Increases in Suicide Deaths Among Adolescents and Young Adults Following US Food and Drug Administration Antidepressant Boxed Warnings and Declines in Depression Care
Objective Studies show decreased depression diagnosis, psychotherapy, and medications and increased suicide attempts following US Food and Drug Administration antidepressant warnings regarding suicidality risk among youth. Effects on care spilled over to older adults. This study investigated whether...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-12-01
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| Series: | Psychiatric Research and Clinical Practice |
| Online Access: | https://doi.org/10.1176/appi.prcp.20200012 |
| _version_ | 1818642227432259584 |
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| author | Christine Y. Lu Robert B. Penfold Jamie Wallace Caitlin Lupton Anne M. Libby Stephen B. Soumerai |
| author_facet | Christine Y. Lu Robert B. Penfold Jamie Wallace Caitlin Lupton Anne M. Libby Stephen B. Soumerai |
| author_sort | Christine Y. Lu |
| collection | DOAJ |
| description | Objective Studies show decreased depression diagnosis, psychotherapy, and medications and increased suicide attempts following US Food and Drug Administration antidepressant warnings regarding suicidality risk among youth. Effects on care spilled over to older adults. This study investigated whether suicide deaths increased following the warnings and declines in depression care. Methods We conducted an interrupted time series study of validated death data (1990–2017) to estimate changes in trends of US suicide deaths per 100,000 adolescents (ages 10–19) and young adults (ages 20–24) after the warnings, controlling for baseline trends. Results Before the warnings (1990–2002), suicide deaths decreased markedly. After the warnings (2005–2017) and abrupt declines in treatment, this downward trend reversed. There was an immediate increase of 0.49 suicides per 100,000 adolescents, 95% confidence interval [CI]: 0.12, 0.86) and a trend increase of 0.03 suicides per 100,000 adolescents per year (95% CI: 0.026, 0.031). Similarly, there was an immediate increase of 2.07 suicides per 100,000 young adults (95% CI: 1.04, 3.10) and a trend increase of 0.05 suicides per 100,000 young adults per year (95% CI: 0.04, 0.06). Assuming baseline trends continued, there may have been 5958 excess suicides nationally by 2010 among yearly cohorts of 43 million adolescents and 21 million young adults. Conclusions We observed increases in suicide deaths among youth following the warnings and declines in depression care. Alternative explanations were explored, including substance use, economic recessions, smart phone use, and unintentional injury deaths. Additional factors may have contributed to continued increases in youth suicide during the last decade. Combined with previous research on declining treatment, these results call for re‐evaluation of the antidepressant warnings. |
| first_indexed | 2024-12-16T23:39:43Z |
| format | Article |
| id | doaj.art-8eefd7a178d54e5290a61f6a5b5d38fb |
| institution | Directory Open Access Journal |
| issn | 2575-5609 |
| language | English |
| last_indexed | 2024-12-16T23:39:43Z |
| publishDate | 2020-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Psychiatric Research and Clinical Practice |
| spelling | doaj.art-8eefd7a178d54e5290a61f6a5b5d38fb2022-12-21T22:11:39ZengWileyPsychiatric Research and Clinical Practice2575-56092020-12-0122435210.1176/appi.prcp.20200012Increases in Suicide Deaths Among Adolescents and Young Adults Following US Food and Drug Administration Antidepressant Boxed Warnings and Declines in Depression CareChristine Y. Lu0Robert B. Penfold1Jamie Wallace2Caitlin Lupton3Anne M. Libby4Stephen B. Soumerai5Harvard Medical School Department of Population Medicine and Harvard Pilgrim Health Care Institute Boston MassachusettsDepartment of Health Services Research Kaiser Permanente Washington Health Research Institute and University of Washington Seattle, WashingtonHarvard Medical School Department of Population Medicine and Harvard Pilgrim Health Care Institute Boston MassachusettsHarvard Medical School Department of Population Medicine and Harvard Pilgrim Health Care Institute Boston MassachusettsDepartment of Emergency Medicine, School of Medicine University of Colorado, Anschutz Medical Campus Denver, ColoradoHarvard Medical School Department of Population Medicine and Harvard Pilgrim Health Care Institute Boston MassachusettsObjective Studies show decreased depression diagnosis, psychotherapy, and medications and increased suicide attempts following US Food and Drug Administration antidepressant warnings regarding suicidality risk among youth. Effects on care spilled over to older adults. This study investigated whether suicide deaths increased following the warnings and declines in depression care. Methods We conducted an interrupted time series study of validated death data (1990–2017) to estimate changes in trends of US suicide deaths per 100,000 adolescents (ages 10–19) and young adults (ages 20–24) after the warnings, controlling for baseline trends. Results Before the warnings (1990–2002), suicide deaths decreased markedly. After the warnings (2005–2017) and abrupt declines in treatment, this downward trend reversed. There was an immediate increase of 0.49 suicides per 100,000 adolescents, 95% confidence interval [CI]: 0.12, 0.86) and a trend increase of 0.03 suicides per 100,000 adolescents per year (95% CI: 0.026, 0.031). Similarly, there was an immediate increase of 2.07 suicides per 100,000 young adults (95% CI: 1.04, 3.10) and a trend increase of 0.05 suicides per 100,000 young adults per year (95% CI: 0.04, 0.06). Assuming baseline trends continued, there may have been 5958 excess suicides nationally by 2010 among yearly cohorts of 43 million adolescents and 21 million young adults. Conclusions We observed increases in suicide deaths among youth following the warnings and declines in depression care. Alternative explanations were explored, including substance use, economic recessions, smart phone use, and unintentional injury deaths. Additional factors may have contributed to continued increases in youth suicide during the last decade. Combined with previous research on declining treatment, these results call for re‐evaluation of the antidepressant warnings.https://doi.org/10.1176/appi.prcp.20200012 |
| spellingShingle | Christine Y. Lu Robert B. Penfold Jamie Wallace Caitlin Lupton Anne M. Libby Stephen B. Soumerai Increases in Suicide Deaths Among Adolescents and Young Adults Following US Food and Drug Administration Antidepressant Boxed Warnings and Declines in Depression Care Psychiatric Research and Clinical Practice |
| title | Increases in Suicide Deaths Among Adolescents and Young Adults Following US Food and Drug Administration Antidepressant Boxed Warnings and Declines in Depression Care |
| title_full | Increases in Suicide Deaths Among Adolescents and Young Adults Following US Food and Drug Administration Antidepressant Boxed Warnings and Declines in Depression Care |
| title_fullStr | Increases in Suicide Deaths Among Adolescents and Young Adults Following US Food and Drug Administration Antidepressant Boxed Warnings and Declines in Depression Care |
| title_full_unstemmed | Increases in Suicide Deaths Among Adolescents and Young Adults Following US Food and Drug Administration Antidepressant Boxed Warnings and Declines in Depression Care |
| title_short | Increases in Suicide Deaths Among Adolescents and Young Adults Following US Food and Drug Administration Antidepressant Boxed Warnings and Declines in Depression Care |
| title_sort | increases in suicide deaths among adolescents and young adults following us food and drug administration antidepressant boxed warnings and declines in depression care |
| url | https://doi.org/10.1176/appi.prcp.20200012 |
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