Posted
09/28/2006
U.S. suicide rates are down, but the
reason is a mystery, according to Arnold School study
First,
the good news: Suicide rates among younger and older Americans have been
declining since the early 1990s. Now, the puzzling news: No one really
knows why.
Those are the findings
of a study conducted by researchers at the University of South Carolina
and released Thursday in the October issue of the American Journal of
Public Health.
Dr. Robert McKeown, a
professor USC’s Arnold School of Public Health, presented the findings
at the forum, "Out of the Shadows: Exploring the Barriers to Mental
Health, Prevention and Treatment," at the National Press Club in
Washington, D.C.
Sponsored by the
American Public Health Association and the Morehouse School of Medicine,
the program included former U.S. Surgeon General Dr. David
Satcher, a Morehouse
faculty member, and Dr. David Shern, president and chief executive
officer of the National Mental Health Association.
"For 40 years
adolescent suicide rates rose," said McKeown, who collaborated on the
study with the USC pharmacy professor Dr. Richard Schulz and School of
Medicine neuropsychiatry professor Dr. Steven Cuffe.
"Then, the rates began
to decline in the late 1980s for adults 65 and older and in the early
1990s for adolescents and young adults," he said. "But many people
weren't aware; they kept saying suicides were increasing when it was no
longer true."
McKeown, who tracked
suicide rates for research and teaching, noticed the trends had reversed
and that rates were declining among adolescents, young adults (younger
than 25) and older adults (65 and older). He recruited Schulz and Cuffe
to explore explanations for the changes.
Their study suggests
several possibilities why those suicide rates have fallen and raises
questions about why suicide rates among the middle groups -- those 25 to
64 -- have not declined.
"In our
medical-literature searches, we began finding international studies that
suggested a correlation of declining suicide rates with an increase in
the use of new-generation antidepressants," McKeown said. "But you can't
blithely assume that drugs like Prozac have lowered the suicide rate. If
that was the reason, why haven't the suicide rates of those in the
25-to-64 age brackets declined, too?"
From 1994 to 2003,
suicide rates declined 30 percent in adolescents and young adults. Among
older adults, the suicide rate fell 33 percent from 1987 to 2003.
Despite the decline, suicide remains the third-leading cause of death
among adolescents behind accidents and homicide. Among older adults,
suicide is surpassed by several chronic diseases as a leading cause of
death.
"We need to understand
how something this significant could turn on a dime," McKeown said.
That understanding is
particularly important because the Food and Drug Administration has
warned physicians about the risk of increased suicidal ideas and
attempts, particularly among children, associated with certain
antidepressants that are used for the treatment of depression, anxiety
disorders and some types of personality disorders.
"We aren't trying to
argue that these drugs are harmless," McKeown said. "But the possible
correlation between the advent of new antidepressants and the decline in
suicide rates needs to be better explored."
Perhaps there is no
association at all, he said.
"It could be that as
antidepressants help a patient's depression improve, that person becomes
more energetic, less apathetic and better able to make decisions,"
McKeown said.
The researchers also
believe that the decline in some suicide rates may have nothing to do
with antidepressants but with improved medical care. For example, some
of the studies they surveyed attributed the decline in American homicide
rates to improved trauma care.
"It could be that the
number of attempted suicides hasn't gone down.
We might just have
better trauma care that keeps more people alive after attempting to take
their own lives," McKeown said.
Not enough attention
has been given to the trends in suicide over the last 20 to 30 years,
McKeown said.
"We need a better
understanding of why rates have declined significantly among
adolescents/young adults and older adults in order to capitalize on
factors that may be effective in prevention," he said. "And we need to
understand better the relationship between antidepressant therapy and
subsequent suicide attempts."
McKeown and his
colleagues are working with the S.C. Rural Health Research Center at USC
to seek research funding to delve deeper into data that could shed more
light on the issue. |