Most adolescents who plan or attempt suicide have already gotten at least some mental health treatment, raising questions about the effectiveness of current approaches to helping troubled teenagers, according to the largest in-depth analysis to date of suicidal behaviours in US teenagers.
The study, posted online Tuesday by the journal JAMA Psychiatry, found that 55% 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.
The findings, based on interviews with a nationwide sample of more than 6,000 teenagers and at least one parent of each, linked suicidal behaviour to complex combinations of mood disorders like depression and behaviour problems that include attention-deficit and eating disorders, as well as alcohol and drug abuse.
The study found that about 1 in 8 teenagers had persistent suicidal thoughts at some point, and about a third of them had made a suicide attempt, usually within a year of having the idea.
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.
The study suggests that effective treatment for severely suicidal teenagers must address not just mood disorders, but also behaviour problems that can lead to impulsive acts, experts said. Around 1,386 people between the ages of 13 and 18 committed suicide in 2010, the latest year for which numbers are available.
"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 psychiatry at the University of Pittsburgh, who was not involved in the study. "We simply do not have empirically validated treatments for recurrent suicidal behaviour."
The report said nothing about whether the therapies given were state of the art, or carefully done, said Matt Nock, a professor of psychology 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," Nock said.