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The Honolulu Advertiser
Posted on: Friday, September 7, 2007

Suicide rate among kids, young adults surged in '04

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By Thomas H. Maugh II and Jia-Rui Chong
Los Angeles Times

After a decade of decline, the suicide rate for girls ages 10 to 14 spiked by 76 percent in 2004, and their method of choice changed from firearms to suffocation and hanging, federal officials said Thursday.

The rate among older boys and girls also increased substantially, driving the overall suicide rate among 10- to 24-year-olds to an 8 percent increase in 2004, the largest jump in 15 years, according to the Centers for Disease Control and Prevention's latest Morbidity and Mortality Weekly Report. The rate had declined by 28 percent between 1990 and 2003 before the jump in 2004.

The overall 2004 increase in suicide rates was previously known, but the new study provided the first breakdown by age and gender. It also provided new data about the methods used to commit suicide.

The absolute numbers of suicides are relatively small. Among 10- to 14-year-old girls, for example, the number of suicides rose from 56 to 94, out of an estimated population of about 10 million. But experts are concerned because the figures are bucking a long-standing trend of declines.

"It seemed like something was working," said Ileana Arias, director of the CDC's National Center for Injury Prevention and Control. "What's concerning is that it is changing for these groups."

Arias said she did not know what caused the increase, but she noted that the declines in the 1990s may have been part of a general trend toward less violence.

BLACK-BOX WARNINGS

Other experts attributed it to a drop in prescriptions for antidepressants following widespread publicity in 2003 linking the drugs to increases in suicidal thoughts in young people. The Food and Drug Administration responded by requiring the drugs to carry a black-box warning. The debate about the impact of the warning has been simmering for more than a year.

Dr. Julio Licinio, chairman of the department of psychiatry and behavioral sciences at the University of Miami, noted that the decline in suicide rates during the 1990s coincided with the 1988 introduction of a family of drugs known as selective serotonin reuptake inhibitors, or SSRIs, including Prozac, Zoloft and Paxil.

Following the flurry of warnings about the drugs, prescriptions for them dropped by 22 percent, according to a report in this month's American Journal of Psychiatry by researchers from the University of Illinois at Chicago.

CONCERN AT FDA

Licinio, who was not involved in the CDC study, speculated that parents may have shied away from giving the drugs to their young daughters because of safety concerns, leading to the sharp jump in suicides among girls.

"What's very distressing is that this is some unintended consequence of the Food and Drug Administration's black-box decision," said Dr. Carolyn Robinowitz , president of the American Psychiatric Association. "I think the FDA needs to go back and carefully look at the science. I don't want them to wait another year to look at the data. In another year, we can lose more youngsters."

Dr. Thomas Laughren, who oversees psychiatric drugs for the FDA, said the agency was concerned about the trend and would continue to monitor suicide rates and antidepressant use. He emphasized that the CDC report was based on just one year of data and was not conclusive.

While many experts have called for removal of the so-called black box warning on SSRIs, biostatistician Joel Greenhouse of Carnegie Mellon University in Pittsburgh said that patients and parents are reading too much into it.

"The warning says, 'There are risks, and physicians ought to monitor the drugs more carefully,' " he said. "But that's not the way the public interpreted the warning. The public interpreted it as, 'This is going to cause you to commit suicide.' "

DIFFERENT METHODS

Researchers are concerned about the increased suicide rates because suicide is already the third-largest cause of death among people younger than 25, trailing only automobile crashes and homicides.

The number of unsuccessful suicide attempts is several times greater than the number of actual suicides, but no good figures are available. A previous Centers for Disease Control and Prevention survey found that 17 percent of youths in grades nine to 12 had "seriously considered" suicide, 13 percent had created a suicide plan and 8 percent had actually attempted suicide.

In 1990, the researchers found, the majority of both boys and girls used firearms to commit suicide. Firearms still predominated among boys in 2004, but 71.4 percent of girls relied on hanging or suffocation.

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