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Moskos, M., Achilles, J., & Gray, D. (2004). Adolescent Suicide Myths in the
United States. Crisis: The Journal of Crisis Intervention and Suicide
Prevention, 25(4), 176-182. Retrieved March 27, 2009,
doi:10.1027/0227-5910.25.4.176
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Adolescent Suicide Myths in the United States
By: Michelle Ann Moskos
Department of Pediatrics, Intermountain Injury Control Research Center, Univ. of
Utah School of Medicine, Salt Lake City, UT, USA
Jennifer Achilles
University of Utah School of Medicine, Salt Lake City, UT, USA
Doug Gray
Department of Psychiatry, Child and Adolescent Specialty Clinic, University of Utah,
Salt Lake City, UT, USA
Neuropsychiatric Institute. Dr. Gray is the Chair for the Utah Youth Suicide
Task Force.
Correspondence concerning this article should be addressed to:
Michelle Moskos615 Arapeen Drive Suite 202Salt Lake City, UT 84102USA
Phone: +1 801 585-9511. Electronic Mail may be sent to:
michelle.moskos@hsc.utah.edu.
Introduction
The prevention of violence, in particular suicide, is of international concern
(Cantor, 2000; Weber, 2000). In 1999, the United States Surgeon General
issued a Call to Action to Prevent Suicide because the most current statistics
identified suicide as the ninth leading cause of mortality in the United States
with nearly 31,000 deaths. Concomitantly, the World Health Organization
(WHO) recognized suicide as a growing problem worldwide with nearly
1,000,000 deaths and urged member nations to take action (World Health
Organization, 1996). The WHO document, Prevention of Suicide: Guidelines for
the Formulation and Implementation of National Strategies (1996),
motivated a partnership to seek a national strategy in the United States
(Institute of Medicine, 2002). In 2001, the United States Surgeon General
released the National Strategy for Suicide Prevention: Goals and Objectives
for Action, which is a plan that will guide the nation's suicide prevention
efforts for the next ten years (Satcher, 2001). This document provides
essential guidance and suggests the fundamental activities that must follow
activities based on scientific evidence. The National Strategy emphasized
that, much of the work of suicide prevention must occur at the community
level where human relationships breathe life into public policy (Satcher,
2001). In 2002, the Institute of Medicine (IOM) released Reducing Suicide: A
National Imperative. The IOM clarifies the medical, social, psychological,
economic, moral, and political facets of suicide and the need for prevention.
Teen suicide rates tripled over several decades in the United States, but have
declined slightly since the mid-1990s (American Psychiatric Association, 2003;
Kachur, Potter, James, & Powell, 1995). Suicide, by its nature, is a complex
problem. Many myths have developed about individuals who complete
suicide, suicide risk factors, current prevention programs, and the treatment
of at-risk youth in the United States. There are certain myths that
suicidologists encounter in their work with the general population, health
professionals, school administrators, and other government officials, as well
as the media. The purpose of this article is to address these myths related to
suicide in the United States, to separate fact from fiction, and offer
recommendations for future suicide prevention programs.
Myths and Recommendations
Myth #1: Suicide Attempters and Completers Are Similar
1991). The genetics of suicide are complex. For example, some families are
parents identified the stigma of mental illness and the denial of mental
illness as the most significant barriers between teen suicide completers and
treatment (Moskos, Achilles, Keller, Workman, & Gray, 2002). More recently, a
study by Olfson and colleagues (2003) examined the relationship between
regional changes in antidepressant medication treatment and suicide rates in
the United States, and reported a relationship between increased
antidepressant use and decreased suicide rates, especially among teenage
males. Psychotropic medications can ameliorate symptoms, reduce disability,
shorten the course of several psychological disorders, and prevent relapse
(World Health Organization, 2001). However, in the United States (Druce, Hoff, &
Rosenheck, 2000) and Finland (Laukkala et al., 2001), while there has been a
several fold increase in antidepressant use in the general population, most
individuals with major depression remain untreated. Undertreatment is more
prevalent among children and adolescents than young adults (Haarasilta,
Marttunen, Kaprio, & Aro, 2003). A limiting factor in treating psychiatric
disorders is the lack of psychopharmacologic studies with children and
adolescents. While some psychotropic medications (i.e., antidepressants)
have FDA approved uses in the pediatric population, many medications
approved for adults are yet to receive adequate trials in younger age groups.
The lack of empirically-based studies, which exist but were not made public
due to proprietary issues (Zito, Derivan, & Greenhill, 2004), has led to some
controversy regarding the use of certain Selective Serotonin Reuptake
Inhibitors (SSRIs) to treat depression in children and adolescents (Sood,
Weller, & Weller, 2004).
Recommendations
The association between the increase of antidepressant use and decrease of
suicide rates warrants further examination. We recommend government
intervention to require pharmaceutical companies to study new psychotropic
medications in pediatric populations, and to inform the public of their
findings before these drugs come to public market (Zito et al., 2004). More
research into biological and psychosocial aspects of mental health is
necessary to increase the understanding of the cause, course, and outcomes
of mental illness and to develop more effective treatment options (World
Health Organization, 2001). We also recommend that all pediatric
psychopharmacologic studies be published, including studies with negative
results (Whittington et al., 2004; Zito et al., 2004). Public awareness of the
available treatments for psychiatric disorders is vital. It may not be the
mental illness itself, but rather the lack of treatment or compliance with
treatment, which may lead to suicide completion. Barriers to treatment for
mental illness must be addressed if the teen suicide rate is to be reduced.
These include denial of mental illness, stigma, mental health insurance
parity, and other barriers. Public awareness can reduce the stigma of both
the diagnosis and treatment of mental illness (World Health Organization,
2001).
Conclusion
Unfortunately, the six myths of teen suicide outlined above indicate that
evidence-based information is still needed to combat the high teen suicide
rate in the United States. Psychiatric illnesses are often viewed differently
from other medical problems. Research should precede any public health
effort, so that prevention programs can be designed, implemented, and
evaluated appropriately. Too often suicide prevention programs do not use
evidence-based research or practice methodologies. More funding is
warranted to continue evidence-based studies in suicide. In accord with the
United States Surgeon General, we support the position that the public
should view mental illness or substance abuse disorders as a real illness.
Public awareness could close the gap in the perception of mental illness and
physical illness as two distinct separate issues. Increased public awareness
regarding the frequency, treatment, and recovery process of mental illness,
and the human rights of people with mental illness could reduce barriers to
treatment and care (World Health Organization, 2001). Suicidal persons with
underlying mental illness who are seeking mental health treatment should be
viewed as persons who are pursuing basic health care. Concomitantly, the
United States Surgeon General reports that our nation is facing a public
health crisis in pediatric mental health. This is of importance for pediatric
populations because untreated mental illness is a known risk factor for youth
suicide (Satcher, 2001). According to the World Health Organization (2001),
countries have the responsibility to give priority to mental health in their
health planning, as enlightened mental health policy, legislation, professional
training, and sustainable fiscal resources will facilitate the delivery of the
appropriate mental health services to those who need them at all levels of
health care.
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