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Study Shows Many Teens at Risk for Suicidal Behavior Despite Mental Health Help

January 9, 2013 at 12:00 AM EDT
A new study shows most teenagers who think about or attempt suicide have already had mental health treatment. Gwen Ifill talks to Dr. Timothy Lineberry of the Mayo Clinic and Drexel University psychologist Brian Daly about concerns over the effectiveness of current clinical treatment programs to prevent adolescent suicide.

GWEN IFILL: A major new study released today concludes that one in eight American teens has had suicidal thoughts. One of every 25 has attempted suicide.

Those findings come from a survey of nearly 6,500 teens published in the journal JAMA Psychiatry, the largest in-depth analysis of teens on this subject.

More than half of the young people who planned, thought of, or attempted to kill themselves had received at least some treatment. Nearly 1,400 between the ages of 13 and 18 took their own life in 2010.

For more about the study and some of the issues it raises, we talk to two experts.

Dr. Timothy Lineberry is medical director of the MayoClinicPsychiatric Hospital.

And Brian Daly is a clinical child and adolescent psychologist and professor at DrexelUniversity.

Welcome to you both.

Dr. Daly, how concerned should we be about these numbers?

DR. BRIAN DALY, DrexelUniversity: I think they’re very concerning, Gwen.

I think some of the data indicates here that once we get them into treatment, with is where we want them, we’re not actually being as effective as we want to be and suggesting really we need to be much more vigilant in terms of working with these youth.

We’re seeing some of these thoughts are coming after the initiation of treatment, which I think is most concerning. And we know that this is a group that is at high risk of dropping out. So there’s some question about I think whether the mental health professionals are being as vigilant in continually assessing suicidal thoughts, attempts and plans for these individuals.

GWEN IFILL: Dr. Lineberry, as you read this report, did you see signs there that gave you new information that you could use to apply to figure out what is driving these numbers?

DR. TIMOTHY LINEBERRY, Mayo Clinic: Well, I think this is a significant kind of addition in terms of research with the information in the prevalence, because this is at higher rates than it is with adults.

As Dr. Daly was pointing out, I think the issues that we have clinically are, how do we identify and treat at-risk individuals and children and adolescents who are at risk for suicide, and can we do a better job with clinical treatment?

GWEN IFILL: Well, here is my question, and I want to ask you both about that. When you talk about treatment — and the interesting thing in the report is these were not the missed people. These were not the missed patients. People knew that they were having trouble. They were already in treatment. How is it that people already in treatment still get to the point where they’re considering or actually acting on suicidal thoughts?

Dr. Lineberry, you first.

TIMOTHY LINEBERRY: You know, as we think about suicide, one of the things to keep in mind is that it’s not a binary phenomenon, where it’s yes or no, that you either are suicidal or you are not suicidal.

So we see changes in terms of how people are thinking about suicide, where they’re acting or planning suicide based on the severity of illness. So, what we need to look at doing is, what are the factors associated in clinical treatment as we’re going that are either signs of treatment or acting more aggressively or assertively when a child or — a child or an adolescent or a parent is reporting that there’s concerns with worsening system symptoms or the initiation of thoughts of suicide?

One of the things about this study that is remarkable is the degree of thoughts of suicide associated with attempts vs. just thoughts of suicide and then thinking about planning for suicide and then subsequent attempts.


GWEN IFILL: Dr. Daly, I want you to pick up on that point. We’re talking about the distinction stopping people from thinking about it and moving to acting on it.

BRIAN DALY: Yes, it’s a great point that is made.

I think, sort of adding on to it, one thing that we’re concerned with is that the old conventional thinking used to be if we’re able to reduce the symptoms of depression that thoughts of suicide and even suicide plans and attempts should also diminish.

And I think we’re seeing some new evidence that suggests even though we’re able to reduce some of these symptoms of depression, it doesn’t necessarily mean that thoughts of suicide or suicide plans are going to drop as well.

And, so, again, back to my earlier point, it sort of suggested the mental health professionals need to continue to remain vigilant during treatment, that even if we see these teenagers becoming better in terms of their symptoms of depression reducing, we need to continue to check in with them about whether they’re having thoughts, plans, or ideas around suicide.

GWEN IFILL: Dr. Daly, if it’s true that suicide is the third leading cause of death among adolescents, is this something which has gotten progressively worse, and is there any way that we can identify why?

BRIAN DALY: No, it’s not necessarily something that has gotten progressively worse.

We actually see some data that suggests that suicide completion is not necessarily rising from an epidemiological perspective. But, nonetheless, it’s the third leading cause of death among teenagers.

And this suggests even when we have them where we want them, which is in some intensive treatment, it doesn’t always mean, as was pointed out earlier, that we’re doing the right things to diminish these ideas, these plans, attempts and certainly from stopping the completions that occur.

GWEN IFILL: Dr. Lineberry, of course it strikes us very close to home when we think about young people having these thoughts or taking these actions, but how does it compare to adult behavior?

TIMOTHY LINEBERRY: Well, I think there are some key differences.

And getting back to what Dr. Daly had said, there’s been the thought — and actually our research shows this — we’re making a difference with depressive symptoms and other syndromes in adults, that we’re more likely to see changes with thoughts of suicide or suicidal behavior.

And that doesn’t seem to be the story that we’re getting from research with children and adolescents. So it’s important to keep in mind that these are two different things in terms of tracking.

From a prevention standpoint, it’s critical that we look at what are things in terms of impulsivity, because the children’s data — the children and adolescent data is very different from impulsive attempts compared to adults.

So it may speak more to the need for risk-prevention strategies, making sure that there’s very clear plans in place for clinicians and for parents and families.

GWEN IFILL: And there’s a difference between girls and boys, between who will think about it and who will act as well?

TIMOTHY LINEBERRY: There is a difference. With girls, we see a higher rate of attempts, but if we look at rates of suicide, we see higher rates in boys, in males.

And so it’s important for us to also keep in mind that there may be some aspects of this research that are helpful in getting to that group as well.

GWEN IFILL: Dr. Daly, what do we do about the stigma, the reluctant the reluctance to talk about this issue, to even idea this issue, especially for parents?

BRIAN DALY: It’s a very difficult issue.

I think the fact of the matter, even counselors who work with these adolescents can be discomforted by working with, you know, a suicidal teenager. And so it’s an issue that needs more national dialogue. There’s certainly been efforts by the surgeon general to promote a dialogue about this.

But I think the individuals that work most closely with teenagers, including teachers and parents, are often very uncomfortable with this idea of speaking with them about it.

And there’s a myth in society that if you bring up the topic of suicide with teenagers, that they’re more likely to act on those impulses, when in fact we know the opposite is true, that parents, peers and teachers, when they bring up this notion with teenagers, it shows care and concern and it actually helps decrease some suicidal ideation.

GWEN IFILL: Dr. Lineberry, are there social or demographic drivers here, that people from a certain background or a certain geographic location are more likely to consider this?

TIMOTHY LINEBERRY: You know, the research study didn’t look at a number of the social and demographic factors as much.

We do see differences in terms of education, so there were some things with the study showing that differences with education, with support at home could be a factor with that.

It’s important to keep in mind that there’s a number of factors associated that are just not related to psychiatric illness, but stressors, culture, support, supports at home, supports with school and those involved with the child or adolescent.

GWEN IFILL: Dr. Timothy Lineberry of the MayoClinicPsychiatric Hospital and Dr. Brian Daly of DrexelUniversity, thank you both so much.


BRIAN DALY: Thank you.