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Suicide attempts on the rise among young U.S. adults

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Public health approach needed

The findings by Mark Olfson, MD, MPH, and his associates “strongly echo” the discussions of Anne Case, PhD, and Angus Deaton, PhD, that underscore “the mortality rate effect of lower education levels, fundamental economic and vocational challenges, and social dislocation occurring in many communities across the United States.” But the work of Dr. Case and Dr. Deaton emphasizes that the biggest impact on deaths, including those caused by suicides, occurred in the middle years.

Meanwhile, findings from the National Violent Death Reporting System on suicide attempts in middle life show that more than two-thirds of men and more than 80% of women report having a disorder related to substance use or mental health, but only 25% of those men and 44% of those women ever received treatment for such conditions. The characteristics of these people, as recorded by the NVDRS, “fit into the populations discerned” by Dr. Case and Dr. Deaton. “While there are suggestions that the surveys used by Olfson et al. may not have been tuned to pick up the ‘signal’ that was associated with the rise in fatal suicide attempts during the first 15 years of the new century, they provided a clear warning that the coming generation of people aging into the ‘middle years’ may see a further rise in suicide rates.”

The National Epidemiologic Survey on Alcohol and Related Conditions surveys were not conducted in clinical settings. Therefore, clinicians need to “look beyond the walls” of their health facilities to engage potentially vulnerable individuals and their families before they become suicidal.

Eric D. Caine, MD, is the chair of the department of psychiatry and codirector of the Center for Study and Prevention of Suicide at the University of Rochester (N.Y.). These remarks have been adapted from an editorial accompanying the article by Dr. Olfson and his associates (JAMA Psychiatry. 2017 Sep 13. doi: 10.1001/jamapsychiatry.2017.2524 ). He reported no financial disclosures.



Suicide attempts continue to increase in the United States, particularly among young adults with lower education levels and greater economic challenges, according to an analysis published Sept. 13.

These conclusions are based on data gleaned from two studies – the 2004-2005 wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-II) and the 2012-2013 NESARC-III. Of the 69,341 people surveyed, 57.2% were women, and the mean age was 48.1 years.

A wrist is shown wrapped in adhesive bandages with the word "HELP" spelled out across them. ArishaRay/Thinkstock
Overall, the percentage of adults more than 21 years old who attempted suicide during the study periods increased significantly, from 0.62% in 2004-2005 to 0.79% in 2012-2013 (adjusted risk difference, 0.17%; 95% confidence interval, 0.01%-0.33%; P = .04), reported Mark Olfson, MD, of the department of psychiatry at Columbia University, New York, and his coauthors (JAMA Psychiatry. 2017 Sep 13. doi: 10.1001/jamapsychiatry.2017.2582).

However, the demographic groups that had the most notable increases were young adults aged 21-34 (ARD, 0.48%; 95% CI, 0.09%-0.87%; P = .02) and those with no more than a high school education (ADR, 0.49%; 95% CI, 0.18%-0.80%; P less than .002).

Dr. Olfson and his coauthors also found an increase in suicide attempts among adults with certain psychiatric disorders. Specifically, the risk for suicide attempts was higher for adults with antisocial personality disorder; among that group, the risk increased from 0.07% (95% CI, –0.09% to 0.23%) in 2004-2005 to 2.16% (95% CI, 0.61%-3.71%) in 2012-2013. “Other high-risk groups included persons with ... schizotypal ... personality disorders and those with anxiety and depressive disorders,” according to Dr. Olfson and his coauthors. “These findings highlight an increasing prevalence of suicide attempts and underscore the prominent role of mental disorders ... in risks for suicide attempts at the population level.”

Almost two-thirds of the adults who had recent suicide attempts in both NESARC survey groups had borderline personality disorder, the investigators reported. However, a finding the coauthors called “encouraging” is that “although most of the adults in the 2012-2013 survey who had recent suicide attempts had borderline personality disorder, the risk of attempted suicide among adults with borderline personality disorder significantly decreased during the study period,” Dr. Olfson and his coauthors wrote. They speculated that this decrease could be tied to findings showing that 40.8% of U.S. psychiatry residency programs offer training in dialectical behavior therapy for borderline personality disorder (Acad Psychiatry. 2013 Jul 1:37[4]:287-8). Clinician training programs are needed to help frontline clinicians manage self-harm among patients with borderline personality disorder, the investigators said.

In addition to many other risk factors, the investigators emphasized the correlation between recent suicide attempts and prior suicide attempts. About one-half of adults who reported a recent attempt also reported a prior attempt (95% CI, 16.46-33.67). “Because 15% to 25% of adults who die by suicide have received treatment for a suicide attempt within the past year, a substantial proportion of suicide deaths” could be subject to prior intervention that could be associated with an attempt, they said.

The data were limited in that adults who are homeless or incarcerated or who have schizophrenia were not surveyed. In addition, the coauthors cited the retrospective nature of NESARC self-reports as a limitation. Given the nature of the study, no data were collected from individuals who died of suicide. “This lack may have led to an underestimation of suicide attempts in each survey,” they wrote.

The study was supported by grants from the National Institutes of Health and the New York State Psychiatric Institute. The surveys were funded in part by the NIH Intramural Research Program. The authors did not report any financial disclosures.

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