Gaps Seen in Therapy for Suicidal Teenagers - NYTimes.com

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><nyt_text style="color: rgb(51, 51, 51); font-family: Georgia, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div id="articleBody"><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Most adolescents who plan or attempt suicide have already received at least some <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/mentalhealthanddisorders/index.html?inline=nyt-classifier" title="Recent and archival health news about mental health and disorders." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">mental health</a> treatment, raising questions about the effectiveness of current approaches to helping troubled youths, according to the largest in-depth analysis to date of suicidal behaviors in American teenagers.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The study, in the journal <a href="http://archpsyc.jamanetwork.com/journal.aspx" style="color: rgb(102, 102, 153); text-decoration: none; ">JAMA Psychiatry</a>, found that 55 percent of suicidal teenagers had received some therapy before they thought about suicide, planned it or tried to kill themselves, contradicting the widely held belief that suicide is due in part to a lack of access to treatment.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The findings, based on interviews with a nationwide sample of more than 6,000 teenagers and at least one parent of each, linked <a href="http://health.nytimes.com/health/guides/disease/suicide-and-suicidal-behavior/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Suicide and suicidal behavior." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">suicidal behavior</a> to complex combinations of mood disorders like<a href="http://health.nytimes.com/health/guides/symptoms/depression/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Depression (Mental)." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">depression</a> and behavior problems like attention-deficit and <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/eatingdisorders/index.html?inline=nyt-classifier" title="Recent and archival health news about eating disorders." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">eating disorders</a>, as well as alcohol and <a href="http://health.nytimes.com/health/guides/specialtopic/drug-abuse/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Drug abuse." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">drug abuse</a>.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The study found that about one in eight teenagers had persistent suicidal thoughts at some point, and that about a third of those who had suicidal thoughts had made an attempt, usually within a year of having the idea.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Previous studies have had similar findings, based on smaller, regional samples. But the new study is the first to suggest, in a large nationwide sample, that access to treatment does not make a big difference.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The study suggests that effective treatment for severely suicidal teenagers must address not just mood disorders, but also behavior problems that can lead to impulsive acts, experts said. According to the Centers for Disease Control and Prevention, 1,386 people between the ages of 13 and 18 committed suicide in 2010, the latest year for which numbers are available.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"I think one of the take-aways here is that treatment for depression may be necessary but not sufficient to prevent kids from attempting suicide," said Dr. David Brent, a professor of <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/psychiatry_and_psychiatrists/index.html?inline=nyt-classifier" title="Recent and archival health news about psychiatry." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">psychiatry</a> at the University of Pittsburgh, who was not involved in the study. "We simply do not have empirically validated treatments for recurrent suicidal behavior."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The report said nothing about whether the therapies given were state of the art or carefully done, said Matt Nock, a professor of <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/psychology_and_psychologists/index.html?inline=nyt-classifier" title="Recent and archival health news about psychology." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">psychology</a> at Harvard and the lead author, and it is possible that some of the treatments prevented suicide attempts. "But it's telling us we've got a long way to go to do this right," Dr. Nock said. His co-authors included Ronald C. Kessler of Harvard and researchers from Boston University and Children's Hospital Boston.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Margaret McConnell, a consultant in Alexandria, Va., said her daughter Alice, who killed herself in 2006 at the age of 17, was getting treatment at the time. "I think there might have been some carelessness in the way the treatment was done," Ms. McConnell said, "and I was trusting a 17-year-old to manage her own medication. We found out after we lost her that she wasn't taking it regularly."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">In the study, researchers surveyed 6,483 adolescents from the ages of 13 to 18 and found that 9 percent of male teenagers and 15 percent of female teenagers experienced some stretch of having persistent suicidal thoughts. Among girls, 5 percent made suicide plans and 6 percent made at least one attempt (some were unplanned).</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Among boys, 3 percent made plans and 2 percent carried out attempts, which tended to be more lethal than girls' attempts.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">(Suicidal thinking or behavior was virtually unheard-of before age 10.)</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Over all, about one-third of teenagers with persistent suicidal thoughts went on to make an attempt to take their own lives.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Almost all of the suicidal adolescents in the study qualified for some psychiatric diagnosis, whether depression, <a href="http://health.nytimes.com/health/guides/disease/phobia-simplespecific/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Phobia - simple/specific." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">phobias</a> or <a href="http://health.nytimes.com/health/guides/disease/generalized-anxiety-disorder/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Anxiety." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">generalized anxiety disorder</a>. Those with an added behavior problem — attention-deficit disorder, substance abuse, explosive anger — were more likely to act on thoughts of self-harm, the study found.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Doctors have tested a range of therapies to prevent or reduce recurrent suicidal behaviors, with mixed success. Medications can ease depression, but in some cases they can increase suicidal thinking. Talk therapy can contain some behavior problems, but not all.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">One approach, called dialectical behavior therapy, has proved effective in reducing hospitalizations and suicide attempts in, among others, people with <a href="http://health.nytimes.com/health/guides/disease/borderline-personality-disorder/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Borderline personality disorder." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">borderline personality disorder</a>, who are highly prone to self-harm.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">But suicidal teenagers who have a mixture of mood and behavior issues are difficult to reach. In one 2011 study, researchers at George Mason University reduced suicide attempts, hospitalizations, drinking and drug use among suicidal adolescent substance abusers. The study found that a combination of intensive treatments — talk therapy for mood problems, family-based therapy for behavior issues and patient-led reduction in drug use — was more effective than regular therapies.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"But that's just one study, and it's small," said Dr. Brent of the University of Pittsburgh. "We can treat components of the overall problem, but that's about all."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Ms. McConnell said that her daughter's depression had seemed mild and that there was no warning that she would take her life. "I think therapy does help a lot of people, if it's handled right," she said.</p><div><br></div><nyt_correction_bottom><div class="articleCorrection" style="margin-bottom: 2.8em; "></div></nyt_correction_bottom><nyt_update_bottom></nyt_update_bottom></div></nyt_text><span style="color: rgb(51, 51, 51); font-family: Georgia, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); display: inline !important; float: none; "></span></div><a href="http://www.nytimes.com/2013/01/09/health/gaps-seen-in-therapy-for-suicidal-teenagers.html?nl=todaysheadlines&emc=edit_th_20130109&_r=0&pagewanted=print">http://www.nytimes.com/2013/01/09/health/gaps-seen-in-therapy-for-suicidal-teenagers.html?nl=todaysheadlines&emc=edit_th_20130109&_r=0&pagewanted=print</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Gaps Seen in Therapy for Suicidal Teenagers - NYTimes.com

Most adolescents who plan or attempt suicide have already received at least some  mental health  treatment, raising questions about the effe...

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