Pediatrics, Vol. 119 No. 2, February 2007, pgs. 345-360
Abstract available at: http://pediatrics.aappublications.org/cgi/content/abstract/119/2/345
A small media frenzy erupted last month over the release of this normally ho-hum annual report compiled by statisticians at the National Center for Health Statistics and the Johns Hopkins Bloomberg School of Public Health, which details birth and death statistics of U.S. citizens.
Tucked among stats on fertility rates (the highest since 1993) and Caesarean deliveries (another record high) was this: For youth ages 14 to19, the suicide rate increased by 11 percent from 2003 to 2004, going from 7.3 per 100,000 to 8.2 per 100,000. The rate among 10- to 14-year-olds increased by 8 percent, going from 1.2 per 100,000 to 1.3 per 100,000.
That got the news engines churning.
The advocacy group Mental Health America issued a news release calling the increase “significant.” While the group acknowledged that “drawing conclusions related to the causes of this increase would be premature,” it took the opportunity to connect the up-tick to the appearance in March 2004 of new warning labels on antidepressant medications
The so-called “black box” warnings were mandated by the U.S. Food and Drug Administration after studies found that the medications could increase suicidal thoughts in youth in some cases. No study has linked the medications to more suicidal behaviors.
An article on the website of ABC News declared, “Some Experts Blame FDA Labeling for Child Suicide Increase,” and gave voice to even stronger opinions about the alleged correlation. “I have no doubt that there is such a relationship,” Dr. Charles Nemeroff of the Emory University School of Medicine told ABC. “The concerns about antidepressant use in children and adolescents have paradoxically resulted in a reduction in their use, and this has contributed to increased suicide rates.”
Similar stories quoting experts appeared on wire services and in newspapers across the country.
But to suicide expert John L. McIntosh – an associate dean and professor of psychology at Indiana University in South Bend, who for years has analyzed federal suicide data – all the attention “seems like an awful lot of to-do about very little.”
“You’re really talking about a change of less than 1 per 100,000 for that group,” he said.
McIntosh said he has a hard time getting excited about that kind of a change, particularly when the black box couldn’t have had an effect during the time period covered by the data. “We’re talking about 2004 data, not the last couple of years,” and the warnings just began in 2004, he said.
The real explanations might be more innocuous. “It really doesn’t fall outside the realm of general fluctuations that we see in the data to start with,” he said of the rate change. “The rates have really changed very little, and in fact over a longer period, the rates are clearly lower for that group today than they were 15, 20 years ago. After a decade of declines, we would expect rates to go back to a more average level.”
Besides, the report showed an increase in suicide rates for the nation as a whole. “Everyone’s rates pretty much went up in 2004,” McIntosh noted, “so to single out this particular age group of young people seems to me a little odd.”