Study highlights factors behind rising rates of child suicide

Author: Mark Gould

Around eight in every 100 children aged 9–10 years in the USA report suicidal ideation – such as temporarily or regularly thinking about, considering, or planning suicide, according to a new study*.

Suicide is the second leading cause of death in 10–14-year-olds in the USA, and the number of children’s hospital admissions for suicidal thoughts or self-harm has more than doubled over the last decade, increasing from 0.67% in 2008 to 1.79% in 2015.

However, suicidal thoughts and behaviours among children have to date received comparatively little attention compared to older age groups.

The new study of almost 8,000 children aged 9-10 years in the USA, published in The Lancet Psychiatry, and the largest of its kind in the USA, identifies important risk and protective factors associated with childhood suicidal ideation which researchers say could be used to identify vulnerable children and plan interventions to promote mental health in school and at home.

Importantly, less than two in every 100 children aged 9–10 years reported a suicide attempt in the study, and around one in 100 had past or current suicidal plans.

The researchers based their findings on data from children taking part in the Adolescent Brain Cognitive Development (ABCD) study—which is following the largest nationally representative sample of 9–10-year-olds in the USA.

To measure suicidal ideation, caregivers and children were independently asked about current wellbeing and suicidal history as well as personal, family, and social characteristics using questionnaires.

Modelling was used to quantify the association between suicidal ideation and a wide array of personal, family, and social characteristics in children who had caregiver-reported or child-reported experiences of suicidal ideation, and those who had never expressed suicidal thoughts or behaviours according to caregiver and self-reports.

Although suicide planning and suicide attempts are relatively rare, the researchers found that factors associated with an increase in risk of suicidal thoughts included psychological problems and exposure to child-reported family conflict.

Children, and particularly boys, who experienced suicidal ideation also reported on average spending around an hour longer using screen-based devices at weekends. However, the authors caution that more research is needed to understand whether the relationship between screen time and suicide ideation is causal (e.g. the result of increased exposure to cyberbullying or negative social comparisons) or correlative (e.g. linked with social withdrawal or avoidance). .
Greater parental supervision (i.e. knowing where children are, what they are doing, and with whom) and a child’s positive view of school (i.e. children who liked going to school) were identified as having a strong protective effect against suicide ideation, possibly because they can aid the development of identity, self-esteem, and resilience.

Importantly, the researchers only noted agreement between caregiver and child reports of suicide ideation in 17% of cases (198/1,140 children), indicating that suicidal thoughts and behaviours in children cannot be reliably assessed by parental report alone.

“While a minority of 9–10-year-olds express suicidal thoughts, the robust associations shown in this study with psychological problems (mostly anxiety and depressive problems) and family conflict provide practitioners with important information as to how they can intervene to help children and their families,” says Dr Sophia Frangou from Icahn School of Medicine at Mount Sinai, USA, who co-led the research.

“The same applies to the protective influences which involve higher parental supervision (i.e, knowing where children are, what they are doing, and with whom) and positive school engagement, which are actionable and modifiable.”

She continues: “Although the best way of offering support to children is unclear, current evidence suggests that school-based programmes which aim to increase awareness, like the Mental Health Packs for Schools initiative in the UK, are likely to be successful public health interventions for reducing both suicidal behaviours and suicidal ideation.”

Writing in a linked comment**, lead author Dr Rory O’Connor from the University of Glasgow, UK, says, “If we are to develop effective suicide prevention interventions, it is essential that we identify and target these childhood risks. In particular, greater effort to protect children from early life adverse experiences is vital, given that family conflict was associated with between a 30% and 75% increased risk of suicidality, even when taking into account the effect of psychopathology… A key focus for future research should be factors that facilitate as well as impede the transition from suicidal thoughts to acts of suicide.”

*Janiri D, Doucet GE, Pompili M, et al. Risk and protective factors for childhood suicidality: a US population-based study. The Lancet Psychiatry, 12 March 2020. DOI: 10.1016/S2215-0366(20)30049-3

**O’Connor RC and Robb KA. Identifying suicide risk factors in children is essential for developing effective prevention interventions. The Lancet Psychiatry, 12 March 2020. DOI: 10.1016/S2215-0366(20)30094-8