World of Psychology

The Story Behind the Increase in Teen Suicide Rates

By John M Grohol PsyD
February 15, 2007

On Monday, February 12 2007, the U.S. Center for Disease Control and Prevention released its Annual Summary of Vital Statistics. Inside the report, suicide rates for children — and especially teens — appeared to have rose dramatically over a one-year time period, 2003 to 2004.

And like moths drawn to a flame, every news outlet in the U.S. dutifully reports the supposed link between this increase in suicide rates to a decrease in antidepressant prescriptions in 2004.

The problem is — like most mainstream medical reporting done on tight deadlines with virtually no time to fact check and get the story right — every news outlet was dead wrong.

But it’s not like we could only blame the news outlets (such as ABC News, whose story was typical reporting on this issue).

Experts in the field, including researchers and university professors, were quick to make pronouncements about the cause of this increase. The report is simply an annual tabulation of data — it is not a study and does not propose any hypotheses to test. Yet researchers, who supposedly should know better, instantly created a causal relationship between two variables where only a correlational relationship exists.

What did these experts blame on the rise in suicide in children?

An FDA label on certain antidepressant medications.

For instance, Dr. Charles Nemeroff, chairman of the department of psychiatry and behavioral sciences at the Emory University School of Medicine, was quoted by ABC News as saying, “I have no doubt that there is such a relationship.” That is a bold, unsupported statement.

The ABC News article continues…

“This is very disturbing news,” said Dr. David Fassler, clinical professor of psychiatry at the University of Vermont College of Medicine. “The adolescent suicide rate has been declining steadily since the early 1990s.

“The sudden increase in the adolescent suicide rate,” Fassler continued, “corresponds to the significant and precipitous decrease in the use of SSRI antidepressants in this age group.”

I can see why these researchers feel this way, because the data seem to support a decline in SSRI prescriptions to teens and children in 2004.

But, as others are making clear, the data and the datatrends about childhood prescriptions is not at all clear for 2004.

Correlation does not equal causation. Without a specific study examining causative factors in this increase, one simply cannot make factually-based claims. The rise in the child suicide rate could’ve been caused by a multitude of equally plausible other factors.

It also looks like researchers are quick to blame the FDA making the “wrong” decision with regard to the black box label. The FDA website has a detailed page about the controversy.

As any scientist will tell you, though, the data don’t support this conclusion. Without an empirical study that examines this specific hypothesis, all we have is a possible correlational relationship. We shouldn’t make public policy decisions — or research or treatment decisions — based upon such a thin relationship.

Read more over at Clinical Psychology and Psychiatry: A Closer Look: SSRI’s and Suicide: Update.


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Links to This Article

New Reports Claim U.S. Teen Suicide Rates Increase after Drop in SSRI Use (9/6/2007)

From Psych Central's World of Psychology:
Teen Suicide Rates Decline - World of Psychology (9/3/2008)

12 Comments to
“The Story Behind the Increase in Teen Suicide Rates”

“We shouldn’t make public policy decisions — or research or treatment decisions — based upon such a thin relationship.”

But isn’t this exactly what happened with the black-box warning?

There is little evidence antidepressants have caused more adolescent suicides, only that kids think about it more, just as they do when treated with Cognitive Behavior Therapy (Bridge JA, et al. 2005)

OTOH, there is a lot of evidence that alcohol and other “recreational” drugs often used to self-medicate anxiety and depressive disorders greatly increase the risk of suicide.

Thanks for linking to my post. I agree with nearly everything you said in your post except for one point: in the same article that you cite in your post regarding SSRI prescriptions decreasing, there is some conflicting information that states: “During that meeting, FDA officials presented data from IMS Health that appeared to show not a decrease in antidepressant prescriptions, as do the Medco data, but a 7 percent increase in the six months following the February meeting and the subsequent warnings.”

Thus, it is not even clear that there was a
decrease in SSRI prescriptions, so there is not even any solid basis for a correlational relationship, much less a causal relationship. I’m glad to see that you are writing on this issue.

Well said, Ian. It’s people against SSRIs vs people for. No one gets convinced of anything.

Look we are nearing the end of the world when god will Judge the whole world. These increaces will be seen not only in suicide but in violent crimes and other such occurances. Watch and Pray. Plead with God that you may be saved. Amen

Let me get this straight. On 12 February 2007 the CDC released statistics that show an increase in teen suicide for 2004. In 2004 the FDA mandates a Black Box warning label for antidepressants and now esteemed professors of psychiatry are claiming that this caused the increases in teen suicide for 2004 because parents took their kids off antidepressants.

Psychiatry is such a complicated science. I have difficulty understanding it. It takes 12 years just to become a psychiatrist I understand. Maybe one of those professors of psychiatry could enlighten me to one fact.

The FDA’s “Labeling Change Request Letter for Antidepressant Medications” as shown at http://www.fda.gov/cder/drug/antidepressants/SSRIlabelChange.htm says “Date created: October 15, 2004, Updated, October 28, 2004. One could reasonably assume the drug companies did not start slapping Black Box warning on new batches of antidepressant that very day. In fact if you take into consideration that new labels would have to be made up and put on bottles of antidepressants and that stocks of these drugs in the pipeline to pharmacies needed to be sold, I don’t think the public became significantly aware of any Black Box warning on antidepressants until early 2005.

I didn’t see any significant news coverage of this Black Box warning for antidepressant until December of 2004 as illustrated by the 3 December 2004 issue of “ScienceDaily” which can be found at http://www.sciencedaily.com/releases/2004/12/041203100252.htm.

So the idea that the Black Box warning on antidepressants had anything to do with an increase in teen suicide is TOTALLY FALSE and just wishful thinking on the part of psychiatrists and a waste of money for any drug company that may have paid them to write such stories. I’m not saying this happened mind you.

In fact, 2004 marked the high point of prescriptions for antidepressants for teens. It is true that prescription rates for antidepressants did drop after the Black Box warning but that didn’t occur in any significant number until 2005–a year that we don’t yet have any CDC suicide stats for. One might just as scientifically infer that the rise in teen suicides during 2004 was due to record numbers of kids taking antidepressants. I wonder if I can get paid for saying that?

my mother is on antidepressants and she is a better person for it. she has more patients for my three younger brothers and i. she used to not be able to make dinner with us in the house. i think that these medications allow you to function normally and you are not having any side-affects, take them.

i think that they can have either affect on anyone. perhaps more in children in teens. Teens are not used to the emotional instability, and need to learn how to cope with it, which is always hard. However, with proper help along with the antidepressants, they might be able to harness their emotions and better understand themselves.

i love this site!!! it changed my friends life.!!!!!!!!!!!!!!!!!!!!!

I too love talking about psychology. I also love talking about philosophy and true monotheistic of thinking and living as well.

Our psychological, emotional, relational, social, financial and physical lives are important to change for the better but our intellectual, spiritual, moral and religious lives are most important to concern ourselves about changing for the better.

The only one who can really save us from destruction and more importantly from eternal torment is our own selves and the One True Eternal God who created all humans, all earthly creatures and the earth itself.

THIS SITE KEPT ME FROM KILLING MYSELF!!

this website just made it seem worse and made me even more depressed hearing other people’s problems in life

it wasnt very long when i wanted to become a psychologist, i really want to interact with children and their problems, in every person their is a story to tell. since i am a teenager myself i rarely see any depression and other situations around me but i still noe the people around me have gone through alot and need that help!! this site is a good example in which it can help a person but in a way make it harder but too those; life is too short so enjoy it a bad thing always leads to sumthing better :) :)

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    Last reviewed: By John M. Grohol, Psy.D. on 15 Feb 2007

 


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