Visit by Google Chairman May Benefit North Korea





BEIJING — As a work of propaganda, the images that North Korea circulated this week showing Google’s executive chairman, Eric E. Schmidt, touring a high-tech incubation center are hard to beat.







Adrian Bradshaw/European Pressphoto Agency

Eric E. Schmidt, Google’s executive chairman, at left wearing a tie, and former Gov. Bill Richardson of New Mexico spoke to reporters in Beijing on Thursday after returning from North Korea.







With former Gov. Bill Richardson of New Mexico at his side, Mr. Schmidt, who is fond of describing the Internet as the enemy of despots, toured what was presented as the hub of the computer industry in one of the world’s most pitiless police states. Both men gazed attentively as a select group of North Koreans showed their ability to surf the Web.


It is unclear what the famously hermetic North Koreans hoped to accomplish by allowing the visit. But the photos of the billionaire entrepreneur taking the time to visit the nation’s computer labs were bound to be useful to a new national leader whom analysts say needs to show his people that their impoverished nation is moving forward.


It will matter little, those experts say, that the visitors were bundled against the cold, indoors — a sign of the country’s extreme privation — or that the vast majority of North Koreans have no access to computers, much less the Web beyond their country’s tightly controlled borders.


The men’s quixotic four-day trip ended Thursday much the way it began, with some analysts calling the visit hopelessly naïve and others describing it as valuable back-channel diplomacy at a time when Washington and Pyongyang are not on speaking terms (again).


“I’m still spinning my wheels to figure out a plausible motivation for why they went,” said Daniel Pinkston, a North Korea specialist at the International Crisis Group.


Mr. Schmidt and Mr. Richardson insist they accomplished some good — showing the world has not forgotten the plight of an American detained in the North, and at least trying to nudge the tightly sealed nation a bit closer to the fold of globally connected nations.


“As the world becomes increasingly connected, their decision to be virtually isolated is very much going to affect their  physical world, their economic growth and so forth,” Mr. Schmidt told reporters after arriving at Beijing International Airport. “We made that alternative very, very clear.”


The unofficial visit, however, raised hackles in Washington, and provided rich fodder for commentators and comedians. Even before the Americans left Pyongyang, someone created an account on Tumblr, the popular social blogging site, called “Eric Schmidt looking at things,” that parodied sites (themselves parodies) featuring the country’s leaders earnestly inspecting livestock, soldiers or leather insoles. (Mr. Schmidt is shown looking intently at computer screens, “the back of a North Korean Student,” and Mr. Richardson.)


Others were less kind. Senator John McCain, Republican of Arizona, took to Twitter to call the self-appointed delegation “useful idiots,” and John R. Bolton, a former United Nations ambassador, said the delegation was unwittingly feeding the North Korean propaganda mill as it sought to burnish the credentials of Kim Jung-un, the nation’s leader, who is in his 20s.


“Pyongyang uses gullible Americans for its own purposes,” Mr. Bolton wrote in The New York Daily News.


The State Department said it did not think the timing of the visit was “particularly helpful,” given efforts by the United States to rally international support for tougher sanctions following North Korea’s recent launching of a rocket that intelligence experts say could help in the development of missiles that could one day reach the United States.


As if on cue, the North Korean news media hailed the visit by “the Google team” — which included Jared Cohen, who leads Google’s think tank — highlighting their visit to the mausoleum where Mr. Kim’s grandfather and father lie in state. There, Mr. Richardson and Mr. Schmidt “expressed admiration and paid respect to Comrade Kim Il-sung and Comrade Kim Jong-il,” the North’s main party newspaper, Rodong Sinmun, said.


Choe Sang-Hun contributed reporting from Seoul, South Korea, Claire Cain Miller from San Francisco, and Edward Wong from Beijing.



This article has been revised to reflect the following correction:

Correction: January 11, 2013

An earlier version of this article paraphrased incorrectly State Department comments about the visit to North Korea by Mr. Schmidt and Mr. Richardson. The Department said it did not think the timing of the visit was “particularly helpful.” It did not call the visit “not particularly helpful.”



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India Ink: Insurgents in Jharkhand Plant Bombs Inside Dead Bodies

Maoist insurgents in Jharkhand state have started to hide explosive devices in the bodies of their enemies, police officials said, a new tactic in the long battle between Indian security forces and the insurgents.

On Monday, rebels killed nine Central Reserve Police Force paramilitary soldiers and three villagers in an ambush in the Karmatiya forest area of Latehar district, about 150 kilometers (90 miles) southwest from the state capital of Ranchi, said state police chief Gauri Shankar Rath. After the insurgents retreated into the woods, the Central Reserve Police Force on Wednesday found the body of Babulal Patel, 29, a constable, with stitches in his abdomen, he said.

His body was flown to Ranchi by helicopter and taken to the Rajendra Institute of Medical Sciences for an autopsy. When the doctors saw the stitches, they grew alarmed and called the top security officials, Binay Kumar, a doctor there, said.

Using X-rays, members of a bomb disposal squad detected an improvised explosive device, or I.E.D., in the soldier’s stomach. With the help of doctors, it took over two hours for the bomb disposal unit to remove the explosive and defuse it outside.

“The I.E.D. connected with detonator batteries and a small solar panel weighing about 2.45 kilograms was extracted with utmost care from the body of the security personnel,” said Dr. Kumar. “Even a small mistake or a little pressure could have exploded the bomb device, triggering a major casualty inside the hospital,” he said. “The abdomen was stitched with surgical precision.”

A similar I.E.D. had detonated when the security personnel, along with some villagers, had removed the body of another colleague in the forest area. Three villagers were killed in that explosion on Wednesday.

Jharkhand’s police chief, Mr. Rath, said this was the first time the Maoist had used bodies as booby traps.

“With this inhuman act, the Maoists have now made it clear that they do not have any regard for human dignity, values and human lives,” said Mr. Rath. “This incident has crossed all limits of cruelty. We’ll definitely retaliate when the time comes.”

Mr. Rath called the Maoists’ most recent attack on security personnel “well planned.”

The state police official said the Maoists had ambushed the security forces under the leadership of Deo Kumar Singh, also known as Arvindji, considered among the top 10 Maoists commanders in Jharkhand and Bihar. “He has executed several deadly operations in the past,” Mr. Rath said.

Latehar’s superintendent of police, Kranti K. Garhdeshi, said that Mr. Singh also was an expert in I.E.D.’s and landmines.

In the past decade, hundreds of security personnel and civilians have been killed in battles with the Maoist insurgents in Jharkhand. The Indian prime minister, Manmohan Singh, has declared the insurgents the biggest internal security threat in India.

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Wall Street Flattens Out





Stocks rose ever so slightly on Wall Street on Thursday as stronger-than-expected exports in China, the world’s second-biggest economy, raised hopes for a more robust recovery in the global economy this year.


The Standard & Poor’s 500-stock index added 0.2 percent, the Dow Jones industrial average rose 0.1 percent and the Nasdaq composite index was flat in morning trading.


Data showed China’s export growth rebounded sharply to a seven-month high in December, a strong finish to the year after seven straight quarters of slowdown, even as demand from Europe and the United States remained subdued.


Ford shares gained 3.2 percent after it doubled its first-quarter dividend to 10 cents a share, despite a recent drop in market share.


Adding to the bullish sentiment, Spanish benchmark government bond yields fell below 5 percent to a 10-month low on the back of a strong bond auction that raised more than the targeted amount. European stock markets were mostly higher after the European Central Bank kept benchmark interest rates steady.


“The market’s more positive and it owes a lot of that to the Chinese economic data,” said Art Hogan, managing director of Lazard Capital Markets in New York, adding that the success of the Spanish auction was also of note.


Shares of the upscale jeweler Tiffany dropped 6 percent after it said earnings for the year through Jan. 31 will be at the lower end of its forecast.


Molycorp shares dropped 20 percent after the company said revenue and cash flow would be lower than expected this year due to lower rare-earth prices.


Nokia shares jumped 14 percent on Wall Street after the Finnish handset maker said its fourth-quarter results were better than expected and that the mobile phone business achieved underlying profitability.


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Institute of Medicine Studying Concussions in Young Athletes





The Institute of Medicine, a federally financed research group, has started a 15-month investigation into sports-related concussions sustained by young athletes.


An ad hoc committee of scientists, which held its first meeting Monday, “will conduct a study on sports-related concussions in youth, from elementary school through young adulthood, including military personnel and their dependents,” according to the Web site of the institute, part of the National Academies of Science.


The committee will look at the causes of concussions and the “relationships to hits to the head or body during sports, and the effectiveness of protective devices and equipment.”


The committee will also review screening, diagnosis, treatment and long-term consequences of concussions and head hits.  


Read More..

Institute of Medicine Studying Concussions in Young Athletes





The Institute of Medicine, a federally financed research group, has started a 15-month investigation into sports-related concussions sustained by young athletes.


An ad hoc committee of scientists, which held its first meeting Monday, “will conduct a study on sports-related concussions in youth, from elementary school through young adulthood, including military personnel and their dependents,” according to the Web site of the institute, part of the National Academies of Science.


The committee will look at the causes of concussions and the “relationships to hits to the head or body during sports, and the effectiveness of protective devices and equipment.”


The committee will also review screening, diagnosis, treatment and long-term consequences of concussions and head hits.  


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Baseball Dumping Dugout-to-Bullpen Landlines





The reserve clause is dead. And so are wool uniforms. There are no longer eight teams in each league. And the Houston Astros have departed the National League.




 Major League Baseball is now about to disconnect the landlines that link dugouts to bullpens. Long after the rest of society embraced cellphones, managers and coaches will soon be able to discuss pitching changes on Samsung Galaxy S III phones.


The 21st-century 4G dugout-to-bullpen connection that is being created by T-Mobile USA as part of its wireless sponsorship with Major League Baseball was announced Tuesday at the International Consumer Electronics Show in Las Vegas.


 “This is baseball’s continued push into the digital age,” said Tim Brosnan, Major League Baseball’s executive vice president for business. “It’s also about a very aggressive wireless provider that sought us out to create this unique communications platform.”


Baseball had not thought of a dugout-to-bullpen phone system in its talks with various wireless providers about a national sponsorship over the past decade, Brosnan said.


The wireless system will be tested at the World Baseball Classic in Arizona in March. After assessing how it works and fixing any problems, baseball will roll it out in the major leagues. Whether each stadium will have it in 2013 has not been determined.


T-Mobile’s sponsorship plans also include enhancing network connectivity for fans at all ballparks and helping MLB Advanced Media create content for smartphones and tablets.


To create the dugout-to-bullpen communications system, each ballpark will get the equivalent of a small cellular system with a miniature cell tower.


But while wireless companies like T-Mobile are continuously trying to broaden their national coverage territory, the dugout-to-bullpen system will have limits enforced by a technology called geo-fencing. So, managers and pitching coaches will not be able to chat with the bullpen coach from the pitcher’s mound. And bullpen coaches cannot ask, “Can you hear me now?” once they leave the bullpen’s environs.


“The guidance we’ve been given is that we shouldn’t fundamentally change what makes baseball baseball,” said Mark McDiarmid, T-Mobile’s vice president for engineering. “There is reason to be cautious about how far the coach could move away from the dugout before the umpires might think it’s inappropriate.”


Baseball is not shifting to cellphones because of an incident during the eighth inning of Game 5 of the 2011 World Series when the noise at Rangers Ballpark in Arlington caused Derek Lilliquist, the Cardinals’ bullpen coach, to misunderstand Manager Tony La Russa’s instructions about which relievers should start warming up.


Twice, La Russa asked that Jason Motte get up. Lilliquist apparently did not hear the first request. When La Russa called again to get Motte ready, Lilliquist thought he was asking for Lance Lynn. The miscommunication led to La Russa’s surprise when he summoned a right-hander and Lynn arrived at the mound, not Motte. Lynn stayed in long enough to issue an intentional walk; Motte quickly got ready and replaced him.


Lilliquist might well have heard La Russa’s instructions if they had used the cellphone system, with multiple microphones, noise mitigation and the ability to raise audio levels.


 Given T-Mobile’s investment over the next three years, it is not surprising that each dugout’s branded cellphone docking station — about the size of a personal computer tower — will be about as visible to TV cameras as the Gatorade vessel is.


But, Brosnan said, baseball has not ordained the obvious commercial tie-in: that each call to the bullpen on Fox, ESPN and TBS’s national telecasts be sponsored by T-Mobile.


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Three Kurdish Activists Killed in Central Paris


Thomas Samson/Agence France-Presse — Getty Images


Members of the Kurdish community in France protested on Thursday near the institute in Paris where three Kurdish women were found killed.







PARIS — Three Kurdish women, including a founding member of a leading militant group fighting for autonomy in Turkey, were shot to death at a Kurdish institute in central Paris, police officials said on Thursday, potentially jeopardizing efforts to negotiate a cease-fire in the decades-old conflict.




News reports identified the women as Sakine Cansiz, a founder of the Kurdistan Workers’ Party, known by the initials P.K.K. , Fidan Dogan, the head of the institute and a representative of the Kurdistan National Committee, and Leyla Soylemez, a youthful Kurdish activist.


The women’s bodies were discovered shortly before 2 a.m. on Thursday, according to Agnès Thibault-Lecuivre, a spokeswoman for the Paris prosecutor’s office, adding that the antiterror department of the prosecutor’s office will oversee the investigation. She confirmed that Ms. Dogan, born in 1984, and Ms. Soylemez, born in 1988, were victims in the killings, but declined to confirm the identity of the third woman.


“No hypothesis can be excluded at this stage” about the motive for the killing, she said.


Visiting the crime scene on Thursday, Interior Minister Manuel Valls called the shootings “intolerable” and said they were “without doubt an execution.” The violence at the Kurdish Institute of Paris, in the city’s 10th district near the Gare du Nord railroad station, seemed to open a new chapter in the often murky annals of Kurdish exile life.


In recent years, Turkey has sought to clamp down on the activities of Kurdish activists outside of Turkey. Sizable exile communities in France, Germany, Belgium and Denmark have established civic and media organizations that Kurdish officials say are a refuge from Turkish censorship.


Turkey has accused some of the institutions of being fronts for separatist activities or terrorism.


Analysts in Turkey argued that it seemed to be no coincidence that the killings had come just days after reports of the peace negotiations involving Abdullah Ocalan, the imprisoned leader of the P.K.K. who was incarcerated in 1999 in a fortresslike prison on the western Turkish island of Imrali.


While Kurdish militants blamed Turkey for the shootings in Paris, Turkish officials said the women could have been killed because of feuding within the P.K.K.


Huseyin Celik, the deputy chairman of the ruling party in Turkey, said the episode seemed to be part of an internal dispute but offered no evidence to support the claim.


“Whenever in Turkey we reach the stage of saying ‘friend, give up this business, let the weapons be silent,’ whenever a determination emerges on this, such incidents happen,” Mr. Celik told reporters in Ankara. “Is there one P.K.K.? I’m not sure of that.”


French police officials said a murder investigation had been opened. The bodies and three shell casings were found in a room at the institute. The women were all said to hold Turkish passports.


The P.K.K. has been fighting a bitter guerrilla war against the Turkish authorities for almost three decades to reinforce demands for greater autonomy. The conflict, which has claimed some 40,000 lives, is fueled by competing notions of national identity rooted in the founding of modern Turkey by Mustafa Kemal Ataturk in 1923 on the ruins of the Ottoman Empire.


Turkey, the United States and the European Union have labeled the P.K.K. a terrorist organization, but sympathy for the group and its goals remains widespread in many towns in Turkey’s rugged southeast.


Restive Kurdish minorities span a broad region embracing areas of Turkey, Syria, Iraq, Iran and parts of the former Soviet Union. Regional turmoil in recent years has emboldened Kurdish separatists inspired by the example of Iraqi Kurds who control an autonomous zone. Turkey also fears that the civil war in neighboring Syria could strengthen the separatist yearnings of Kurds there, feeding Kurdish activism in Turkey.


The killings, which apparently took place Wednesday, inspired hundreds of Kurdish exiles to gather outside the institute on Thursday, chanting “We are all P.K.K.!” and accusing Turkey of assassinating the three women, abetted by the French president, François Hollande.


The bodies were first discovered in the early hours of Thursday by Kurdish exiles who had become concerned about the whereabouts of the women.


The victims had been alone in the building on Wednesday and could not be reached by telephone in the late afternoon, according to Leon Edart, who manages the center. Mr. Edart, speaking to French reporters, suggested the victims may have opened the door to their killer or killers.


Dan Bilefsky reported from Paris, Alan Cowell from London, and Sebnem Arsu from Istanbul. Scott Sayare contributed reporting from Paris.



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Analysts Skeptical as Majority Owner Takes Role as Chief Executive of Sears


Elise Amendola/Associated Press


A Sears in Peabody, Mass.







Just hours after a board discussion on Monday, a note went out to Sears Holdings employees from Edward S. Lampert, the company’s majority owner and chairman, that he would now be its chief executive.




“I believe in our company,” Mr. Lampert wrote.


But not everyone shares his optimism.


Seven years after he engineered the merger of Sears and Kmart, Mr. Lampert’s plans for the company face a new round of skepticism.


On Monday, Sears announced that its chief executive of two years, Louis J. D’Ambrosio, would be stepping aside because of a health issue in his family and that Mr. Lampert would assume the role. Despite the unexpected departure, Sears is not expected to change course.


“The reality is, Eddie’s been running the company the whole time,” said Gary Balter, an analyst at Credit Suisse.


Mr. Lampert once stepped back from day-to-day management, but more recently he has increased involvement in Sears as he has scaled back his influence on other investments. He maintains an office at Sears headquarters in Hoffman Estates, Ill., although he lives on the East Coast.


If employees “wanted to make merchandising decisions, they had to fly up to Connecticut to get approval from Eddie. He was making day-to-day decisions in this company, and clearly he’s making the capital decisions,” Mr. Balter said.


But Mr. Lampert is a money man, not a merchant, and analysts question his plans for reviving Sears, which has faltered since he combined Sears and Kmart. It has valuable assets, they say, but sales and profitability continue to slide. In his most recent chairman’s letter, Mr. Lampert outlined some ways he wanted to take Sears forward, including building on its loyalty program and expanding what he called “integrated” options — allowing shoppers to buy online, in stores, via mobile devices or a combination. He highlighted Sears’s liquidity options and its ownership of and access to cash from Lands’ End, the clothing retailer Sears bought in 2002, and its real estate, “should the circumstances warrant.” He further wrote, “We do not expect to utilize or execute all of these options,” but he said he wanted to reassure vendors.


“If you’re unwilling to try new things, and to fail and learn, you don’t have a shot,” Mr. Lampert said in an interview last year. “That doesn’t mean you’re going to be successful, but you have to try to change.”


Mr. Lampert’s new role as chief executive of a struggling company is a new one for him.


When he was younger, Mr. Lampert made a name for himself with his fast rise through the ranks at Goldman Sachs, his brash courtship of Wall Street idols like Richard Rainwater and Robert Rubin and, when he started his investment fund ESL Investments in 1988, the high returns at the fund. He invested in struggling retailers like AutoNation and AutoZone in the 1990s and early 2000s, then bought a controlling stake in Kmart when it was in bankruptcy. In 2005, he completed the merger with Sears.


And, adding some Hollywood flair to the story line, after being kidnapped at gunpoint from a parking garage in 2003, Mr. Lampert, after being held for about 30 hours, managed to negotiate his own release.


Fortune called the billionaire “the best investor of his generation.” Bloomberg Businessweek asked if he was “The Next Warren Buffett?”


But Sears value has declined since then. His initial idea was to combine the best of Sears and Kmart and sell some appealing locations to competitors. But the recession meant the real estate was no longer in demand, and now many large retailers are downsizing or closing stores.


As the real estate options diminished, Sears was losing sales. The people Mr. Lampert hired to run the company were not retailers, and instead had backgrounds in fast food, supply chains and technology.


Sears’s sales have declined for five straight years, and its market capitalization now is 15 percent of what it was at the beginning of 2006. In the third quarter, the company lost $498 million, up from $410 million for the same quarter in 2011. Sales fell by $548 million, to $8.9 billion.


In the last year, Mr. Lampert has directed a cleanup of the balance sheet. He sold some valuable real estate, spun off business units and reduced inventory to assuage liquidity concerns after a dismal 2011 holiday sales season.


This year, it spun off a profitable hardware retail division and part of its stake in Sears Canada.


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Gaps Seen in Therapy for Suicidal Teenagers





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 youths, according to the largest in-depth analysis to date of suicidal behaviors in American teenagers.




The study, in 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.


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 like attention-deficit and eating disorders, as well as alcohol and drug abuse.


The study found that about one in eight teenagers had persistent suicidal thoughts at some point, and that about a third of those who had suicidal thoughts had made an 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, experts 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 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,” Dr. Nock said. His co-authors included Ronald C. Kessler of Harvard and researchers from Boston University and Children’s Hospital Boston.


Margaret McConnell, a consultant in Alexandria, Va., said 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,” Ms. 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 from the ages of 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. Among girls, 5 percent made suicide plans and 6 percent made at least one attempt (some were unplanned).


Among boys, 3 percent made plans and 2 percent carried out attempts, which tended to be more lethal than girls’ attempts.


(Suicidal thinking or behavior was virtually unheard-of before age 10.)


Over all, 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. Those with an added behavior problem — attention-deficit disorder, substance abuse, explosive anger — were more likely to act on thoughts of self-harm, the study found.


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 they 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 suicide attempts in, among others, people with borderline personality disorder, who are highly prone to self-harm.


But suicidal teenagers who have a mixture of mood and behavior issues are difficult to reach. In one 2011 study, researchers at George Mason University reduced suicide attempts, hospitalizations, drinking and drug use among suicidal adolescent substance abusers. The study found that a combination of intensive treatments — talk therapy for mood problems, family-based therapy for behavior issues and patient-led reduction in drug use — was more effective than regular therapies.


“But that’s just one study, and it’s small,” said Dr. Brent of the University of Pittsburgh. “We can treat components of the overall problem, but that’s about all.”


Ms. McConnell said that her daughter’s depression had seemed mild and that there was no warning that she would take her life. “I think therapy does help a lot of people, if it’s handled right,” she said.


Read More..

Gaps Seen in Therapy for Suicidal Teenagers





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 youths, according to the largest in-depth analysis to date of suicidal behaviors in American teenagers.




The study, in 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.


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 like attention-deficit and eating disorders, as well as alcohol and drug abuse.


The study found that about one in eight teenagers had persistent suicidal thoughts at some point, and that about a third of those who had suicidal thoughts had made an 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, experts 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 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,” Dr. Nock said. His co-authors included Ronald C. Kessler of Harvard and researchers from Boston University and Children’s Hospital Boston.


Margaret McConnell, a consultant in Alexandria, Va., said 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,” Ms. 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 from the ages of 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. Among girls, 5 percent made suicide plans and 6 percent made at least one attempt (some were unplanned).


Among boys, 3 percent made plans and 2 percent carried out attempts, which tended to be more lethal than girls’ attempts.


(Suicidal thinking or behavior was virtually unheard-of before age 10.)


Over all, 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. Those with an added behavior problem — attention-deficit disorder, substance abuse, explosive anger — were more likely to act on thoughts of self-harm, the study found.


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 they 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 suicide attempts in, among others, people with borderline personality disorder, who are highly prone to self-harm.


But suicidal teenagers who have a mixture of mood and behavior issues are difficult to reach. In one 2011 study, researchers at George Mason University reduced suicide attempts, hospitalizations, drinking and drug use among suicidal adolescent substance abusers. The study found that a combination of intensive treatments — talk therapy for mood problems, family-based therapy for behavior issues and patient-led reduction in drug use — was more effective than regular therapies.


“But that’s just one study, and it’s small,” said Dr. Brent of the University of Pittsburgh. “We can treat components of the overall problem, but that’s about all.”


Ms. McConnell said that her daughter’s depression had seemed mild and that there was no warning that she would take her life. “I think therapy does help a lot of people, if it’s handled right,” she said.


Read More..