Report 3 of the Council on Science and Public Health (I-06) Full Text

Resources to Combat Teen and Young Adult Suicide in the United States

Full Text

Resolution 424 (A-05), introduced by the Medical Student Section at the 2005 Annual Meeting and adopted as amended, asks that the American Medical Association (AMA) recognize teen and young-adult suicide as a serious health concern in the United States and work with appropriate federal agencies, national organizations, and medical specialty societies to compile resources to reduce teen and young-adult suicide, including but not limited to continuing medical education (CME) classes, patient education programs, and other appropriate educational and interventional programs for health care providers.

Methods

Google Scholar and PubMed were searched for English-language articles published between 1996-2006 using the search terms youth suicide, youth suicide resources, and suicide resources for professionals.  Web sites of various medical specialty organizations, including psychiatry, family medicine, pediatrics, and gynecology, and relevant governmental, mental health, and child health entities were reviewed to identify resources on adolescent suicide.  Family support, advocacy, and suicide prevention Web sites also were reviewed. 

Background

Suicide is the third leading cause of death for U.S. residents aged 10 to 24 years.¹  The overall rate of suicide among youth has declined slowly since 1992.² However, according to the 2005 Youth Risk Behavior Survey (YRBS), among students in grades 9 to 12 during the 12 months preceding the survey, 28.5% of students nationwide had felt so sad or helpless almost every day for >2 consecutive weeks that they stopped performing some of their usual activities.³  Nationwide, 16.9% of students had seriously considered attempting suicide during the 12 months preceding the survey.³   In 1998 dollars, completed and medically treated suicides involving youth up to 20 years of age, totaled $945,000,000 for medical costs and $2,853,000,000 in lost future earnings.⁴   More teenagers and young adults die from suicide than from heart disease, cancer, stroke, respiratory diseases, AIDS, and birth defects combined.⁵ 

Healthy People 2010 objectives include reducing the rate of suicide attempts by adolescents and increasing the proportion of children with mental health disorders who receive treatment.⁶  Preventing suicide and suicidal behavior requires the support and contributions of many partners, including federal agencies, state and local health departments, nonprofit organizations, academic institutions, and private industry. These groups assist in highlighting risk factors, developing strategies for prevention, and ensuring that appropriate interventions reach those at risk.⁷

Relevant AMA Policy

Council on Science and Public Health Report 8 (A-06) reviewed the scientific data on the efficacy of prevention programs aimed at reducing the incidence of depression, substance abuse, and suicide on college campuses, as well as information on the access to, and utilization of, college mental health services.  Policy emanating from this report (Policy D-345.995, AMA Policy Database) contains  directives designed to reduce suicide in this young adult population, including increased availability and quality of on-site college and university-based mental health services and treatment coupled with appropriate community support, and the elimination of policies that discriminate against students who disclose or seek treatment for depression, substance use disorders, or other mental health disorders. The AMA also opposes media presentations that directly or indirectly encourage suicide in young children and adolescents (Policy H-60.980).

Preliminary Findings

Although hundreds of published articles and reports address adolescent suicide, few specifically discuss resources for the prevention of suicide and treatment for adolescents who are at risk or who have attempted suicide.  However, most primary care medical specialty societies have developed policy and created fact sheets or other resources for their members.  Other initiatives sponsor Web sites containing a variety of resources on youth suicide prevention, including fact sheets, training programs, and tool kits for professionals, patients, and families.  Additionally, many states have developed initiatives to address suicide and some have created youth suicide prevention programs.  Many organizations work exclusively on suicide prevention, either in general or specifically for youths at risk.  Some organizations offer support for families whose children have committed suicide, while others support survivors of suicide attempts and their families.  Unfortunately, despite the number of organizations devoted to suicide prevention and the volume of materials that have been developed, evidence that these materials have significant beneficial effects is limited. 

Specific Resources 

Materials that address suicide were identified from the following professional medical specialty associations:  American Academy of Child and Adolescent Psychiatry (AACAP), American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Obstetrics and Gynecology (ACOG), American Psychiatric Association (APA), American Society for Adolescent Psychiatry (ASAP), and the Society for Adolescent Medicine (SAM). Materials included fact sheets, CME programs, practice guidelines, and policy statements.  The psychiatric associations have more in-depth materials and a broader range of information and educational options for their members.

Numerous governmental agencies have made a commitment to developing and distributing materials that address youth suicide.  These agencies include, but are not limited to, the Centers for Disease Control and Prevention (CDC), Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB), National Institute on Drug Abuse (NIDA), National Institute of Mental Health (NIMH), Substance Abuse and Mental Health Services Administration (SAMHSA), the Surgeon General’s office, and the U.S. Preventive Services Task Force.

Each governmental agency has a specific focus. For example, approximately one year ago SAMHSA awarded 37 grants to address national suicide prevention efforts, including support for a suicide prevention resource center, suicide prevention efforts for college-age youth, state and tribal youth suicide prevention, and early intervention programs across the country.  NIMH offers information about mental illnesses that carry an increased risk for suicide, as well as fact sheets, statistics, and links to related resources.  The MCHB addresses suicide as part of its commitment to meeting the comprehensive physical, psychological, and social needs of the maternal and child population, and links to numerous other organizations that offer youth suicide materials.  NIDA addresses youth suicide because of its relationship with depression and drug abuse.  The CDC sponsors the national Youth Risk Behavior Surveillance Survey, which asks high school aged youth about mental health issues.  The CDC also provides suicide statistics in the Morbidity and Mortality Weekly Report. 

Concerns about youth suicide are shared by mental health organizations, advocacy and policy organizations, certain foundations, and organizations that focus on young people or on families that have lost a child to suicide.  Examples of the latter include the National Suicide Prevention Lifeline, The Jason Foundation, Inc., National Alliance for the Mentally Ill, National Mental Health Association, The Jed Foundation, and the American Foundation for Suicide Prevention.  The Jed Foundation was started in 2000 after the suicide of a college sophomore named Jed whose family understood the impact that his death had on the entire campus community.  The Jed Foundation describes itself as the “leading organization focusing exclusively on college student mental health and suicide prevention.”⁸    The Foundation has developed a framework that is designed to help institutions reach acutely distressed or suicidal college students, in addition to other materials.

Approach to Implementing Resolution 424 (A-05)

Medical specialty societies (pediatrics, family practice, internal medicine, gynecology, and various psychiatric specialties) offer numerous resources to address youth suicide, including fact sheets, policy statements, training workshops, CME programs, and physician tool kits.  The federal government has made a commitment to developing and distributing resources that address youth suicide; many of these are available through various Web sites.  Non-medical professional organizations, private foundations, advocacy organizations, and others offer resources as well.  Categorizing or classifying these materials in a meaningful, accessible manner for physicians and other health care professionals is challenging due to their volume, quality, and disparate target audiences.  Consequently, a process and strategy is required to assess the usefulness, evidence base, and value of these resources for physicians. 

Therefore, Resolution 424 (A-05) will be implemented through the creation of an AMA-led task force convened with the following objectives: (1) review youth suicide prevention and treatment resource materials; (2) develop inclusion criteria for materials that will be included in an on-line database; (3) recommend a strategy for categorizing the materials to enhance accessibility; (4) outline a plan for making the resources available to interested physicians and other health care professionals who treat adolescents and young adults, especially those who may be at risk for suicide; (5) identify potential support for developing the database; and (6) propose an evaluation strategy to determine utilization of the database over time.  

The teen and young adult population will be considered in three groupings based on National Center for Health Statistics-defined age categories: 10-14 years, 15-19 years, and 20-24 years.  The task force will comprise selected members of the Council on Science and Public Health, physician representatives and/or staff members of several medical specialty associations (the AAFP, AAP, APA, AACAP, ASAP), a representative from the American Association of Suicidology (AAS), a representative of SAMHSA, and selected state mental health department directors. 

The task force will review materials, establish inclusion and categorization criteria for resource materials, and recommend a process to make the resource materials publicly available.  Initially, materials to be considered will include evidence-based practice guidelines, best practices, promising programs, public health and medical resources, CME programs, active programs with consensus evaluations, and enduring resources.  A sample categorization scheme is attached (see Table [PDF, 30KB, requires Adobe® Reader®]).  It is anticipated that the validated resources will be hosted on the AMA Adolescent Health Web site. 

RECOMMENDATION

The following statement, recommended by the Council on Science and Public Health, was adopted by the AMA House of Delegates at the 2006 AMA Interim meeting:

The AMA will convene a time-limited work group to meet through conference call to identify and evaluate appropriate resources for physicians intended to prevent and reduce teen and young adult suicide, and  such resources will be maintained on a publicly accessible Web page hosted by the AMA. (Directive)

References

1. Centers for Disease Control and Prevention.  Suicide and attempted suicide.  MMWR. 2004;53(22):471.
2. National Center for Injury Prevention and Control. Suicide: Fact Sheet. Centers for Disease Control and Prevention; 2005. 
3. Centers for Disease Control and Prevention.  Youth Risk Behavior Surveillance --- United States, 2005.  MMWR Surveillance Summaries.  2006;55(SS05):12.
4. Miller TR, Covington KL, Jensen AF. Costs of injury by major cause, United States, 1995: cobbling together estimates. In: Mulder S, ed.  Measuring the Burden of Injuries, Proceedings of a Conference in Noordwijkerhout, Netherlands, May 13-15, 1998. December 1999.
5. National Strategy for Suicide Prevention (NSSP): Suicide: Cost to the Nation.  Available at: http://www.mentalheatlh.samhas.gov.  Accessed: 6/30/06.
6. Towey K, Fleming M. Healthy Youth 2010 – Supporting the 21 Critical Adolescent Objectives. Chicago, Ill: American Medical Association; 2003.
7. Centers for Disease Control and Prevention. Preventing Suicide: Program Activities Guide. Available at: http://www.cdc.gov/ncipc/dvp/Preventing_Suicide.pdf. (PDF requires Adobe® Reader®)  Accessed 6/29/06.
8. The Jed Foundation.  Available at http://www.jedfoundation.org.  Accessed 7/24/06.

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