Summary: Findings show suicidal thoughts can begin in children as young as nine years of age. Family conflict and parental monitoring are significant predictors of suicidal thoughts in children.
Death by suicide in children has reached a 30-year high in the United States. During middle and high school, 10 to 15% of kids have thoughts of suicide, according to the Centers for Disease Control and Prevention.
How early in a child’s life do these thoughts begin? New research from Washington University in St. Louis is narrowing the gap in psychology’s understanding of suicidal thoughts in young people, the findings show that such thoughts begin as early as 9 and 10 years old.
Further, family conflict and parental monitoring are significant predictors of suicidal thoughts, and the majority of children surveyed had caregivers who either didn’t know, or didn’t report, the suicidal thoughts of the children in their charge.
“There’s already been press about suicidal ideation in teenagers,” said Deanna Barch, chair and professor of Psychological & Brain Sciences in Arts & Sciences and professor of radiology in the School of Medicine “But there’s almost no data about rates of suicidal ideation in this age range in a large population sample.”
The results were published in the JAMA Network Open.
The study, conducted by Barch and Diana Whalen, PhD, psychiatry instructor at the School of Medicine, as well as colleagues at the Laureate Institute for Brain Science, looked at 11,814 9- and 10-year-olds from the Adolescent Brain Cognitive Development (ABCD) study, a national, longitudinal study on adolescent brain health in which caretakers also participate.
Dividing suicidal thoughts and actions into several categories, researchers found that 2.4 to 6.2% of the children reported having thoughts about suicide, from wishing they were dead to devising — but not carrying out — a plan.
When it came to actions, they saw 0.9% of these 9- and -10-year-olds said they had tried to commit suicide; 9.1% reported non-suicidal self-injury.
Going into this study, Barch said she did not know what to expect, but she did expect to see nontrivial amounts of suicidal thoughts in this age group.
“There were two reasons I was sure,” she said. “When you look at the CDC rate of kids in middle and high school who have these thoughts, it’s pretty high. It’s clear that they weren’t arising out of the blue.”
The second reason she was prepared: In previous work, she had already seen suicidal thoughts in preschoolers.
Also of note are some discrepancies seen between males and females. Specifically, males showed more suicidal thoughts and more non-suicidal self-injury than the girls; these trends reverse as people age, studies show.
“We don’t really know why ,” Barch said. “By the time adolescence hits, the rates go up for everyone, but they go up disproportionately for girls. The discrepancy was completely unexpected.”
Another group that may have found the results unexpected: caregivers.
This is the age when kids and their caregivers generally tend to give different reports of internal experiences, Barch said, but still, the disconnect between self-reports of suicidal thoughts and caregivers’ reports of their kids’ thoughts diverged widely. In more than 75% of cases where children self-reported suicidal thoughts or behaviors, the caregivers did not know about the child’s experience.
The nature of the ABCD study, following the children over time, will allow researchers to tease out this apparent contradiction. “One question is going to be whether one of those reports” — that of the child or the caregiver — “is more predictive than the other of how the kids do over time,” Barch said.
In fact, caregivers seem to play an important role when it comes to suicidal thoughts and behaviors in this young age group. After adjusting for sex, family history, and other variables, family conflict was a predictor of suicidal thoughts and non-suicidal self-injury. Monitoring by a caretaker was also predictive of those measures, as well as suicide attempts.
Historically, the belief has been that people don’t need to ask kids about suicidal thoughts before adolescence, Barch said. “Our data suggests that’s absolutely not true. Kids are having these thoughts. They’re not at the same rates as adults, but they are nontrivial.”
She suggested parents, caregivers and people working with children should be aware of the possibility that a 9-year-old is thinking about suicide.
“If you have kids who are distressed in some way, you should be asking about this,” she said. “You can help identify kids that might be in trouble.”
Prevalence and Family-Related Factors Associated With Suicidal Ideation, Suicide Attempts, and Self-injury in Children Aged 9 to 10 Years
Importance Although suicide is a leading cause of death for children in the United States, and the rate of suicide in childhood has steadily increased, little is known about suicidal ideation and behaviors in children.
Objective To assess the overall prevalence of suicidal ideation, suicide attempts, and nonsuicidal self-injury, as well as family-related factors associated with suicidality and self-injury among preadolescent children.
Design, Setting, and Participants Cross-sectional study using retrospective analysis of the baseline sample from the Adolescent Brain Cognitive Development (ABCD) study. This multicenter investigation used an epidemiologically informed school-based recruitment strategy, with consideration of the demographic composition of the 21 ABCD sites and the United States as a whole. The sample included children aged 9 to 10 years and their caregivers.
Main Outcomes and Measures Lifetime suicidal ideation, suicide attempts, and nonsuicidal self-injury as reported by children and their caregivers in a computerized version of the Kiddie Schedule for Affective Disorders and Schizophrenia.
Results A total of 11 814 children aged 9 to 10 years (47.8% girls; 52.0% white) and their caregivers were included. After poststratification sociodemographic weighting, the approximate prevalence rates were 6.4% (95% CI, 5.7%-7.3%) for lifetime history of passive suicidal ideation; 4.4% (95% CI, 3.9%-5.0%) for nonspecific active suicidal ideation; 2.4% (95% CI, 2.1%-2.7%) for active ideation with method, intent, or plan; 1.3% (95% CI, 1.0%-1.6%) for suicide attempts; and 9.1% (95% CI, 8.1-10.3) for nonsuicidal self-injury. After covarying by sex, family history, internalizing and externalizing problems, and relevant psychosocial variables, high family conflict was significantly associated with suicidal ideation (odds ratio [OR], 1.12; 95% CI, 1.07-1.16) and nonsuicidal self-injury (OR, 1.09; 95% CI, 1.05-1.14), and low parental monitoring was significantly associated with ideation (OR, 0.97; 95% CI, 0.95-0.98), attempts (OR, 0.91; 95% CI, 0.86-0.97), and nonsuicidal self-injury (OR, 0.95; 95% CI, 0.93-0.98); these findings were consistent after internal replication. Most of children’s reports of suicidality and self-injury were either unknown or not reported by their caregivers.
Conclusions and Relevance This study demonstrates the association of family factors, including high family conflict and low parental monitoring, with suicidality and self-injury in children. Future research and ongoing prevention and intervention efforts may benefit from the examination of family factors.