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Suicide rates for U.S. youths, especially young girls, climb

The '04 increases come as prescriptions for antidepressants tumble.

September 07, 2007|Thomas H. Maugh II and Jia-Rui Chong | Times Staff Writers

After a decade of decline, the suicide rate for 10- to 14-year-old girls jumped by 76% 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% 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 28% between 1990 and 2003 before the unexpected jump to 4,599 suicides in 2004.

The overall number of suicides in 2004 was previously known, but the new study provided the first breakdown by age and gender in addition to new data about methods.

The numbers of suicides are relatively small: Among 10- to 14-year-old girls, for example, the number rose from 56 to 94, out of a 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.

Other experts attributed the increase to a drop in the number of 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 strongest possible advisory. 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, said 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.

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

Licinio, who was not involved in the CDC study, speculated that parents may have shied away from giving the drugs to their 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 B. Robinowitz, president of the American Psychiatric Assn. "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 P. 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.

Although many experts have called for removal of black-box warnings on SSRIs, biostatistician Joel Greenhouse of Carnegie Mellon University in Pittsburgh said 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.' "

Researchers are concerned because suicide is already the third-most common 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 suicides, but no good figures are available. A previous CDC survey found that 17% of ninth- through 12th-graders had "seriously considered" suicide, 13% had created a suicide plan, and 8% had attempted it.

In 2004, the CDC said, 161,000 youths and young adults received treatment at emergency rooms for self-inflicted injuries.

The new study used data from the CDC's National Vital Statistics System. The team chose 1990 as a starting year, Arias said, because the data before that time were not as good.

The net increase in suicide rates was driven by increases in three groups:

* Among 10- to 14-year-old girls, the rate increased from 0.54 suicides per 100,000 girls in 2003 to 0.95 in 2004.

* Among 15- to 19-year-old girls, the rate increased from 2.66 to 3.52 per 100,000.

* Among 15- to 19-year-old males, the rate increased from 11.61 to 12.65 per 100,000.

Suicide rates declined only among 10- to 14-year-old boys, and the drop was small -- 0.02 per 100,000.

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

"It is possible that hanging and suffocation are more easily available," Arias said.

thomas.maugh@latimes.com

jia-rui.chong@latimes.com

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