 per 100,000 population in 1992 to 0.4 in 2001,
whereas the rate of suffocation suicide increased from 0.5 in 1992 to
0.8 in 2001. Rate regression analyses indicated that, during the study
period, firearm suicide rates decreased an average of approximately
8.8% annually, and suffocation suicide rates increased approximately
5.1% annually. Among persons aged 15-19 years, the firearm suicide
rate declined from 7.3 in 1992 to 4.1 in 2001; the suffocation suicide
rate increased from 1.9 to 2.7. Rate regression analyses indicated
that, during the study period, the average annual decrease in firearm
suicide rates for this age group was approximately 6.8%, and the
average annual increase in suffocation suicide rates was approximately
3.7%. Poisoning suicide rates also decreased in both age groups, at an
average annual rate of 13.4% among persons aged 10-14 years and 8.0%
among persons aged 15-19 years. Because of the small number of
suicides by poisoning, these decreases have had minimal impact on
changes in the overall profile of suicide methods of youths.
4) Among persons aged 10-14 years, suffocation suicides began
occurring with increasing frequency relative to firearm suicides in
the early- to mid-1990s, eclipsing firearm suicides by the late 1990s.
In 2001, a total of 1.8 suffocation suicides occurred for every
firearm suicide among youths aged 10-14 years. Among youths aged 15-19
years, an increase in the frequency of suffocation suicides relative
to firearm suicides began in the mid-1990s; however, in 2001, firearms
remained the most common method of suicide in this age group, with a
ratio of 0.7 suffocation suicides for every firearm suicide.
5) The findings in this report indicate that the overall suicide rate
for persons aged 10-19 years in the US declined during 1992-2001 and
that substantial changes occurred in the types of suicide methods used
among those persons aged 10-14 and 15-19 years. Rates of suicide using
firearms and poisoning decreased, whereas suicides by suffocation
increased. By the end of the period, suffocation had surpassed
firearms to become the most common method of suicide death among
persons aged 10-14 years.
6) The reasons for the changes in suicide methods are not fully
understood. Increases in suffocation suicides and concomitant
decreases in firearm suicides suggest that persons aged 10-19 years
are choosing different kinds of suicide methods than in the past. Data
regarding how persons choose among various methods of suicide suggest
that some persons without ready access to highly lethal methods might
choose not to engage in a suicidal act or, if they do engage in
suicidal behavior, are more likely to survive their injuries.(4)
However, certain subsets of suicidal persons might substitute other
methods.(5) Substitution of methods depends on both the availability
of alternatives and their acceptability. Because the means for
suffocation (e.g., hanging) are widely available, the escalating use
of suffocation as a method of suicide among persons aged 10-19 years
implies that the acceptability of suicide by suffocation has increased
substantially in this age group.
References (abridged):
1. CDC. Web-based Injury Statistics Query and Reporting System
(WISQARSTM). Atlanta, Georgia: U.S. Department of Health and Human
Services, CDC, National Center for Injury Prevention and Control,
2004.
2. National Center for Health Statistics. Multiple cause-of-death
public-use data files, 1992 through 2001. Hyattsville, Maryland: U.S.
Department of Health and Human Services, CDC, 2003
3. Anderson RN, Minino AM, Fingerhut LA, Warner M, Heinen MA. Deaths:
injuries, 2001. Natl Vital Stat Rep. 2004;52:1-5
4. Cook PJ. The technology of personal violence. In: Tonry M, ed.
Crime and Justice: An Annual Review of Research, vol. 14. Chicago,
Illinois: University of Chicago Press, 1991:1-71
5. Gunnell D, Nowers M. Suicide by jumping. Acta Psychiatrica
Scandinavica. 1997;96:1-6
Centers for Disease Control and Prevention http://www.cdc.gov
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