US study challenges thinking on suicidal teens
More than half of teens who contemplated suicide have had some therapy, a US-wide survey has found
Most adolescents who plan or attempt suicide have already had some mental health treatment, raising questions about the effectiveness of current approaches to helping troubled teenagers, according to the largest in-depth analysis to date of suicidal behaviours in US teenagers.
The study, posted online last week by the journal JAMA Psychiatry, found that 55 per cent of suicidal teenagers had received some therapy before they thought about suicide, planned it or tried to kill themselves, contradicting the widely held belief that suicide is due in part to a lack of access to treatment.
The findings, based on interviews with a US-wide sample of more than 6,000 teenagers and at least one parent of each, linked suicidal behaviour to complex combinations of mood disorders such as depression and behavioural problems that include attention-deficit and eating disorders, as well as alcohol and drug abuse.
The study found that about one in eight teenagers had persistent suicidal thoughts at some point, and about a third of them had made a suicide attempt, usually within a year of having the idea.
Previous studies have had similar findings, based on smaller, regional samples. But the new study is the first to suggest, in a large sample, that access to treatment does not make a big difference.
The study suggests that effective treatment for severely suicidal teenagers must address not just mood disorders, but also behavioural problems that can lead to impulsive acts, experts said.
According to the US Centers for Disease Control and Prevention, 1,386 people between the ages of 13 and 18 committed suicide in 2010, the latest year for which numbers are available.
“I think one of the take-aways here is that treatment for depression may be necessary but not sufficient to prevent kids from attempting suicide,” said Dr David Brent, a professor of psychiatry at the University of Pittsburgh, who was not involved in the study. “We simply do not have empirically validated treatments for recurrent suicidal behaviour.”
The report said nothing about whether the therapies given were state of the art, or carefully done, said Matt Nock, a professor of psychology at Harvard and the lead author; it is possible that some of the treatments prevented suicide attempts.
“But it’s telling us we’ve got a long way to go to do this right,” Nock said. His co-authors included Ronald C Kessler of Harvard, and researchers from Boston University and Children’s Hospital Boston.
In the study, researchers surveyed 6,483 adolescents aged 13-18 and found that 9 per cent of male teenagers and 15 per cent of female teenagers experienced some stretch of having persistent suicidal thoughts. Suicidal thinking or behaviour was virtually unheard of before age 10.
Overall, about one-third of teenagers with persistent suicidal thoughts went on to make an attempt to take their own lives.
Almost all of the suicidal adolescents in the study qualified for some psychiatric diagnosis, whether depression, phobias or generalised anxiety disorder. Those with an added behavioural problem – attention-deficit disorder, substance abuse, explosive anger – were more likely to act on thoughts of self-harm, the study found.
Doctors have tested a range of therapies to prevent or reduce recurrent suicidal behaviours, with mixed success. Medications can ease depression, but in some cases can increase suicidal thinking. Talk therapy can contain some behavioural problems, but not all.
One approach, called dialectical behaviour therapy, has proved effective in reducing hospitalisations and suicide attempts in people with so-called borderline personality disorder, who are highly prone to self-harm, among others.
– New York Times