Suicidal Behavior in US Teens Common

Findings Highlight Need for Distinct Prediction and Prevention Strategies, Experts Say

Caroline Cassels

January 10, 2013

Suicidal behavior, including thoughts, plans, and attempts, among US teens is common and often preceded by mental health issues, most frequently depression, a national study shows.

Investigators from Harvard University in Boston, Massachusetts, found that among a national sample of adolescents aged 13 to 18 years, the estimated lifetime prevalence of suicidal thoughts, plans, and attempts was 12.1%, 4.0%, and 4.1%, respectively.

These findings are consistent with those from other, smaller studies, the authors, led by Matthew K. Nock, PhD, write. They also note that "nationally representative studies of adults have reported that the first onset of suicidal behaviors increases dramatically during adolescence."

However, they add, the current study extends the research and "provides a more fine-grained picture of these increases and extends prior studies in documenting that approximately one-third of youth with suicide ideation go on to develop a suicide plan during adolescence, approximately 60% of those with a plan will attempt suicide, and most of the adolescents who make this transition do so within the first year after onset."

Furthermore, the researchers found that the vast majority of teens with suicidal behavior met lifetime criteria for at least 1 of 15 DSM-IV mental disorders studied, including fear and anxiety disorders, distress disorders, disruptive behavior disorders, and substance abuse.

The study was published online January 9 in JAMA Psychiatry.

A Leading Cause of Teen Death

Worldwide, suicidal behaviors are among the leading causes of death, especially among teens, the authors report.

However, they note that despite the scale and severity of the problem, little is known about the correlates, prevalence, or treatment of suicidal behavior among US teens, because large studies of this nature are rare.

"Comprehensive national data on suicidal behavior among adolescents are needed to improve our understanding of the nature of this perplexing and devastating problem, to arm clinicians with information about risk profiles, and to help inform decisions about promising prevention targets," the authors write.

The study included 6483 adolescents aged 13 to 18 years and their parents, who were participants in the National Comorbidity Survey Replication Adolescent Supplement (NCS-A).

Parents completed self-administered questionnaires about their child's mental health. In addition, all adolescents underwent an interview with a trained interviewer who administered the World Health Organization's Composite International Diagnostic Interview (CIDI).

Sociodemographic variables, including race/ethnicity, parental education, birth order, and the number of biological parents living with the adolescent, were also gathered and assessed.

Further, the researchers obtained data on lifetime history of treatment for emotional or behavioral problems.

The study's primary outcome measures were lifetime suicide ideation, plans, and attempts.

Girls at Higher Risk

The investigators found that 33.4% of those who consider suicide go on to develop a suicide plan and that 33.9% make an attempt.

Further, 60.8% of those who make a suicide plan go on to make a suicide attempt. In contrast, 20.4% of those who consider suicide but who make no plan go on to make an attempt.

The study also revealed that although the lifetime prevalence of suicide ideation is less than 1% through age 10, it gradually increases through 12 years of age and accelerates more rapidly from age 12 to 17.

From the time they first contemplate suicide, 63.1% transition to a plan and 86.1% transition to an attempt within the first year. In addition, the researchers report that 88.4% of adolescent transitions from plan to attempt occur within the first year of developing a suicide plan.

The researchers also found that teenage girls are significantly more likely than teenage boys to contemplate suicide (OR = 1.7), attempt suicide (OR = 2.9), and make an unplanned attempt (OR = 3.7).

Children living with neither of their biological parents or living with 1 biological parent were significantly more likely than their counterparts living with both biological parents to attempt suicide, either planned or unplanned.

The vast majority of teens with a lifetime history of suicidal ideation (89.3%) and attempts (96.1%) met criteria for at least 1 of the DSM-IV/CIDI disorders.

Among suicidal adolescents, the most prevalent lifetime disorder was major depressive disorder/dysthymia, followed by specific phobia, oppositional defiant disorder, intermittent explosive disorder, substance abuse, and conduct disorder.

The researchers found that most suicidal adolescents receive treatment before the onset of suicidal behavior. However, they add, there is no way of knowing from this study how effective early intervention is in preventing the onset of suicidal behavior.

"It is clear, though, that treatment does not always succeed in this way because the adolescents in the NCS-A who received treatment prior to their first attempt went on to make an attempt anyway. This finding is consistent with recent data highlighting the difficulty of reducing suicidal thoughts and behaviors among adolescents," the authors write.

The investigators conclude that the study findings "point to a need for future work to increase our understanding of the dramatic increase in suicidal behaviors during adolescence, of the causal pathway linking child-adolescent mental disorders to adolescent suicidal behaviors, and of actionable strategies for clinical prediction and prevention of these behaviors."

Dr. Nock has disclosed no relevant financial relationships. Disclosures for the other authors can be found in the full article.

JAMA Psychiatry. Published online January 9, 2013. Full article

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