[Show abstract][Hide abstract] ABSTRACT: In the United States, teen suicide rates tripled over several decades, but have declined slightly since the mid-1990s. Suicide, by its nature, is a complex problem. Many myths have developed about individuals who complete suicide, suicide risk factors, current prevention programs, and the treatment of at-risk youth. The purpose of this article is to address these myths, to separate fact from fiction, and offer recommendations for future suicide prevention programs. Myth #1: Suicide attempters and completers are similar Myth #2: Current prevention programs work. Myth #3: Teenagers have the highest suicide rate. Myth #4: Suicide is caused by family and social stress. Myth #5: Suicide is not inherited genetically. Myth #6: Teen suicide represents treatment failure. Psychiatric illnesses are often viewed differently from other medical problems. Research should precede any public health effort, so that suicide prevention programs can be designed, implemented, and evaluated appropriately. Too often suicide prevention programs do not use evidence-based research or practice methodologies. More funding is warranted to continue evidence-based studies. We propose that suicide be studied like any medical illness, and that future prevention efforts are evidence-based, with appropriate outcome measures.
Full-text · Article · Feb 2004 · Crisis The Journal of Crisis Intervention and Suicide Prevention
[Show abstract][Hide abstract] ABSTRACT: To delineate the probability of contact between government agencies and youths who complete suicide, to investigate the nature of those contacts, and to identify new risk factors for suicide.
A descriptive epidemiological analysis of data from multiple Utah government agencies on consecutive youth suicides (n = 151) between August 1, 1996, and June 6, 1999, aged 13-21 years. Data were collected from four government agencies: Office of the Medical Examiner, Juvenile Justice, Department of Human Services, and the Department of Education.
Utah descriptive data were similar to national statistics, with the majority of completers being male (89%) and firearms the most common method of suicide (58%). The data demonstrated an association between youth suicide and contact with Juvenile Justice. Sixty-three percent of youths who completed suicide in Utah had contact with Juvenile Justice, and there was a direct correlation between number of referrals and increased suicide risk. Suicide completers had multiple minor offenses over many years. A significant minority of school-age subjects could not be located within the school system. Few suicide completers had evidence of active psychiatric treatment.
Juvenile Justice is identified as a novel site for the screening and identification of youths at risk for suicide.
Full-text · Article · May 2002 · Journal of the American Academy of Child & Adolescent Psychiatry
[Show abstract][Hide abstract] ABSTRACT: Chronic fatigue syndrome (CFS) is a controversial diagnosis with unknown cause. Adult studies indicate high rates of psychosocial dysfunction and psychiatric comorbidity. The authors compared three groups of pediatric patients selected by diagnosis-(1l) CFS (n = 15), (2) juvenile rheumatoid arthritis (n = 15), and (3) mood disorders (n = 15)-across many psychological measures. CFS subjects had dramatic elevation of the Somatic Complaints subscale (mean T score = 75), whereas the mood disorders group had higher externalizing scores (mean T score = 68) on the Child Behavior Checklist. The CFS subjects missed significantly more school compared with the two control groups. After the onset of CFS, 13 of 15 of the CFS patients required significant educational accommodation. Only 4 of the 15 CFS patients had an Axis I psychiatric diagnosis, as determined by the Computerized Diagnostic Interview for Children. Despite a low rate of psychiatric diagnosis in the CFS sample, these data attest to their psychosocial and school dysfunction.
No preview · Article · Sep 2001 · Journal of Developmental & Behavioral Pediatrics
[Show abstract][Hide abstract] ABSTRACT: Chronic fatigue syndrome (CFS) is a controversial diagnosis with unknown cause. Adult studies indicate high rates of psychosocial dysfunction and psychiatric comorbidity. The authors compared three groups of pediatric patients selected by diagnosis-(1) CFS (n = 15), (2) juvenile rheumatoid arthritis (n = 15), and (3) mood disorders (n = 15)-across many psychological measures. CFS subjects had dramatic elevation of the Somatic Complaints subscale (mean T score = 75), whereas the mood disorders group had higher externalizing scores (mean T score = 68) on the Child Behavior Checklist. The CFS subjects missed significantly more school compared with the two control groups. After the onset of CFS, 13 of 15 of the CFS patients required significant educational accommodation. Only 4 of the 15 CFS patients had an Axis I psychiatric diagnosis, as determined by the Computerized Diagnostic Interview for Children. Despite a low rate of psychiatric diagnosis in the CFS sample, these data attest to their psychosocial and school dysfunction.
Chronic fatigue syndrome (CFS) has been characterized by profound fatigue that may come on suddenly or gradually and persist for the duration of the illness, often years. Fatigue is a common symptom of many illnesses. One study demonstrated that 24% of patients visiting primary care clinics reported a past episode of fatigue lasting at least 1 month.1 However, only a small fraction of patients who reported fatigue met specific criteria for CFS. The prevalence rate of CFS has been estimated to be 4 to 10 cases per 100,000.2
A working case definition of CFS was created by a group of public health epidemiologists, academic researchers, and clinicians at the Centers for Disease Control.3 This definition was intentionally restrictive, to maximize the chance that research studies would detect significant associations. The diagnosis included a minimum of 6 months' duration of illness, with average daily activity below 50% of the patient's premorbid activity, exclusion of cases where chronic physical or psychiatric diagnoses could account for the symptoms, and a specific number of minor symptoms associated with CFS. A less restrictive case definition was established in 1994, eliminating a specific definition of fatigue, decreasing the number of minor symptoms required, and defining cases that persist but do not meet criteria as idiopathic chronic fatigue.4
CFS has been a controversial diagnosis. Studies have failed to identify a viral cause when adequate controls are used.5-8 Many believe that a number of different factors, including exposure to a virus, may be the trigger for CFS in a susceptible individual.9 Immunologists have occasionally found abnormalities of the immune system, but these results have been inconsistent and unrepeatable.10
Psychiatric studies of adults with CFS have demonstrated high rates of psychiatric comorbidity, with 45% to 75% having a concurrent Axis I psychiatric disorder.10-14 The majority of these patients had major depression, with smaller groups diagnosed with an anxiety disorder or somatization disorder. Studies have conflicted on whether individuals have high rates of psychiatric problems before the onset of CFS11,12 or only after onset of CFS.14 Psychological testing of adult CFS patients with the Minnesota Multiphasic Personality Inventory (MMPI) has demonstrated abnormalities, including a high frequency of the "neurotic triad," similar to the profile found with chronic pain patients.15 The results of the psychological tests were not consistent with reaction to an illness, but were consistent with emotionality as a predisposing factor. Other controversial illnesses, such as premenstrual syndrome16 or torticollis,17 when studied in specialized clinics, are associated with high rates of major depression and abnormal psychological tests. Research shows that patients with recurrent depression have high rates of medical utilization, somatic symptoms, and disabilities associated with chronic pain.18-20
CFS may be a modern version of neurasthenia, an illness described by George Beard in a medical publication in 1869.21 Neurasthenia propagated for many years as an epidemic and was referred to as "nervous exhaustion." This illness differed from melancholia because of the absence of guilt and worthlessness. Currently, when adults with CFS and depression are compared with groups who have depression alone, the CFS patients primarily externalize their problems, whereas patients with depression generally internalize their problems.22
Several adult studies compare patients with CFS with those with other medical and psychiatric diagnoses. Patients with known neuromuscular disease have primarily physical fatigue, but patients with CFS and patients with affective disorders have both physical and mental fatigue.23 Similar to adults with depression, CFS patients have difficulty with both concentration and memory.23 Adults with CFS were found to have three times the relative risk of psychiatric disorder when compared with adults with muscle disease.24 When illnesses such as lupus were studied, fatigue and depression had low correlations.25 When adults with CFS were compared with adults with rheumatoid arthritis, the CFS patients had much higher rates of depression and somatization.13
There is evidence to suggest that recovery from objective medical illness is strongly influenced by individual personality profiles. For example, MMPI tests were performed on 600 subjects before an influenza epidemic.26 When 26 patients developed influenza, the psychological test data served to differentiate those persons who recovered quickly from those whose symptoms persisted. In summary, adult studies of CFS indicate high rates of psychosocial dysfunction and psychiatric comorbidity.
The data on children and adolescents with CFS are limited. One study found that 5 of 15 patients met criteria for a major depressive episode, although no control group was used.27 Another study found that 9 of 20 subjects met criteria for major depression.28 The second study did use a control group of adolescents with depression and found that CFS patients with major depression had milder symptoms, compared with the control group. Still, "major quality of life changes" were noted in the CFS group as a whole. A study examining the psychology of pediatric CFS versus juvenile rheumatoid arthritis found that psychological factors may play an active role in debilitating fatigue.29 Finally, a study comparing pediatric CFS with a control group with depression found that the CFS group had more frequent illnesses and regular physician visits and multiple somatic symptoms. By comparison, the depressed group had more suicidal ideation and affective symptoms and more difficulties with externalizing or acting-out behaviors.30 Studies to date have not examined personality profiles, parental functioning, family history, or history of abuse. This study of children and adolescents was designed to compare subjects with CFS with a group with rheumatoid arthritis and a second group with mood disorders across a wide range of psychological tests and surveys. The possibility that psychiatric diagnosis or psychological factors might play a role in the cause of some CFS cases was the study hypothesis.
No preview · Article · Jul 2001 · Journal of Developmental & Behavioral Pediatrics
[Show abstract][Hide abstract] ABSTRACT: The Utah Youth Suicide Study provides information on the government agency contacts of suicide completers, and outlines new suicide risk factors. For example, 65% of suicide victims were found in the Juvenile Justice system, and most had multiple minor offenses over several years. The demographics of Utah youth suicide, as collected by the Utah Office of the Medical Examiner, are consistent with national data. The predominant gender is male and firearms are the most common method. A comprehensive approach requires integration of Utah and National data. Current knowledge of suicide risk factors for Utah's youth are outlined, described, and referenced.
[Show abstract][Hide abstract] ABSTRACT: Both environmental and genetic factors appear to contribute to the risk for suicide. The serotonergic system has been implicated in depression, impulsivity and suicidality. Tryptophan hydroxylase (TPH) is the rate-limiting enzyme in the synthesis of serotonin. Suicide has been associated with polymorphisms in intron 7 of the TPH gene. These alleles were studied in samples from 47 deceased Caucasian males as part of the Utah Youth Suicide Study. A 918 base pair fragment spanning the region of interest was amplified. The A218C polymorphism was visualized by restriction fragment length polymorphism (RFLP) and the A779C was sequenced. Neither A218C nor A779C appeared to be associated with suicide in this population. These results did not change when the sample was stratified by age (10-21 years, 22-31 years) or when violent suicides were selected. The complexity of the phenotype of suicide may reflect multiple biological and social etiologic factors, and poses a worthy challenge for genetic studies.
[Show abstract][Hide abstract] ABSTRACT: Objective: State agency records of all Utah suicide victims, age 13-2 1 were reviewed for risk factors and prevention opportunities. Method: Data were reviewed from 4 state agencies. Results: Medical Examiner's records (n=54) indicate a 4: 1 male:female ratio, and methods: firearms 5 1%, hanging 26%; Juvenile Justice records (n=49) show 65% had contact, and by age 18 (n=24) 75% have contact, and significantly more offenses than controls; School records (n=3 1) show 47% with record of suspension or expulsion, and 39% with special education evaluation; Child Protective Services review (n=5 1) show 21% with a family referral. Conclusions: Preliminary results suggest this approach contributes to the understanding of youth suicide. Referral to Juvenile Justice is an important risk factor.