Suicidal adults are more likely to receive treatment now than they were in the early 1990s, but there has been no decline in the number of Americans exhibiting suicidal tendencies.

"Despite a dramatic increase in treatment, no significant decrease occurred in suicidal thoughts, plans, gestures, or attempts in the United States during the 1990s," Ronald C. Kessler, PhD, and colleagues write in the current issue of The Journal of the American Medical Association.

"Continued efforts are needed to increase outreach to untreated individuals with suicidal ideation before the occurrence of attempts," they write.

"Suicide is one of the leading causes of death worldwide," write the researchers. "As a result, the World Health Organization and the U.S. surgeon general have highlighted the need for more comprehensive data on the occurrence of suicidal thoughts and attempts, with the assumption that such data would be useful for planning national health care policy, as well as for evaluating efforts to reduce suicide and suicide-related behaviors."

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Suicidal Decline Report Card

The authors looked at trends in data from the 1990-1992 National Comorbidity Survey and the 2001-2003 National Comorbidity Survey Replication. These surveys asked more than 9,000 people aged 18 to 54 whether they had thought about, planned, or attempted suicide or received treatment for suicidal tendencies over the past year. The only significant difference between the two time periods was in the percentages who reported receiving treatment after attempts.

Among those who had made a suicidal gesture, the percentage that received treatment increased from 40 percent in the earlier survey to almost 93 percent in the 2001-2003 survey.

Among respondents who had attempted suicide, the percentages of those who received treatment increased from almost 50 percent to 79 percent.

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Question of Timing

The authors say one reason the dramatic increase in treatment appears to have had no effect on suicidal thoughts, plans, or attempts is that most people may only receive treatment after making an attempt.

Another interpretation, according to the researchers, is that "the increase in treatment was of such low intensity or quality that it had no effect on suicide-related behaviors."

They recommend a greater reliance on evidence-based treatments for suicidal patients. "This means that expansion of disease management programs, treatment quality-assurance programs, and 'report cards' to improve the quality of care for suicidal patients may all be needed to reduce the burden of suicidality."

Women, Young People at Higher Risk

The authors also found a greater risk of suicidal tendencies "in several vulnerable subgroups, including the young, women, individuals with low education, and individuals lacking stable relationships or employment."

These patterns have not changed significantly since the early 1990s. "Because the dramatic increase in treatment in the last decade failed to reduce sociodemographic disparities in the suicidal behaviors considered here, programs specifically targeting high-risk populations are needed."

The researchers received funding from the National Institute of Mental Health as well as several major pharmaceutical companies.

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By Sherry Rauh, reviewed by Brunilda Nazario, MD

SOURCES: Kessler, R. The Journal of the American Medical Association, May 25, 2005; vol. 293: 2487-2495.