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Suicidal Thoughts, Attempts Remain Unchanged in U.S.

Trend persists despite increased spending for treatment programs, study finds

TUESDAY, May 24, 2005 (HealthDay News) -- A decrease in suicides in the United States since the early 1990s has not been matched by a drop in suicidal behaviors, a new study finds.

The unchanged rate is also occurring despite an increase in treatment for people exhibiting suicidal traits, said the study, which appears in the May 25 issue of the Journal of the American Medical Association.

The findings beg the question of how effective current treatment systems are.

"We have thrown an enormous amount of money into the system, and we don't see any improvement," said study author Ronald C. Kessler, a professor of health care policy at Harvard Medical School. "What hits you between the eyes is an awful lot of money spent for not such great care."

Kessler also made the point that suicide and suicide-related behaviors are entirely separate matters, and "one is not a mini-version of the other." Often, people who contemplate suicide are not the same people who will take their own life.

According to the study authors, suicide is one of the leading causes of death worldwide. But while there has been about a 6 percent reduction in completed suicides in the United States -- from 14.8 per year per 100,000 people in 1990-1992 to 13.9 per year per 100,000 people in 2000-2002 -- there has been little data on suicide-related behaviors.

In an effort to capture the prevalence of such behaviors, the authors of the study looked at nationally representative data from surveys conducted in 1990-92 and in 2001-03.

The surveys asked identical questions of 9,708 people aged 18 to 54 about whether they had had suicidal thoughts, plans, gestures, attempts and treatment during the past year.

There were no significant changes between the two time periods in suicidal thoughts (2.8 percent in 1990-92 vs. 3.3 percent in 2001-03), plans (0.7 percent vs. 1 percent), gestures (0.3 percent vs. 0.2 percent), or attempts (0.4 percent vs. 0.6 percent).

At the same time, treatment increased dramatically among those who made a suicidal gesture (40.3 percent vs. 92.8 percent) and among those who made an attempt (49.6 percent vs. 79 percent), the study found.

There could be any number of explanations for the rise in funding for treatment programs while the rate of suicide-related behavior has remained constant, including the possibility that people are getting treatment after the behaviors take place, the researchers said.

But Kessler thinks quality of treatment is a more likely culprit. "No more than 40 percent of people who get treated for depression get minimally adequate care," he said. "If there was coordination between specialties, things would work a lot better."

"We have a lot of reason to think that people who are getting treatment are not necessarily getting treatment with practitioners who are trained effectively in working with people who are at risk for suicide," confirmed Alan L. Berman, executive director of the American Association of Suicidology.

The study also found that risk of suicide-related behaviors was elevated in several groups, including young people, women, individuals with low educational levels and people who were unemployed or without stable relationships. The increase in treatment did not decrease these disparities, illuminating a need for programs that target high-risk populations, the authors stated.

The bigger question is where to go from here for all groups of people.

"We have to do better at getting to people before they make an attempt," Berman said. Roughly 90 percent of people who commit suicide have a diagnosed mental disorder, making this the most obvious group to target, he said.

More information

For more information about suicide, visit the American Association of Suicidology.

SOURCES: Ronald C. Kessler, Ph.D., professor, health care policy, Harvard Medical School, Boston; Alan L. Berman, Ph.D., executive director, American Association of Suicidology, Washington, D.C.; May 25, 2005, Journal of the American Medical Association
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