Explaining the Rise in Youth Suicide

Abstract

Emile Durkheim's Suicide documented a monotonically increasing relation between age and suicide. Such a relation has been observed repeatedly since the beginning of the nineteenth century, making it one of the most robust facts about suicide. The differences in suicide rates by age are very large. In the United States in 1950, for example, suicide rates were four times higher for adults (ages twenty-five to sixty-four) than for youths (ages fifteen to twenty-four) and eight times higher for the elderly (sixty-five and older) than for youths.1 Economic theory explained this relation naturally, with the young having the most life to lose and also having the least information about what their life will be like (Hamermesh and Soss 1974).In recent decades, however, the monotonic relation between age and suicide has disappeared. Figure 5.1 shows suicide rates by age in 1950 and 1990 . Between 1950 and 1990, youth-suicide rates tripled (particularly among young men), while suicide rates for adults fell by 7 percent, and suicide rates for the elderly fell by 30 percent. In 1990, suicide rates for young adults (ages twenty to twenty-four) were equal to those for primeage adults and were only 25 percent below suicide rates for the elderly.David M. Cutler is professor of economics at Harvard University and a research associate of the National Bureau of Economic Research. Edward L. Glaeser is professor of economics at Harvard University and a faculty research fellow of the National Bureau of Economic Research. Karen E. Norberg is assistant professor of psychiatry at Boston University Medical School and a clinical associate of the National Bureau of Economic Research.The authors are grateful to Srikanth Kadiyala for expert research assistance, to Jonathan Gruber and Senhil Mullainathan for comments, and to the National Institute on Aging for research support.1. Throughout the paper, we refer to the fifteen-to twenty-four-year-old age group as youths. We sometimes divide this into teens (ages fifteen to nineteen) and young adults (ages twenty to twenty-four). 219Suicide is now the second or third leading cause of death for youths in the United States, Canada, Australia, New Zealand, and many countries of Western Europe.If youth suicide is an epidemic, attempted suicide is even more so. For every teen who commits suicide (0.01 percent each year), four hundred teens report attempting suicide (4 percent per year), one hundred report requiring medical attention for a suicide attempt (1 percent per year), and thirty are hospitalized for a suicide attempt (0.3 percent per year).Why have youth-suicide rates increased so much even as suicide among adults and the elderly has fallen? Why are there so many suicide attempts? It is easier to say what suicide is not than what it is. The U.S. rise in youth suicide has not been centered in America's troubled inner cities. The states with the largest increase in youth suicides between 1950 and 1990 are predominantly rural: Wyoming, South Dakota, Montana, New Mexico, and Idaho. The states w...

Economic reform and mortality in the former Soviet Union: A study of the suicide epidemic in the 1990s

“…Divorce rates are also a significant predictor of male suicide rates; this parallels results found in the U.S. for all adults (Cutler et al 2000) and coincides with individual-level studies indicating that divorced men are more prone to commit suicide than married or single men (Kposowa 2000). However, this correlation could also indicate that an omitted third variablesuch as stress -resulted in both rising divorce rates and rising suicide rates.…”

Anti-depressants and Suicide

“…Suicide increased dramatically for youth starting in 1950 and is now the third leading cause of death among persons age 15-24 in the US [Cutler, Glaeser and Norberg, 2001;Goldsmith et al, 2002]. Suicide is an important cause of death in all age groups, claiming the lives of around 30,000 Americans every year and another one million people or so worldwide [Goldsmith et al, 2002].…”

“…As a result most previous studies, and even meta-analyses of studies, rely on measures of non-lethal "suicidality," [e.g., Fergusson et al, 2005;Hammad et al, 2006], but the association between these indicators and actual suicide mortality remains unclear [Cutler, Glaeser and Norberg, 2001;Baldessarini et al, 2006a]. In addition the subjects enrolled in RCTs typically exclude subjects at highest risk for suicide, and the conditions under which both treatment and control subjects receive treatment in clinical trials may differ from the standard level of care provided to patients outside of such trials.…”

“…Hansen et al, 2001;Flechner, Wolf and Priebe, 1995;Salzer et al, 2006] Kahneman and Tversky [1979] call "editing" and ignore these risks altogether [see also Kunreuther, 1978]. Another "lulling effect" might stem from the fact that some self-injury attempts may be motivated by reasons other than the desire to end life, including to signal for help, punish family or friends, or secure resources more generally [Rosenthal, 1993;Cutler, Glaeser and Norberg, 2001;Marcotte, 2003]. The introduction of a safer overdose alternative -SSRIs -could paradoxically lead to an increase in the number of suicide attempts, thus increasing the number of unintentional deaths resulting from self-injury attempts without lethal intent.…”

“…However as Baldessarini et al [2006a, p. 246-7] note, only a small fraction of patients with suicidal thoughts attempt suicide, few attempts prove to be fatal, and, importantly, the risk factors for suicide attempts versus completions differ markedly [see also Cutler, Glaeser and Norberg, 2001]. …”