Little change in suicidal thoughts, plans, attempts

Despite a substantial increase in treatment for suicide attempts, no significant decrease occurred in the number of persons reporting suicide-related behaviors in the U.S. in the 1990s, according to a study in the May 25 issue of JAMA.

Suicide is one of the leading causes of death worldwide, according to background information in the article. As a result, the World Health Organization and the U.S. surgeon general have highlighted the need for more comprehensive data on the occurrence of suicidal thoughts and attempts, with the assumption that such data would be useful for planning national health care policy, as well as for evaluating efforts to reduce suicide and suicide-related behaviors.

Ronald C. Kessler, Ph.D., of Harvard Medical School, Boston, and colleagues examined nationally representative general-population trend data on the 12-month prevalence and treatment of suicide-related behaviors. Data came from the 1990-1992 National Comorbidity Survey and the 2001-2003 National Comorbidity Survey Replication. These surveys asked identical questions to 9,708 people aged 18 to 54 years about the past year’s occurrence of suicidal ideation, plans, gestures, attempts, and treatment. Face-to-face interviews were administered in the homes of respondents.

The researchers found that no significant changes occurred between 1990-1992 and 2001-2003 in suicidal ideation (2.8 percent vs. 3.3 percent), plans (0.7 percent vs. 1.0 percent), gestures (0.3 percent vs. 0.2 percent), or attempts (0.4 percent-0.6 percent). Treatment increased dramatically among ideators who made a gesture (40.3 percent vs. 92.8 percent) and among ideators who made an attempt (49.6 percent vs. 79.0 percent). The authors add that “… we found that risk of suicide-related behaviors is consistently elevated in several vulnerable subgroups, including the young, women, individuals with low education, and individuals lacking stable relationships or employment.”

Previous studies have reported a 6 percent decrease in actual suicides among people in this age range (18-54 years) from 14.8 per 100,000 per year in 1990-1992 to 13.9 per 100,000 per year in 2000-2002.

“Efforts are needed to identify optimal interventions for primary and secondary prevention of suicidality,” the authors write. “Substantial barriers to uptake of effective interventions continue to exist, including competing clinical demands and distorted incentives for treating mental disorders and symptoms. Failure to disseminate evidence-based treatments widely may, in fact, help explain why suicidality did not decline in response to the treatment increases during the 1990s. This means that expansion of disease management programs, treatment quality-assurance programs, and ‘report cards’ to improve the quality of care for suicidal patients may all be needed to reduce the burden of suicidality.”


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