September 17, 2007

Youth Suicide Rates Up? Not So Fast

The headlines read, "Highest increase in youth suicide" and "girls aged 10-14 increased 75%."  And of course, the only explanation anyone seems to want to debate is antidepressants: was it too many prescriptions, or too few?   And self-righteous indignation all around.

Well, I did something apparently no one else cares to do: I looked up the individual suicides.  They are individuals, right?  With different reasons for doing things?  And guess what?  I have another explanation:  Ohio. 


The year in question is 2004, the most recent year the data is available.  I focused on girls aged 10-14, because that's what the majority of the news articles focused on.  Most reports described an increase of 75%, from 56-94.  I actually found 98 total suicides in this group.

If antidepressants had any effect-- in either direction-- then the increase should have been spread out throughout the country. 

Most states had very few suicides in this demographic.  Maine had zero.  North Carolina had 1.  Oregon, 1.  Florida, 1.  Etc.  These small numbers are generally unchanged from 2003.  California, which had the one of the highest absolute number of suicides, had 6 in 2003, and 7 in 2004.

If you look at Ohio, however, you see something interesting.  In 2003, there were no suicides.  In 2004, there were 11. 

Indiana was next: 0 in 2003, 6 in 2004. 

This, of course, speaks to the problem of medicine’s over-reliance on epidemiology.  People are different, and even “matched controls” have such variability that association studies are often nearly useless.  This is even more true in psychiatry.  Suicide is not an involuntary pathogen, it is a complex, volitional behavior whose causes can only be meaningfully investigated at an individual level.  

I have to go back and look closely at all the states' data, etc.   But it seems to me that when two small states account for almost half of the entire increase in the suicides, we should stop talking about antidepressants and maybe go find out what the hell happened over there?