[Paleopsych] SW: Trends in Thoughts of Suicide in the US

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Public Health: Trends in Thoughts of Suicide in the US

     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
     Related Material:
     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
     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
     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
     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,
     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:
     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
     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,
     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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