Suicide

Older adults are more likely than younger adults to be hospitalized following emergency department care related to suicidal behavior. Comprehensive prevention strategies that address multiple risk factors such as better identification and treatment of clinical depression by primary care physicians and enhancing social support for at-risk individuals may be helpful.

In 2005, there were an estimated 7,105 emergency department visits for nonfatal self–inflicted injuries among U.S. adults 65 and older, with more than 80 percent of these visits identified as suicidal behavior. Self-inflicted injuries are suicidal and self–harming behaviors.

There are certain factors or characteristics that definitely increase the risk for suicide. For example:

• history of previous suicide attempts,
• family history of suicide,
• history of depression and other mental illness,
• family dysfunction,
• social isolation,
• alcohol and drug use,
• stressful life events,
• hopelessness,

The Black Box warning by the FDA was implemented in early 2005. However, beginning in 2003 there were many advisories to alert physicians on the increase potential for suicide when antidepressants are initiated.

The recent report of an upswing in suicides, particularly among our young, raises questions as to whether the decreased use of antidepressants has any correlation.

The FDA response is that suicide, as we all know, has a very complex, multi-factorial causation. It is too simplistic to say that one item would make that much of a difference in the number of suicides, particularly among teenagers.

Our news today is sobering and it raises a great concern for us. Suicide is the third leading cause of death for people ages 10 to 24, surpassed only by car crashes and homicide. Earlier this year, CDC′s national center for health statistics provided data indicating that youth suicide spiked between 2003 and 2004.

Today, CDC is releasing data on suicides occurring in the U.S. from 1990 through 2004. We found that combined suicide rates for persons 10 to 24 years declined 28.5 percent from 1990 to 2003. But from 2003 to 2004 the rate increased by eight percent, signaling the largest single rise in 15 years. The significant increase in rates of suicide from 2003 to 2004 was limited to 10 to 14-year-old girls, 15 to 19-year-old girls and young women and 15 to 19-year-old boys and young men. Prior to 2003, the rates for all of these three groups had generally been trending downward. However, from 2003 to 2004, there was a 75.9 percent increase in the suicide rate among 10 to 14-year-old girls, a 32.3 percent increase among 15 to 19-year-old girls and young women and a nine percent increase among 15 to 19-year-old boys and young men. In surveillance speak, this is a dramatic and huge increase.

War is hell, and no one knows this better than the infantryman or Marine who are sent to kill others. This main mission undoubtedly would place stresses on anyone of us. Are the stresses high enough to expect suicides to rise?

The number of suicides in America for white males in their 20’s is approximately 24 per 100,000. Would you expect those in war to be higher?

99 soldiers committed suicide 2006. This is almost 18 suicides per 100,000 soldiers.

The risk of antidepressant usage and suicides has caused a warning by the FDA. This warning alerts the provider that suicide may be a problem, and requires extra monitoring. Because of this warning, the use of antidepressants decreased. Suicides increased!

Now, trends indicate that suicides are the highest one month prior to treatment, but drop 50% the first month of treatment, and continue to decrease as treatment is provided.

The relationship between antidepressants and suicidality (the risk of suicidal thinking and behavior) is paradoxical. According to the U.S. FDA, antidepressant medications apparently increase the risk of suicidality in children, adolescents, and young adults up to their middle 20s, but they apparently protect against it in those 30 and older, particularly for those 65 and older.

A recent meta-analysis has been conducted of suicidal behavior and ideation in placebo-controlled clinical trials of paroxetine in adult patients with psychiatric disorders including Major Depressive Disorder (MDD), other depression, and non-depression disorders.