Suicide Research Today is a free monthly online journal that collates and summarizes the latest research about Suicide, including details on depression, causes, prevention, treatment, help.

Persisting decline in depression treatment after FDA warnings.

Libby AM, Orton HD, Valuck RJ

School of Public Health, University of Colorado Denver, 13055 E 17th Ave, Nighthorse Campbell Native Health Building, Campus Box F800, Aurora, CO 80045, USA. anne.libby@ucdenver.edu

CONTEXT: In October 2003 the Food and Drug Administration (FDA) issued a Public Health Advisory about the risk of suicidality for pediatric patients taking antidepressants; a boxed warning, package insert, and medication guide were implemented in February 2005. The warning was extended to young adults aged 18 to 24 years in May 2007. Immediately following the 2003 advisory, unintended declines in case finding and non-selective serotonin reuptake inhibitor substitute treatment were shown for pediatric patients, and spillover effects were seen in adult patients, who were not targeted by the warnings. OBJECTIVE: To determine whether the unintended declines in depression care persisted for pediatric, young adult, and adult patients. DESIGN: Time series analyses. SETTING: Ambulatory care settings nationally. Patients Pediatric, young adult, and adult cohorts of patients with new episodes of depression (n = 91 748, 70 311, and 630 748 episodes, respectively). INTERVENTIONS: Post-FDA advisory trends were compared with expected trends based on preadvisory patterns using a national integrated managed care claims database from July 1999 through June 2007. MAIN OUTCOME MEASURES: Depression diagnosis; antidepressant, antipsychotic, and anxiolytic prescriptions; and psychotherapy visits. RESULTS: Changes in pediatric depression care were similar to changes for adults. National diagnosis rates of depression returned to 1999 levels for pediatric patients and below 2004 levels for adults. Primary care providers continued significant reductions in new diagnoses of depression (44% lower for pediatric, 37% lower for young adults, 29% for adults); diagnoses by mental health providers who were not psychiatrists increased. Numbers of prescriptions of anxiolytic and atypical antipsychotic medications did not significantly change from preadvisory trends. Psychotherapy increased significantly for adult, though not pediatric, cases. Selective serotonin reuptake inhibitor use decreased in all cohorts; serotonin-norepinephrine reuptake inhibitor increased for adults. CONCLUSIONS: Diagnosing decreases persist. Substitute care did not compensate in pediatric and young adult groups, and spillover to adults continued, suggesting that unintended effects are nontransitory, substantial, and diffuse in a large national population. Policy actions are required to counter the unintended consequences of reduced depression treatment.

Published 2 June 2009 in Arch Gen Psychiatry, 66(6): 633-9.
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Articles on Suicide published 2 June 2009:

Frequent change of residence and risk of attempted and completed suicide among children and adolescents.   Arch Gen Psychiatry, 66(6): 628-32.

CONTEXT: In contemporary society, people change their place of residence frequently. However, large-scale population studies documenting the influence of frequent moves on mental health among children and adolescents are limited. OBJECTIVE: To evaluate the influence of frequent change of residence on risk of attempted and completed suicide among children and adolescents. Design, Setting, and PARTICIPANTS: We used data from Danish longitudinal population registries to identify all children born ... [Abstract] [Full-text]

Articles on Suicide published 11 May 2009:

Dementia and suicidal behavior: a review of the literature.   Int Psychogeriatr, 21(3): 440-53.

BACKGROUND: While dementia is more common in older people and suicide rates in many countries are higher among the elderly, there is some doubt about the association between these two phenomena. METHODS: A search of the major relevant databases was carried out to examine the evidence for this possible association. RESULTS: The association between dementia and suicide and also non-fatal self-harm did not appear strong but many studies have significant methodological limitations and there are few ... [Abstract] [Full-text]

A comparative study of elderly suicides in England and Wales, Scotland and Northern Ireland: trends over time and age-associated trends.   Int Psychogeriatr, 21(3): 581-7.

BACKGROUND: The elderly population size in the U.K. and its constituent countries is increasing. Traditionally, suicide rates increase with aging. METHODS: Time trends in elderly suicide rates and age-associated trends in suicide rates in the U.K. and its three constituent countries (England and Wales, Scotland and Northern Ireland) were examined and comparisons were made of elderly suicide rates in these three countries using data from the World Health Organization. RESULTS: Elderly suicide ... [Abstract] [Full-text]

Articles on Suicide published 6 May 2009:

Death ideas, suicidal thoughts, and plans among nursing home residents.   J Geriatr Psychiatry Neurol, 22(2): 141-8.

Recent studies have shown that suicides are at least as frequent among Nursing Home (NH) residents as they are among older people in the general population. The objective of the present study was to evaluate the prevalence of death- and/or suicidal feelings, thoughts, and plans and any attempted suicides in a random, unselected sample (N=288) of individuals aged 65-years-and-over, living in NHs located in the Veneto Region (the Italian North-East). One hundred seventy-two participants were ... [Abstract] [Full-text]

Articles on Suicide published 4 May 2009:

Differential association of socioeconomic status in ethnic and age-defined suicides.   Psychiatry Res, 167(3): 258-65.

Suicide rates vary among racel- and age-defined groups, yet little is known about how suicide risk factors differentially impact individual groups. This study assessed differential associations of socioeconomic status among age- and race-defined groups of suicide victims. A database containing demographic information on declared suicides in Fulton County, GA, from 1 January 1988 through 31 December 2003 was combined with annual per capita income by zip code in Atlanta, GA. Analyses were ... [Abstract] [Full-text]

Completed suicide in schizophrenia: evidence from a case-control study.   Psychiatry Res, 167(3): 251-7.

Suicide is the single major cause of death among patients with schizophrenia. Despite great efforts in the prevention of such deaths, suicide rates have remained alarming, pointing to the need for a better understanding of the phenomenon. The present sample comprised 20 male patients with schizophrenia who committed suicide and who were investigated retrospectively for a large number of characteristics. Controls were 20 living patients with schizophrenia. The results suggest that suicide ... [Abstract] [Full-text]

Articles on Suicide published 24 April 2009:

Alcohol use disorders increase the risk of completed suicide--irrespective of other psychiatric disorders. A longitudinal cohort study.   Psychiatry Res, 167(1): 123-30.

Knowledge of the epidemiology of suicide is a necessary prerequisite for developing prevention programs. The aim of this study was to analyze the risk of completed suicide among individuals with alcohol use disorders (AUD), and to assess the role of other psychiatric disorders in this association. A prospective cohort study was used, containing three updated sets of lifestyle covariates and 26 years follow-up of 18,146 individuals between 20 and 93 years of age from the Copenhagen City Heart ... [Abstract] [Full-text]

Articles on Suicide published 22 April 2009:

Mindfulness-based cognitive therapy may reduce thought suppression in previously suicidal participants: findings from a preliminary study.   Br J Clin Psychol, 48: 209-15.

OBJECTIVES: Thought suppression is a strategy aimed at mental control that may paradoxically increase the frequency of unwanted thoughts. This preliminary study examined effects of mindfulness-based cognitive therapy (MBCT) on thought suppression and depression in individuals with past depression and suicidality. METHODS: In a randomized controlled trial design, 68 participants were allocated to an MBCT group or a treatment-as-usual waitlist control. Measures of thought suppression and ... [Abstract] [Full-text]

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