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Suicide is the third leading cause of death—behind unintentional injury and homicide—of Americans aged 15 to 24, but we know shockingly little about the transition from “suicidal ideation” and planning to actual attempts.

A new study has looked at these links in detail, and one of the most notable findings is that treatment for other mental conditions ordinarily occurs before suicidal behaviors occur, and this has understandably been interpreted as a critique of the current, medication-happy approach to psychological conditions. However, the relationship between psychological treatment and suicidal behaviors isn’t this simple—and in order to understand the relationship, it is essential to read about the study, learn about the links between psychological conditions and suicidal behaviors and come to grips with a common logical fallacy. 

The Study

The research was published in JAMA Psychiatry, and was based on interviews with almost 6,500 adolescents (between 13 to 18 years old) and questionnaires issued to their parents. One of the primary objectives of the research was to estimate the prevalence of suicidal ideation, plans and attempts among the participants. Suicidal ideation is a technical term for thinking about committing suicide without making any concrete plans—and was found to have occurred in 12.1 percent of the sample. Plans were formulated by only 4 percent, and 4.1 percent of the sample actually went through with an attempt. The majority of those in the study found to display these behaviors (or to have displayed them at some point in the past) had at least one condition according to guidelines from the DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders), with the majority having fear or anger issues, distress, substance use disorders and generally disruptive behavior.

These were most frequently associated with suicidal ideation, and as you might expect, the vast majority of the affected sample had received psychological treatment (over 80 percent). However, most had actually received treatment prior to displaying the suicidal behaviors—with over 55 percent of those affected falling into this group. This wasn’t deemed as especially relevant by the study’s authors, except as evidence that the current interventions weren’t effective. The conclusion to the research stressed the need to determine which factors cause adolescents to transition from mere suicidal ideation (which is closely tied to existing conditions) to actual plans or attempts, but media outlets such as Natural News took the opportunity to place the blame on the psychoactive drugs often given to those with psychological conditions.

The Interpretation: Is Treatment Causing the Attempts?

The argument put forward runs something like this: Because drugs like paroxetine (brand name Paxil) have been shown to increase the risk of suicidal ideation, it is absurd that the study’s researchers didn’t consider that as part of the research. The critics argue that the DSM is little more than a marketing manual for pharmaceutical companies, and go on to criticize many mental health professionals’ approach of merely upping the dosage if a pharmaceutical intervention is ineffective. The research on paroxetine shows that a person taking the drug is about seven times more likely to attempt suicide, and most of these cases were in young users. However, the “absolute” rates of suicide attempts are less impressive, being 0.05 percent for those taking the dummy sugar pill and 0.34 percent for people taking the drug—both well below 1 in 100.

Psychological Conditions, Drug Use and Suicide

There are many potential factors that can increase somebody’s risk for suicidal thoughts and behaviors, including drug abuse, existing psychological conditions, impulsive tendencies, access to potentially lethal weapons or medications and having a family history of suicide. In other words, although some drugs—like Paxil—do appear to increase the risk of suicide attempts, a wide range of other factors ultimately contribute to the problem. The pharmaceutical industry is obviously not blameless, but with the wide range of possible factors and the ultimately low rates of suicide, it’s difficult to say that treatment for psychological conditions is actually causing the problem and not the conditions themselves.

A Lesson in Logic: Post Hoc, Ergo Propter Hoc

This fancy Latin phrase is just a way of saying “after this, therefore because of this,” which is a logical fallacy. The reason for this is clear if you use an analogy. It’s true that the temperature of the Earth has risen over the last 200 years, and the number of practicing pirates has been decreasing over the same time period. Does this mean that pirates prevent global warming, or that the decline in pirates is causing a rise in temperature? Of course not, but that is precisely the sort of argument being put forward by those who misinterpret this research.

In other words, they say that since the psychological treatment often came before the suicidal ideation and behavior, then the behavior must be caused by the treatment. If you were planning to refute the pirate example above, the best option would be to demonstrate in controlled study that pirates actually have no effect on temperature, or to simply ask the individuals to propose a mechanism by which pirates prevent global warming. The same argument can equally be applied to the interpretation of this research: clinical trials on psychological drugs must have shown relative safety and efficiency for them to receive approval, and without a clearly defined mechanism by which these drugs increase the risk of suicide (or purposefully-designed clinical trial showing that they do) the argument is nothing but logically-flawed conjecture.

In fact, from things we already know about the risks of suicide, it’s quite likely that these individuals received treatment because they were suffering from conditions that increased their risk of suicide in the first place. Therefore, it’s incredibly flawed to claim the drugs increase the risk of suicide on the basis of this study. Other research has indicated that this could be the case, but the only way we can ever draw that conclusion is if we directly test the likelihood of suicidal thoughts or behavior in people receiving psychoactive drugs vs. the likelihood in people with comparable conditions receiving a placebo or alternative intervention. As the researchers concluded, the biggest priority is to find out what might cause teens to transition from suicidal ideation to attempted suicide, not to point the finger at the big, bad pharmaceutical industry without significant evidence.


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