Suicides among children and young adults rose by an alarming 8 percent in 2004, the largest rise in 15 years, the U.S. Centers for Disease Control and Prevention reported on Thursday.
In 2004, 4,599 children and adults aged 10 to 24 committed suicide, making it the third leading cause of death in that age group, the CDC said.
The suicide rate for 10 to 24-year-olds rose to 7.32 deaths per 100,000 in 2004 from 6.78 deaths per 100,000 in 2003.
"This is the biggest annual increase that we've seen in 15 years. We don't yet know if this is a short-lived increase or if it's the beginning of a trend," said Dr. Ileana Arias, director of CDC's National Center for Injury Prevention and Control.
In 2003, the U.S. Food and Drug Administration issued a warning that the use of antidepressant drugs could increase the chances of suicidal thoughts or actions in children and teenagers. The warnings were added in a "black box" on the medications in October 2004.
Millions of Americans take antidepressants. Many psychiatrists have criticized the warnings, saying they scare people away from effective treatment and may have contributed to an increase in suicide in recent years.
Prior to 2003, the suicide rate among youth aged 10 to 24 had fallen by 28.5 percent over a 13-year period, from 1990 to 2003, the CDC said.
But in 2003 to 2004, the suicide rate for girls ages 10-14 jumped 76 percent. There were 94 suicides in that age group in 2004, compared to 56 in 2003. That’s a rate of fewer than one per 100,000 population.
Recognize warning signs
In 2004, about 161,000 youth and young adults between 10 and 24 received medical care for self-inflicted injuries in hospital emergency rooms across the nation.
"It is important for parents, health care professionals, and educators to recognize the warning signs of suicide in youth," said Dr. Keri Lubell, who led the study.
"Parents and other caring adults should look for changes in youth such as talking about taking one's life, feeling sad or hopeless about the future. Also look for changes in eating or sleeping habits and even losing the desire to take part in favorite activities."
The study also documented a change in suicide methods. In 1990, guns accounted for more than half of all suicides among young females. By 2004, though, death by hanging and suffocation became the most common suicide method. It accounted for about 71 percent of all suicides in girls aged 10-14, 49 percent among those aged 15-19 and 34 percent between 20-24.
"While we can't say (hanging) is a trend yet, we are confident that's an unusually high number in 2004," Lubell said.
Scientists speculated that hanging may have become the most accessible method.
"It is possible that hanging and suffocation is more easily available than other methods, especially for these other groups," Arias said.
The CDC is advising health officials to consider focusing suicide-prevention programs on girls ages 10-19 and boys between 15-19 to reverse the trends. It also said the suicide methods suggest that prevention measures focused solely on restricting access to pills, weapons or other lethal means may have more limited success.
As for why rates are up, Richard Lieberman, who coordinates the suicide prevention program for Los Angeles public schools, said one cause could be a rise in depression during tumultuous adolescent years.
"There's a lot of pressure in and around middle school kids. They're kind of all transition kids. They're turbulent times to begin with," he said. "The hotline's been ringing off the hook with middle school kids experimenting with a wide variety of self-injurious behavior, exploring different ways to hurt themselves."
Arias said the declining use of antidepressants in those age groups might play a role. But it's "not the only factor" that health officials will be studying.
"It is true that antidepressant prescriptions in pediatric patients has come down and that coincides with this one-year uptick in adolescent suicides. Obviously, that is a concern for us," the FDA's Dr. Tom Laughren said during the briefing.
A second report, published in the American Journal of Psychiatry, makes a clear connection between the warnings and the suicide rate.
Robert Gibbons of the University of Illinois at Chicago found that youth antidepressant prescriptions fell 22 percent among children aged 0 to 19 in both the United States and the Netherlands after the warnings were issued.
In the Netherlands, the youth suicide rate rose 49 percent between 2003 and 2005. Youth suicide rates in the United States rose 14 percent between 2003 and 2004.
The CDC said its report looked at a slightly older population, starting with children at age 10 because that is the age when suicide becomes a leading cause of death.
More education is needed, some specialists said, so that teachers, parents and others can quickly spot troubled teens.
"It underscores the need for more evaluation methods for school personnel and pediatricians to be able to better identify at-risk youth," said Dr. Alec Miller, director of the adolescent depression and suicide program at Montefiore Medical Center in New York. "They are out there, and everyone needs to be better trained in identification."
He said people who commit suicide tend to have a psychiatric condition, even if it has not been formally diagnosed.
Arias said warning signs include mental illness, alcohol and drug use, family dysfunction and relationship problems.
"For some, talking about suicide is awkward," she said. "Our goal is to stop suicides, and to do that we need everyone's willingness to talk about it."