Suicidal ideation seen in 8 percent of kids says study

By Dr. Ananya Mandal, MDMar 15 2020

According to an alarming new report from the American researchers, 8.4 percent of the children aged between 9 and 10 years are temporarily or regularly thinking about suicide or considering and planning suicide. This study that included 7,994 children was titled, "Risk and protective factors for childhood suicidality: A US population-based study" and was published in the latest issue of The Lancet Psychiatry journal.

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What was the study about?

There has been very little evidence looking at suicidal ideation among children who wrote the researchers. The researchers and experts state that among 10 to 14-year-olds in the United States, suicide is the second leading cause of death. There has been a two-fold rise in the number of children presenting in the hospitals for suicidal behavior or self-harm over the last decade (0.67 percent in 2008 and 1.79 percent in 2015), they wrote.

For this study, the children who were part of the Adolescent Brain and Cognitive Development (ABCD) study were examined to look for suicidal ideation and behaviors. The ABCD study, in general, is a significant mental health study that traces the mental health of children through their adolescence and adulthood. The study looks at not only mental and physical well being but also behavioral and cognitive changes seen in the children as they grow in different social and family environments, explained the researchers. The study was funded by the National Institutes of Health.

What was done in this study?

For this study, the children enrolled in the ABCD study were examined, and their risk and protective factors regarding suicidal planning, ideation, and behaviors were looked at and evaluated. Both self and caregiver statements were taken into consideration.

The total ABCD cohort consists of 11,875 children aged between 9 and 10 years. The children belong to both gender, different races, socio-economic backgrounds, and also different urban cities. They were recruited from 22 different locations or sites. The children were a representative sample from 20 percent of the entire American population aged between 9 and 10 years, wrote the researchers.

The data gathered from the cohort was accessed by the ABCD Study Curated Annual Release 2.0. To assess suicidality or suicidal thoughts and behaviors, each of the children of the group was examined via reports given by themselves as well as their caregivers. These reports were based on the computerized Kiddie Schedule for Affective Disorders and Schizophrenia for DSM-5 (KSADS-5), wrote the researchers. The measures of physical and mental health, behaviors, cognitive abilities, social and family environments were correlated with suicidal ideation and suicidal behaviors of the children using logistic regression.

What was found?

The study sample comprised a total of 7,994 children of an average age of 9.9 years. None of the children were related to each other. Of these, there was 53 percent of boys and rest girls. Results from self-reports of the children showed:

• There was present or past suicidal ideation among 673 children (8.4 percent)

• Past or present suicidal attempts were noted in 107 children (1.3 percent)

• Past or present suicidal plans were found among 75 children (0.9 percent)

Results from caregiver reports showed:

• Past or present suicidal ideation was seen in 650 or 8.1 percent children

• Past or present suicidal attempts were noted in 39 children (0.5 percent)

• Past or present suicidal plans were found among 46 children (0.6 percent)

The team next looked at the agreement between reports from the children and their caregivers and found that the agreement between the two was low. There was a high association between psychopathology or psychiatric illness among the child and the suicidal ideation.

A similar high association between a "child-reported family conflict" and suicidality among the child was noted.

A higher amount of weekend screen time was associated with greater child-reported suicidality, the researchers noted. When there were more parental supervision and positive involvement of the school, the suicidality was found to be reduced. According to caregiver reports, boys were more at risk of suicidality, and caregiver educational level was also associated with suicidality among the children. From the caregiver accounts, as the number of members within the residence cohabiting with the child rose, the risk of suicidality among the child decreased.

Dr. Sophia Frangou from Icahn School of Medicine at Mount Sinai, USA, co-leader of the study said, "While a minority (around 8%) 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.

The same applies to the protective influences which involve higher parental supervision (ie, knowing where children are, what they are doing, and with whom) and positive school engagement, which are actionable and modifiable." She added, "Although the best way of offering support to children is unclear, current evidence suggests that school-based programs 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 behaviors and suicidal ideation."

Conclusions and implications

The team of researchers outlined the risk factors as well as the protective factors associated with suicidality, suicidal ideation, and planning among children aged between 9 and 10 years. They wrote, "These factors provide actionable targets for optimizing prevention and intervention strategies, support the need to identify and treat psychopathology in school-age children, and underscore the importance of school and family interventions for childhood suicidality."

Dr. Beatriz Luna from the University of Pittsburgh, USA, author of the study said in her statement, "Fears of stigmatization, communication difficulties, and lack of social and family support may mean young children feel less comfortable talking about their mental health. This disconnect underscores the need for a separate and independent assessment of suicide risk in children and parents."

Additional commentary from Dr. Rory O'Connor from the University of Glasgow, UK, stated, "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."