Suicide Rates: Lowest In 30 Years, Not Affected By Reducing Antidepressant Prescriptions

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Main Category: Depression
Also Included In: Regulatory Affairs / Drug Approvals;  Psychology / Psychiatry;  Mental Health
Article Date: 16 Feb 2008 - 0:00 PDT

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Two studies related to suicide performed by researchers from the University of Bristol report that 1) suicide rates in young men are at their lowest levels in 30 years and 2) the reduction in prescribing of antidepressants to people under the age of 18 does not seem to be associated with change in suicidal behavior in young people. Both papers are published online at bmj.com.

Authors of the first paper analyzed men and women aged 15-34 years in England and Wales between 1968 and 2005. The time trend analysis included data on mortality, population statistics and surveys, prescription information, and data on unemployment and divorce. The main finding was that fewer young men in England and Wales are dying by suicide than at any time in the last 30 years.

Specifically, the researchers report that:

• For 15-24 year-old men, the overall suicide rate dropped from 16.6 per 100,000 people in 1990 to 8.5 per 100,000 in 2005.
• For 25-34 year old men, overall suicide rates declined from 22.2 per 100,000 in 1990 to 15.7 per 100,000 in 2005.

A reduction in unemployment and laws that have reduced the risks from car exhaust fumes are cited as contributory factors. The increased number of cars with catalytic converters - due to emissions legislation from 1993 - has led to a sharp reduction in exhaust gas poisoning; this has contributed to the falling suicide rates. However, there are several factors, including the suicide prevention policy initiatives in England and Wales, which have played a role in the decline.

The results for women are slightly different. Female suicide rates in the 21st century are at their lowest levels since 1968, but there has been a dramatic increase in the proportion of women aged 15-34 who commit suicide by hanging - 5.7% of all suicides in 1968 to 47.3% in 2005.

Co-author David Gunnell reports, "Favorable changes in several different factors - levels of employment, substance misuse and antidepressant prescribing as well as policy focus on suicide and vehicle exhaust gas legislation - may have contributed to the recent reductions."

In the second study, researchers analyzed three separate sets of data between 1993 and 2006: 1) Selective serotonin reuptake inhibitors (SSRI) antidepressant prescriptions to 12-19 year olds in the UK, 2) annual deaths from suicide in 12-17 year olds in England and Wales, and 3) hospital admissions for self-harm in 12-17 year olds in England.

The main finding is that the recent restrictions prescribing antidepressants to children and adolescents in the UK has had no effect on suicide rates.

Although the regulatory restrictions led to a halving of antidepressant prescriptions, the study authors found no evidence of a temporal association between trends in antidepressant prescribing and deaths from suicide or hospital admissions for self harm.

"These findings are important because they suggest that reduced access to antidepressants in young people appears not to have had an adverse impact on suicide deaths," conclude the authors.

In an editorial accompanying both articles, Gregory Simon argues that that sustained use of antidepressants is probably too infrequent to have much of an overall effect on the risk of suicide in people living with depression. "Clinical trials cannot determine whether antidepressants increase or decrease the risk of genuine suicide attempts or death from suicide because these outcomes are, fortunately, too rare. No deaths from suicide and few attempts at suicide have occurred to date in trials of antidepressants in adolescents."

Suicide rates in young men in England and Wales in the 21st century: time trend study
Lucy Biddle, Anita Brock, Sara T Brookes, David Gunnell
BMJ. (February 14, 2008)
doi:10.1136/bmj.39475.603935.25
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The population impact on incidence of suicide and non-fatal self harm of regulatory action against the use of selective serotonin reuptake inhibitors in under 18s in the United Kingdom: ecological study
Benedict W Wheeler, David Gunnell, Chris Metcalfe, Peter Stephens, Richard M Martin
BMJ. (February 14, 2008)
doi:10.1136/bmj.39462.375613.BE
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Written by: Peter M Crosta
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