Press Briefing Transcripts

Suicide Trends Among Youths and Young Adults Aged 10-24 Years-United States, 1990-2004

Host: Glen Nowak, September 6, 2007, 12:00 p.m. EST

OPERATOR: Good afternoon, and thank you all for holding. At this time, your lines have been placed on listen-only until we open up for questions-and-answers.

Please be advised today′s conference is being recorded. If you have any objections, you can may disconnect at this time.

I would now like to turn the conference over to Mr. Glen Nowak. Please go ahead, sir.

GLEN NOWAK, MEDIA RELATIONS DIVISION, CENTERS FOR DISEASE CONTROL AND PREVENTION: Thank you. This is Glen Nowak from CDC′s media relations division, and today we′re going to be discussing youth suicide trends, based on some findings in today′s Morbidity and Mortality Weekly Report. And with us today are a number of people, and we′ve actually expanded the list and I want to spend a few moments talking about a couple of things.

First of all, this morning, we have with us Dr. Ileana Arias. And Dr. Arias′ named is spelled or first name is I-l-e-a-n-a. And her last name is A-r-i-a-s. And she′s director of CDC′s National Center for Injury Prevention and Control.

Also, available to answer questions this morning are: Dr. Keri Lubell. And her name is spelled K-e-r-i. Last name is L-u-b-e-l-l. She is a behavioral scientist at CDC and one of the lead authors on the study that′s published in today′s MMWR on youth and young adult suicides.

We are also joined this morning by two colleagues from some of our sister agencies. Dr. Richard McKeon, special advisory on suicide prevention from the substance abuse and mental health services administration is also on this line and available to answer questions. As is Dr. Tom Laughren, head of FDA′s psychiatric products division.

Dr. McKeon′s name first name is R-i-c-h-a-r-d. His last name is M-c-K-e-o-n. And Dr. Laughren – Dr. Laughren, can I get you to spell your name quickly?

Dr. Tom Laughren, director, Division of Psychiatric Products, FDA: L-a-u-g-h-r-e-n.

GLEN NOWAK: Thank you. As some of you may know, that there was an article that came off embargo, it′s published today in the American Journal of Psychiatry that looks at the effects of suicide warnings on SSRIs, which is a type of prescription antidepressant. And it looks at those prescriptions and suicide in children and adolescents, and I think that may cause some confusion.

One of the things that is true is that the data that was cited in that article and the data we are talking about this morning came from the same data source. The article in the American Journal of Psychiatry looked at the data for children zero to 19 years of age. What we′re going to be focusing on today in the MMWR is data that looks at children 10 to 24 years of age. And we focused on those age groups because that′s when suicide is a leading cause of death. Before age 10, suicide is not a leading cause of death. And so Dr. Arias will be focusing her remarks on our MMWR. And again, as questions come up, I will try to send them to the right person. But with that, I will turn this over to Dr. Ileana Arias, CDC′s Director for the National Center for Injury Prevention and Control.

DR. ILEANA ARIAS, PH.D., DIRECTOR, CDC NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL: Good afternoon. Our news today is sobering and it raises a great concern for us. Suicide is the third leading cause of death for people ages 10 to 24, surpassed only by car crashes and homicide. Earlier this year, CDC′s national center for health statistics provided data indicating that youth suicide spiked between 2003 and 2004. We felt that it was important to explore this increase in order to better understand the scope of the problem and who it′s effecting, especially so that we can work to prevent it.

Today, CDC is releasing data on suicides occurring in the U.S. from 1990 through 2004. We found that combined suicide rates for persons 10 to 24 years declined 28.5 percent from 1990 to 2003. But from 2003 to 2004 the rate increased by eight percent, signaling the largest single rise in 15 years. The significant increase in rates of suicide from 2003 to 2004 was limited to 10 to 14-year-old girls, 15 to 19-year-old girls and young women and 15 to 19-year-old boys and young men. Prior to 2003, the rates for all of these three groups had generally been trending downward. However, from 2003 to 2004, there was a 75.9 percent increase in the suicide rate among 10 to 14-year-old girls, a 32.3 percent increase among 15 to 19-year-old girls and young women and a nine percent increase among 15 to 19-year-old boys and young men. In surveillance speak, this is a dramatic and huge increase.

We also find that changes had taken place in the methods used in suicide. In 2004, hanging and suffocation became the most common method among girls, accounting for 71.4 percent of suicides among 10 to 14-year-old girls, and 49 percent among 14 to 19-year-old girls. From 2003 to 2004, hanging and suffocation suicides among 10 to 14-year-old girls more than doubled and increased by almost 44 percent for girls 15 to 19. We didn′t find any differences between black and white suicide deaths. One of the challenges in working with the 2003 to 2004 data is the relatively small numbers and therefore, we couldn′t pull out information for Native American, Alaska native youths, Pacific Islander or Hispanic youth.

Today′s findings alert us that CDC along with others in the field of suicide prevention need to work harder to prevent the underlying causes of suicide with the shift towards methods that are so commonly available and difficult to restrict. We believe that there′s now more urgent need for broader prevention measures that aren′t limited to specific methods of suicide, but rather, focus on underlying causes and address, especially, the needs of use. We′ve developed a promising surveillance or monitoring system, the National Violent Death Reporting System or NVDRS which will enable us to collect and link information about violent deaths including suicides from state and local medical examiners, coroners, police, crime labs, and death certificates to reveal the role of circumstances such as alcohol or drug use, and history of mental health treatment.

As the NVDRS grows, we′ll be able to provide information that caregivers, communities and others can use to pinpoint ways to intervene before situations, such as suicide, become such tragic endings. Supporting the development of a robust and timely monitoring or surveillance system is crucial and timely we have to do it now. In addition, we′re also supporting research to better understand, and therefore, prevent suicidal behavioral. Specifically at CDC we′re funding research that assesses suicide risk during that critical transitional period from the late adolescents to early adulthood. We′re also supporting research that assesses the effectiveness of screening for service use and looking at barriers to treatment.

And then, finally, specific to younger groups, we′re looking at brief family therapy for adolescents were presenting with serious risk of suicide in primary care settings.

Before I address the questions you may have, I′d like to acknowledge that for some, talking about suicide may be comfortable. Often victims are blamed and families, friends and communities may feel guilty because of a loss of a loved one. Our goal is to stop suicides and to do that we need everyone′s willingness to listen to this information and discuss it. Talking about suicide, and what can be done to prevent it does not cause suicide to occur.

In fact, talking about suicide can be an excellent prevention tool. Talking about suicide breaks the secrecy that surrounds suicidal behavior and lets people know that help is available. We need to decrease the isolation and despair of individuals who are thinking about suicide. We want to empower parents, families and friends to recognize warnings signs. And we want them to know what resources they can turn to for help.

Now I′d be glad to answer any questions you may have.

OPERATOR: Thank you. And at this time, if you would like to ask a question, please press star followed by one on your touch-tone phone. You′ll be prompted to record name for proper registration. Once again, to ask a question, please press star followed by one. Our first question comes from Julie Steinheisen (ph) with Reuters, please go ahead.

JULIE STEINHEISEN (ph): Hi. Thank you everyone. Really, I′d like to get, you know, since the timing of this increase is so closely related to the warnings on antidepressants and SSRIs, I′m just wondering if you think there′s any sort of connection here, with, I mean perhaps a reduction in the use of these types of prescriptions and then increasing the suicide rate?

GLEN NOWAK: I think what I′ll do is direct that question to Dr. Tom Laughren of FDA.

DR. TOM LAUGHREN, FDA: OK. I should say that we had an advisory committee in December of last year, to present the – our analysis of the adult suicidality data. And just prior to that meeting, these same data that are now being presented by CDC were actually available to us and were a focus – somewhat of a focus of discussion at that meeting. And I believe we′re factored into the committee′s recommendation on what we do with the warnings, but obviously that is a concern.

It′s true that antidepressant prescribing in pediatric patients has come down. And that coincides with this one year up tick in adolescent suicide so obviously that′s a concern. On the other hand, we do, as a regulatory agency have an obligation to alert prescribers and patients of risks that we find with drugs that are being used. And so it′s a dilemma for us, but clearly it′s a concern.

DR. ILEANA ARIAS: This is Ileana Arias at CDC. One of the things that I think s important is for all of us to recognize, what we know on the basis of the science that is available. Suicide is a multi dimensional and complex problem. As much as we would like to attribute suicide to any single source, so that we can fix it quickly, unfortunately, we can′t do that. And so while things such as antidepressant medication may have a role in either ideation or actual fatal suicide, probably is not the only factor.

And one of the things that we have to do is make sure that we look at all of the factors that could increase the risk for suicide and need to be addressed in order to reduce those rates. One of the things that we′re specifically concerned about is, again, seeing these increases in a significant younger cohort of Americans than we have been looking at in the past. And so the issue is, what is the wide range of factors that may be accounting for the rate of suicide in those groups and especially the increase in those young groups, that is that 10 to 14-year-old group that can then guide the development of interventions and prevention efforts that could be efficacious.

OPERATOR: Thank you. Our next question comes from Daniel DeNoon with WebMD, please go ahead.

DANIEL DENOON, WEBMD: Thank you for taking my question and for doing this press conference. The data here is from 2004. I understand the 2004 data is in, by not analyzed yet. But in terms of crude numbers, can you say whether things – whether this blip has gone back down or gone up or stayed the same?

DR. ILEANA ARIAS: We don′t have those data available yet. They will become available later in the year. The preliminary data will be available in November but actually I think that preliminary data are available – will be available in a couple of weeks, but the final data will not be available until the end of the year. And we are hesitant to even peak because as you may imagine with a low base rate behavior such as suicide, just a few incidents may actually make a significant difference. And so we are very careful to wait until all of the numbers are in before we then make those trend analysis.

OPERATOR: Thank you. Our next question comes from Anita Manning with USA Today.

ANITA MANNING, USA TODAY: Hi. Thank you again for doing this for us. I have a couple of questions. One of them has to do with these reports from the American Journal of Psychiatry. If you could just help us understand, I thought that the black box warning went on in 2004. So if you could help me to understand when the decline in prescribing of these SSRIs occurred, and how it does dovetail with the increase in suicide?

And then the other question is…

GLEN NOWAK: Anita, why don′t we let Dr. Laughren answer that question.

ANITA MANNING: OK. Thank you.

GLEN NOWAK: We′ll come back to you.

DR. TOM LAUGHREN: OK. It′s true that the black box warning was initially implemented early in 2005, actually. We asked for it in late 2004. But there were other advisories coming out from FDA beginning as early as June 2003. And then in March of 2004, we actually make a labeling change short of the black box. And I believe the downward trend in pediatric and anti depressant prescribing began later in 2004. So there were a number of advisories other than the final implementation of the black box.

ANITA MANNING: But do you feel it′s – you′re comfortable that there was a correlation between the downward – the fewer prescriptions being written for these drugs and increase in suicide.

DR. TOM LAUGHREN: It′s true that there′s been a reversal in both trends, you know, antidepressant prescribing had been going up for years, and now it′s down slightly. And there is this one year up tick in adolescent suicides. But you cannot reach causal conclusions from these kinds of data. As was pointed out earlier, there are many factors that come into play in determining these behaviors, and I think we′re going to have to look at a data over time before we can make any final judgments about this.

ANITA MANNING: Thank you. And the other question that I had if you look at the fluctuation over 10 or 15 years, I mean even in the young girls suicide rates 10 years ago in ′94, it looks to be exactly the same as in 2004.

GLEN NOWAK: Dr. Arias.

DR. ILEANA ARIAS: I′m sorry, this is Ileana Arias. Yes, you are correct. They had been trending downward. And now, with this sort of up tic, we wind up with a number that is very similar to where we started.

ANITA MANNING: Do you have any idea why that might have occurred?

DR. ILEANA ARIAS: No. Unfortunately, the data that we have only allows us to look at the trend. We didn′t have any information available in this data set to try to identify what may account for that change, either whether it′s a consistent or stable up turn, and then what′s driving it. One of the things that will be important to do is for, not only CDC but others, to start looking into what maybe going on with that age group regardless of whether it′s a trend or not, but is it regardless, of whether it continues in 2005, certainly it′s a change that occurred and we need to understand what drove that change so that we can prevent similar changes in the future.

GLEN NOWAK: Dr. McKeon, is there anything you′d like to add?

DR. RICHARD MCKEON: Well, I think, I would just like to emphasize that regardless of what the next year′s statistics may show, which would certainly be very important for all of us to be tracking on, but regardless of that, each suicide remains an important priority for all of us, and where we all need to be continuing to work on youth suicide prevention activities.

And if I might, I′d like to just mention a couple of activities that are ongoing and that are resources for youth suicide prevention, and there are three in particular. The Garrett Lee Smith Memorial Act was passed by Congress and signed by the President, and currently they are funding suicide prevention grants focused on youth from age 10 to 24, the same age group that the focus of this analysis. And these grants are now going to 31 states, seven tribes or tribal organizations, and 55 college campuses. And there will be a new grant announcement for these programs that will be coming out within the next several months.

Also, I′d like to bring to your attention that there is a national suicide prevention lifeline that utilizes a toll free number, 1-800-273-TALK. And anyone who calls this number is connected to one of over 120 local crisis centers around the country. Currently, this network answers over 36,000 calls per month. In addition, the National Suicide Prevention Lifeline is in efforts to work specifically with youth has been working with social networking sights, because we know that youth are particularly likely to communicate over the Internet and with Web based social networking mechanisms such as MySpace and Facebook.

Finally, the – there is a suicide prevention resource center which is a resource center around suicide prevention for the nation. And its Web site – its URL is www.sprc.org. And anyone is welcome to go to that Web site, get additional information or contact the suicide prevention resource center and to take a look at the variety of suicide prevention resources that are available there. So thank you for the opportunity to brief our audience on these resources.

OPERATOR: Thank you. Our next question comes from Tom Watkins with CNN.

TOM WATKINS, CNN: Given the fact that these appear to be pretty small numbers, how confident are you that there′s a statistically significant shift? And can you compare the youth suicide rates with those of older people?

GLEN NOWAK: I will have Dr. Keri Lubell answer that question. Keri.

DR. KERI LUBELL, PH.D., BEHAVIORAL SCIENTIST AND STUDY AUTHOR, NCIPC: Hi. Well, the first thing is that we are certainly confident that the change that we′ve seen between 2003 and 2004 is out of range for what the trend had been prior to that, between 1990 and 2003. So while the overall rates have been trending downward for 10 to 14-year-old males, 15 to 19-year-old females and males, and 20 to 24-year-old females and males, all of a sudden, you know there′s a reversal of that trend.

But yes, the case numbers, the actual number of deaths particularly among the 10 to 14-year-old girls is quite small. But the thing to keep in mind, I think, is that the numbers that we′re seeing is significantly different than what we have seen in the past, particularly for the hanging suffocation suicides, that particular method. During the entire trend between 1990 and 2003 there were never in excess of 34 cases. And suddenly in 2004 we′re seeing 70 cases. So while we can′t say this is a trend, we are confident that that is definitely an usually high number in 2004.

GLEN NOWAK: I think Dr. Arias has something to add to this.

DR. ILEANA ARIAS: The data for the uses and trends article in the MMWR came from the National Vital Statistics System or NVSS. NVSS bases all data on vital registration records such as birth certificates, death certificates, marriages, divorces, et cetera in the U.S. The findings in the report documenting case counts specifically taken from these records, so that while we do acknowledge that the study has some limitations and those are included in the article, the data points used are official mortality records data. A traditional analysis of this type of data for suicide, actually are known to reflect a degree of undercount, we know that. Therefore, the findings may represent actually an undercount of the true rate of suicide.

Although it may represent an undercount in the rate, we know that in the past, this has not effected conclusions about trends over time. So that if anything is affected, it′s the quotes on the rate but the trend is not affected by that.

GLEN NOWAK: Next question, please.

OPERATOR: Thank you. Our next question comes from Susan Dentzer with NewsHour with Jim Lehrer.

SUSAN DENTZER, NEWSHOUR WITH JIM LEHRER: Yes, thank you very much. Staying on this question of hanging and suffocation, what, in particular, could potentially explain that as distinct from other methods of suicide. One could understand a correlation between declining antidepressant use and suicide in general, but what could be driving the hanging/suffocation end of it, in particular? Is it just that younger girls, that′s obviously a method that′s easily accessed as distinct from getting a gun, or what?

GLEN NOWAK: This is Glen. I think what I′ll do is I′ll have Dr. Arias answer that question and also turn over to Dr. McKeon, after she′s done and see if he has any additional thoughts.

DR. ILEANA ARIAS: You know, we did not have data specifically, to be able to say why a method of suicide is chosen. I mean number one, these are fatalities, and so we wouldn′t ever be able to ascertain that. However, we don′t have that data from even non fatal. It is possible that, you know, hanging and suffocation is more easily available than other methods especially for younger groups, that sort of makes sense. However it′s not data that we have collected to be able to confirm that.

GLEN NOWAK: Dr. McKeon, is there anything you want to add?

DR. RICHARD MCKEON: I would certainly agree that in terms of evidence of why an increase in hanging, we don′t know about that. It is certainly the case that access to lethal means is an important risk factor. When we worked to try to publicize the warning sides for suicide, access to lethal means of whatever source is certainly one thing that is emphasized, so that′s a possibility but we don′t know for sure.

GLEN NOWAK: OK, next question please.

OPERATOR: Thank you. Our next question comes from Joanne Silberner with National Public Radio.

JOANNE SILBERNER, NATIONAL PUBLIC RADIO: Yes, thanks. I think this is a question for Dr. Laughren, and there was the December meeting on adult suicidality, can you tell us what′s going on now with the FDA? You know, has anything happened since then? And are there any plans for the future?

DR. TOM LAUGHREN: Well the major thing that′s happened, the advisory committee, as you know, recommended that we go ahead and extend the black box warning suicidality to young adults, but also include in the label, information on other parts of the age spectrum. Basically, from our adult data, we did not see an extension of the signal beyond age 24, and in fact, in elderly patients the drugs appear to have a protective effect on suicidality. And so that language has now been implemented into labeling.

In addition to that, because the committee was concerned about a possible negative impact of the warning language, they asked us to include some language in the warning statement itself indicating that depression itself is a major predictor of suicide and so that has been (done) as well.

So really what′s the current state of things is that we have now implemented these labeling changes, and that′s really where we are right now.

GLEN NOWAK: Thank you. Next question, please.

OPERATOR: Thank you. Our next question comes from Ben Carey (ph) with the New York Times.

BEN CAREY (ph): Hello. Thanks. This is a question for Dr. Laughren. Again, I wonder it′s strange that this data, these two trends, that is, downward for antidepressant prescriptions and use, and upward, up tick for a year here in number of suicides, seems to contradict that the drug trial data that you analyzed in December and before that. And, you know, what′s happening? I mean they seem to be pointing in exactly the opposite directions. Have you thought about that?

DR. TOM LAUGHREN: Well as I pointed out. It is a dilemma for us. You know, obviously, it′s now what you would want to see. But again, this is one year of data, and I think I want to emphasize this, one cannot reach causal conclusions based on these kinds of ecological findings.

On the other hand, it′s possible that there is some sub group of patients who are particularly vulnerable and do become worse when they are given antidepressants, but that the population – the larger percent of the population benefits from the drugs over the long term. So it′s possible for two different things to be happening at the same time, you know, one in sub group, you know, one on the larger population.

I think, you know, we are obviously concerned about this. We will continue to monitor both suicide rates and antidepressant use and other new data as they come out and make whatever – take whatever regulatory actions we think are appropriate.

GLEN NOWAK: Next question, please.

OPERATOR: Thank you. Our next question come from Ja Rei Chung (ph) with the Los Angeles Times.

JA REI CHUNG (ph): Hi, thank you for taking my questions. I had a couple here. My first one is, I know that we talked about this up tick possibly being multi factorial and I was wondering what are the factors that you′re looking at or the likely contributors to this up tick. And how important is the antidepressant issue?

GLEN NOWAK: I′ll have Dr. Arias take the first crack at that question.

DR. ILEANA ARIAS: We did not – in this data set, we didn′t look at specific risk factors. However, on the basis of work that we have done in the past, and others have done, there are certain factors or characteristics that definitely increase the risk for suicide. For example, we know that history of previous suicide attempts, a family history of suicide, certainly a history of depression and other mental illness, family dysfunction, social isolation, alcohol and drug use, stressful life events, hopelessness, access to methods as was mentioned before, exposure to the suicidal behaviors of others, and incarceration.

In the case of kids, or of youth, specifically, we know that there are certain things that are particularly significant for them. Relationship problems either with family members or with boyfriends and girlfriends are significant issues for them. Those are the kinds of things that on the basis of research, we know, are risk factors that need to be attended to in evaluating a risk for suicide on a particular kid.

In terms of the kinds of things that we recommend parents, teachers, and other adults in the lives of young kids, and adolescents to look for, as a way of signaling whether they should be checking in, or that they should be checking in and talking to kids about suicide or whatever stressors they are experiencing, we usually recommend that people look for warning signs such as changes in eating and sleeping habits, withdrawal from friends, families, and regular activities, an increase or engaging in violent actions and rebellious behavior, including running away.

Again, I mentioned drug and alcohol use, neglect of personal appearance, marked personality changes, persistent boredom, physical complaints and then loss of interest in pleasurable activities and other things that are associated with depression. So those are the kinds of things that specifically in the case of kids we recommend looking out for in order to signal that a conversation should take place with that child in order to determine what it is that they are experiencing and are they coping with whatever they are experiencing in an optimal way?

JA REI CHUNG (ph): Right. But in terms of what has changed, though, I mean was there anything else that was changing besides the warnings on the antidepressants that could have caused this up tick?

DR. ILEANA ARIAS: Like I said, , we didn′t have that information available, because that′s not included in those official records, in fact, it′s not included in those official records. I think what remains to be seen is similar to what was done with the SSRIs or changes in prescription of SSRIs is looking to see specifically in these cohorts, that is the 10 to 14-year-old, whether there has been a change in the same period of time in terms of general stress levels or coping or kinds of models that are being depicted or presented to these girls and see if that may account or at least suggest that that may account for the changes. At this point in time, we don′t know that. Not only do we not have that information at CDC, we′re not aware of anybody having done that kind of analysis.

GLEN NOWAK: Thank you. Next question, please.

OPERATOR: Thank you, our next question comes from Judith Graham with the Chicago Tribune.

JUDITH GRAHAM, CHICAGO TRIBUNE: I don′t think anybody has asked yet, how you understand the rise of rates in girls, as opposed to boys, and what it is about and I know we keep on asking you for the why of this, but what it is about girls that has made them particularly vulnerable to this increase. Any thoughts on that matter?

GLEN NOWAK: I guess we′ll have Dr. Arias take the first crack at that and then I′ll have Dr. McKeon.

DR. ILEANA ARIAS: Unfortunately, we don′t know that yet. I mean we can speculate about various reasons why that may be. You know, part of it may simply be statistical, the rates were higher among boys to begin with and therefore there was a greater room for change among girls, a statistical artifact, if you will. But there could be more substantive things going on with girls recently that may account for a change, why is it that, you know, so to speak they are catching up to boys. Unfortunately we don′t know that.

I think that there are hypotheses that we can generate, but definitely they are going to have to be tested.

GLEN NOWAK: Dr. McKeon.

DR. RICHARD MCKEON: Yes, I would agree, that we don′t know the specific reason for why there might be this increase among girls. But I think that what it does underscore is the important of taking seriously when adolescent girls report suicidal thoughts, make suicidal statements. And particularly if there is a suicide attempt, these are all – these kinds of behaviors related to suicide, it′s very importance that they be taken seriously. And be taken seriously both in boys, as well as in girls.

GLEN NOWAK: Thank you. Next question, please.

OPERATOR: Thank you. Our next question comes from Michelle Cortez with Bloomberg News.

MICHELLE CORTEZ, BLOOMBERG NEWS: Yes, can you give us a little bit more background on how you actually conducted the survey and whether this is supposed to be – I know you said that it′s under reported, but is this, you know, in general thought to capture all of the suicides we have in the country?

GLEN NOWAK: Dr. Arias will answer that question.

DR. ILEANA ARIAS: It was not a survey. We actually got information from death certificates and other vital records, so that essentially it depended upon a medical examiner or coroner to classify a death as a suicide.

The reason it may be an undercount is because there are times where there may be questions about whether a suicide – whether a death was intentional, that is was it a suicide? Was it unintentional? And in cases where the medical examiner or coroner cannot – doesn′t have enough data to be able to make a definite conclusion coding it as undetermined. So that the reason we say that there may be an undercount even when the final numbers are in, is that there may be some cases of quote undetermined death that might have actually been suicides.

GLEN NOWAK: Next question, please.

OPERATOR: Thank you. Our next question comes from Fred Pascar (ph) with the Miami Herald.

FRED PASCAR (ph): My question was just answered. Thank you.

GLEN NOWAK: All right. Next question.

OPERATOR: Thank you. Our next question comes from Ray Weiss with Daytona Beach News-Journal.

RAY WEISS, DAYTONA BEACH NEWS-JOURNAL: Hi. Our county here has got the highest level of suicides in the state, yet, funding through the state and also locally has been cut drastically for the agencies that would handle this. How can it be done that health can be given to these youngsters while in the same – conversely there are cutting funding on the very help that they need?

GLEN NOWAK: Dr. McKeon, do you want to take the first crack at that and I′ll have Dr. Arias follow.

DR. RICHARD MCKEON: Yes. There′s – I would emphasize that there is the availability through the federal government of various resources for suicide prevention. And the Garrett Lee Smith Memorial Act, there are two separate programs that are available. One is available to states and so any state in the United States is able to apply for these funds. It′s also available to tribes, as well, to apply. And in addition, there is also a campus suicide prevention program that focuses on college students. And that program actually is funding a suicide prevention initiative in the Daytona Beach area.

So these programs are available. As I mentioned earlier, we′re anticipating that we have a target date for the end of October for issuing a request for applications for new rounds of these grants. And in both the campus program and the state and tribal program focus on youth and we think are important as parts of our overall suicide prevention efforts.

GLEN NOWAK: Dr. Arias.

DR. ILEANA ARIAS: You know, we understand that we′re living in times of competing priorities when it comes to the federal budget, certainly, and that′s true of state and local governments as well. Our duty is to report findings in the research that we have available to us and that we support to generate. And then we commit ourselves to working with Congress and policy makers to address this important public health problem.

With that said, you know, there are concrete things that we can do currently with the resources that we do have and what we then try to do is given the data that we have available, how do we invest the resources that we have in order to make the biggest possible impact on the area? As I mentioned, one of the things that we′re doing is making sure that we continue to develop the surveillance systems and the monitoring systems that would be able to give us complete and quick information on trends and rates to be able to identify who is in need of services, and how it is that we should be targeting our investments.

In addition to that, again, because of the increase among younger kids, with a number of problems but with suicides specifically, since that′s what we′re talking about today is then investing our resources in developing family programs, and family interventions and measures that parents can then engage in in order to protect their children.

GLEN NOWAK: Next question, please.

OPERATOR: Thank you. Our next question comes from Mary Manning with Las Vegas Sun newspaper.

MARY MANNING, LAS VEGAS SUN: Thank you very much for this press conference at this time. We are dealing with quite a bit of turmoil from the Iraq War as soldiers are recycled to home and then back to Iraq. And I wondered, because of the particular up tick in that year, has – would that be considered a factor, especially with the problems the families are encountering as they try to get back together, or stay together?

GLEN NOWAK: I′ll have Dr. Arias answer that question.

DR. ILEANA ARIAS: To the extent that those suicides, military suicides are captured by vital statistics then they would have been included in these analysis already. We have not separated out specifically, whether the rate is any different for civilian versus active, duty personnel. We have not done those analysis. That information is not necessarily available in vital records, so it would take a different kind of data set to be able to separate out the sample in that way.

DR. RICHARD MCKEON: This is Richard McKeon from SAMHSA. One thing I would just like to mention on that issue is that SAMHSA has worked closely with the Veteran′s Administration. And earlier this summer, we partnered with the Veteran′s Administration to make a specialized service for veterans available through our national suicide prevention lifeline and that is currently available. So any caller who calls the 1-800-273-TALK number will hear a prompt indicating the availability of that service.

DR. ILEANA ARIAS: This is Ileana Arias, again. And although we did not have that classification in this data set, I mentioned the National Violent Death Reporting System earlier where that information is captured, that is military status both active and not– in decedents. One of the things that we′re doing is working with the Veteran′s Administration to look at the rates among military personnel and then any changes over time.

GLEN NOWAK: Next question, please.

OPERATOR: Thank you. Our final question comes from Molly McCray (ph) with KPIX.

MOLLY MCCRAY (ph), KPIX: Hi. Thank you for taking my question. I′m wondering among the poisonings, do we have any idea what they use to poison themselves?

And then regarding the hangings, the self suffocation can you rule out that any of the numbers might have been due to kids playing that choking game and were not intentional suicides?

DR. ILEANA ARIAS: Yes, this is Ileana Arias. It′s an excellent question on the choking game because we have had anecdotal reports of sort of an unfortunate increase in kids playing the game and unfortunate fatalities associated with that.

We do not – there′s no specific documentation in the vital records as to whether or not the choking game specifically was involved in the suicide. However, we′re concluding that it′s less – it′s not very likely that the choking game played a significant role either in an increase generally in those age groups, but then specifically because the changes were more likely to be represented among the girl groups.

One of the things that we see as far as the choking game is concerned is that boys are more likely to engage in that game than girls are. And so it doesn′t fit the pattern that we found in our data.

And I′m sorry your second question – about the poisonings. We also did not have information about specific substances used in these overdoses. We have information, not necessarily in these age groups but from other data sources showing that unintentional poisonings and in the case of suicides, it′s not clear how true that is, a significant increasing role of analgesic opiates involved in those, potentially, painkillers.

GLEN NOWAK: Thank you. Well I thank you all for participating this afternoon in this press conference. I thank Dr. McKeon and Dr. Laughren for joining us. And if you have additional questions don′t hesitate to call the respective public affairs offices. We hope to have transcripts for this Web conference posted on the CDC Web site probably in about three hours. So thank you and we′ll talk to you soon. Bye.

OPERATOR: Thank you. This does conclude today′s conference call, and we thank you for your participation.

END

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES