Youth Suicide Rates Rise in Reversal of 15-Year Trend

ATLANTA, Sept. 6 -- Suicide rates among adolescents and young adults in the United States increased by 8% from 2003 to 2004, the largest increase in 15 years, CDC investigators reported today.

"In surveillance-speak this is a dramatic and huge increase," said Ileana Arias, Ph.D., director of the CDC's National Center for Injury Prevention and Control, in a press briefing.

The increase followed a decline in combined suicide rates for 10- to 24-year-olds of 28.5% from 1990 through 2003, reported Keri M. Lubell, Ph.D., and CDC colleagues in the Sept. 7 issue of the Morbidity and Mortality Weekly Report.

All of the increase in the latest figures can be accounted for by a spike in suicides among three groups: girls 10 to 14, girls 15 to 19, and boys 15 to 19.

For young girls, there was a shift away from suicide by firearms or poisoning toward hanging or suffocation.

The rise in suicide rates coincides with a 22% decline in pediatric prescriptions for selective serotonin reuptake inhibitors (SSRIs) after the implementation of black box warnings about the risk of suicidality and suicidal ideation, which was reported in the September issue of the American Journal of Psychiatry.

But suicide is complex and multifactorial, and the data cannot be used to determine causality, Dr. Arias cautioned.

Among pre-teen and young adolescent girls, the rate of suicide by hanging/suffocation went from 0.31 per 100,000 in 2003, to 0.68 per 100,000 in 2004. In contrast, the next highest annual rate was 0.35 per 100,000, in 1998. Hanging or suffocation suicides by girls 15 to 19 also increased significantly over the same period.

"The marked increases in suicide rates among females in the two younger age groups suggest possible changes in risk factors for suicide and the methods used, with greater use of methods (e.g., hanging by rope) that are readily accessible," MMWR editors commented.

The reasons for the increase are unknown, but may include family issues, legal or disciplinary problems, trouble at school, and mental health disorders such as depression, all of which can be made worse by substance abuse, the investigators noted.

Overall, suicides among girls 10 to 14 increased by 75.9%, followed by self-killings among girls ages 15 to 19 (up 32.3%), and boys age 15 to 19 (up 9%).

The increase in absolute numbers from 2003 to 2004 was from 56 to 94 among girls ages 10 to 14, from 265 to 355 among girls 15 to 19, and from 1,222 to 1,345 among boys 15 to 19.

"We didn't find any differences between black and white suicide deaths," Dr. Arias said. "One of the challenges in working with the 2003 to 2004 data is the relatively small numbers, and therefore we couldn't pull out data for Native Americans, Alaska native youths, Pacific Islander or Hispanic youths.

The findings of a shift toward easily accessible methods of suicide, released on the cusp of National Suicide Prevention Week (Sept. 9 to 15), highlight the need for broader public health efforts aimed at preventing the underlying causes of suicide, Dr. Arias said.

Dr. Arias said that risk factors for suicidality include:

• History of previous suicide attempts.
• Family history of suicide.
• History of depression or other mental disorders.
• Family dysfunction.
• Social isolation.
• Alcohol/drug use.
• Hopelessness.
• Access to methods of suicide.
• Exposure to suicidal behaviors of others.
• Incarceration.

Warning signs of suicide in children and young adults that parents, teachers, and others should look for include:

• Changes in eating and sleeping habits
• Withdrawal from family and friends
• Violent or rebellious behaviors, including running away
• Drug and alcohol use
• Neglect of personal appearance
• Marked personality changes
• Physical complaints
• Loss of interest in pleasurable activities and other signs associated with depression.

The MMWR report is available at http://www.cdc.gov/mmwr