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Most teens who attempt suicide got treatment first

Study suggests access to help is not a solution

Researchers found that 15 percent of female and 9 percent of male teens experienced some suicidal thoughts.

Jonathan Hayward/The Canadian Press via AP

Researchers found that 15 percent of female and 9 percent of male teens experienced some suicidal thoughts.

NEW YORK — Most adolescents who plan or attempt suicide have already received at least some mental health treatment, raising questions about the effectiveness of current approaches to helping troubled teenagers, according to the largest in-depth analysis to date of suicidal behaviors in US teenagers.

The study, posted online Tuesday by the journal JAMA Psychiatry, found that 55 percent of suicidal teenagers had received some therapy before they thought about suicide, planned it, or tried to kill themselves, contradicting the widely held belief that suicide is due in part to a lack of access to treatment.

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The findings, based on interviews with a nationwide sample of more than 6,000 teenagers and at least one parent of each, linked suicidal behavior to complex combinations of mood disorders like depression and behavior problems that include attention deficit and eating disorders, and alcohol and drug abuse.

The study found that about 1 in 8 teenagers had persistent suicidal thoughts at some point, and about one-third of them had made a suicide attempt, usually within a year of having the idea.

Previous studies have had similar findings, based on smaller, regional samples. But the new study is the first to suggest, in a large nationwide sample, that access to treatment does not make a big difference.

The study suggests that effective treatment for severely suicidal teenagers must address not just mood disorders, but also behavior problems that can lead to impulsive acts, specialists said.

According to the Centers for Disease Control and Prevention, 1,386 people between the ages of 13 and 18 committed suicide in 2010, the latest year for which numbers are available.

‘‘I think one of the take-aways here is that treatment for depression may be necessary but not sufficient to prevent kids from attempting suicide,’’ said Dr. David Brent, a professor of psychiatry at the University of Pittsburgh, who was not involved in the study. ‘‘We simply do not have empirically validated treatments for recurrent suicidal behavior.’’

The report said nothing about whether the therapies given were state of the art, or carefully done, said Matt Nock, a professor of psychology at Harvard University and the lead author; and it is possible that some of the treatments prevented suicide attempts.

“But it’s telling us we’ve got a long way to go to do this right,’’ Nock said. His coauthors included Ronald C. Kessler of Harvard, and researchers from Boston University and Boston Children’s Hospital.

Margaret McConnell, a consultant in Alexandria, Va., said that her daughter Alice, who killed herself in 2006, at the age of 17, was getting treatment at the time.

‘‘I think there might have been some carelessness in the way the treatment was done,’’ McConnell said, ‘‘and I was trusting a 17-year-old to manage her own medication. We found out after we lost her that she wasn’t taking it regularly.’’

In the study, researchers surveyed 6,483 adolescents ages 13 to 18 and found that 9 percent of male teenagers and 15 percent of female teenagers experienced some stretch of having persistent suicidal thoughts.

Overall, about one-third of teenagers with persistent suicidal thoughts went on to make an attempt to take their own lives.

Almost all of the suicidal adolescents in the study qualified for some psychiatric diagnosis, whether depression, phobias, or generalized anxiety disorder.

Doctors have tested a range of therapies to prevent or reduce recurrent suicidal behaviors, with mixed success.

Medications can ease depression, but in some cases can increase suicidal thinking. Talk therapy can contain some behavior problems, but not all.

One approach, called dialectical behavior therapy, has proved effective in reducing hospitalizations and attempts in people with so-called borderline personality disorder, who are highly prone to self-harm, among others.

But suicidal teenagers who have a mixture of mood and behavior issues are difficult to reach.

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