Psychiatric News July 1, 2005
Volume 40 Number 13
© 2005 American Psychiatric Association
p. 8
Mixed Message Seen in Major Study Of Suicide Behavior
Eve Bender
New population-based research on suicide and suicidal behaviors points
to an intractable problem that may need more attention from physicians and
health professionals.
The prevalence of suicide-related behaviors has held steady since the early
1990s even though the proportion of people receiving mental health treatment
for those behaviors has increased substantially.
This is one of the key findings from a study comparing data from two
epidemiological surveys. Study results appeared in the May 25 Journal of
the American Medical Association.
Due to the study's design, researchers were unable to determine when
respondents received mental health treatment in relation to their experiences
with suicidal thoughts and behaviors.
"It is problematic that we have more resources than ever directed at
treating mental health problems, but we don't see the prevalence of suicidal
behaviors dropping," said lead author Ronald Kessler, Ph.D., a professor
of health care policy at Harvard Medical School.
However, it is important to note that the rate of completed suicides
dropped by 6 percent in the study by Kessler and his colleagues, or from about
15 suicides per 100,000 people to 14 suicides per 100,000 people, according to
Darrel Regier, M.D., M.P.H., director of APA's Division of Research and
executive director of the American Psychiatric Institute for Research and
Education. He was not involved in Kessler's study.
Regier noted that a "large proportion of the population with suicidal
ideation or attempts may not access treatment" for their symptoms.
"However, if people with severe depression, schizophrenia, and other
disorders that place patients at high risk for suicide are receiving more
treatment, the drop in completed suicides could be reflective of improved
treatment effectiveness."
Kessler compared data on mental health treatment with data on suicidal
ideation, plans, gestures, and attempts for respondents to the 1990-1992
National Comorbidity Study (NCS) and the 2001-2003 NCS Replication
(NCS-R).
For the NCS, researchers interviewed 8,098 randomly selected people aged 15
to 54 in their homes. For the NCS-R, 10 years later, they interviewed a
separate, randomly selected sample of 9,282 adults over age 18 in their
homes.
When Kessler merged the data from the two surveys for respondents in the
overlapping age range, he found that there were no significant differences in
the percentage of people who had reported suicidal ideation in the prior year.
Just 2.8 percent (210) reported experiencing suicidal ideation in the NCS, and
3.3 percent (205) did so in the NCS-R.
Nor were there significant changes in the proportion of people who had a
plan to commit suicide during the year prior to the surveys. About 0.7 percent
(50) said they had formulated such a plan in the NCS, and 1 percent (63) a
decade later.
Among those who made a suicidal gesture—defined as making an attempt
that was a "cry for help" but lacked an intent to die—0.3
percent (17) reported doing so in the NCS, and 0.2 percent (12) in the
NCS-R.
About 0.4 percent (37) reported making a suicide attempt during the
preceding year, the NCS found, and 0.6 percent (47) acknowledged doing so in
the NCS-R.
When he analyzed the number of respondents who reported receiving any type
of treatment "for emotional problems" during the prior year, he
found that for those with certain suicidal behaviors, the number who received
treatment rose dramatically during the 1990s.
For instance, among those who said they had made a suicidal gesture, the
NCS found that 40.3 percent received mental health treatment in the early
1990s. A decade later, that percentage had risen to 92.8 percent, according to
the NCS-R.
Researchers did not determine when the respondents received treatment in
relation to experiencing suicidal thoughts or exhibiting suicidal
behaviors.
For respondents who made a suicide attempt, 49.6 percent reported having
received mental health treatment in the first survey, and 79 percent did in
the second survey.
The proportion of people with suicidal ideation and behavior who sought
treatment from psychiatrists in particular rose throughout the 1990s.
Among those with suicidal ideation but who did not make a suicidal gesture
or attempt, the NCS found that 14.4 percent saw a psychiatrist during the
prior year, while 33.5 percent did so in the NCS-R.
Among those who reported making a suicidal gesture, 13.4 percent reported
seeing a psychiatrist in the preceding year in the NCS, while 42.8 percent did
so a decade later in the NCS-R.
There were also substantial increases in the proportion of respondents with
suicidal ideation and behavior who reported seeing a general medical
practitioner for mental health problems from the first to the second survey.
Kessler attributed the increase in visits to psychiatrists and general medical
practitioners in large part to "the introduction of direct-to-consumer
marketing of psychotropic drugs."
He said he could not explain the discrepancy in the increase in mental
health treatment among people reporting suicidal behaviors and the failure of
those behaviors to decrease during the same period.
Because he could not determine whether the respondents received treatment
before or after becoming suicidal, Kessler said he was unable to conclude that
they didn't get treatment in time to prevent an attempt, or if they did get
treatment in time, whether it was ineffective in preventing suicide
attempts.
"Both processes could have been at work," the authors
wrote.
Kessler and his colleagues called for an increase in the number of programs
that emphasize suicide prevention and "timely treatment seeking,
specifically among people with suicidal ideation."
They also acknowledged that "recognition is needed that effective
prevention of suicide attempts might require substantially more intensive
treatment than is currently provided to the majority of people in outpatient
treatment for mental disorders."
An abstract of "Trends in Suicide Ideation, Plans, Gestures,
and Attempts in the United States, 1990-1992 to 2001-2003" is posted
online at
<http://jama.ama-assn.org/cgi/content/abstract/293/20/2487>.
JAMA 2005 293 2487[Abstract/Free Full Text]
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