Trajectories of Suicidal Thoughts and Behaviors From Preschool Through Late Adolescence

Dampened positive emotion and a PTSD diagnosis are related to suicidal thoughts and behavior in young children receiving intensive psychiatric care

OBJECTIVE

This study examined the prevalence of suicidal thoughts and behavior (STB), as well as clinical characteristics, emotional responsiveness, as well as executive functioning and death understanding, in young children receiving intensive psychiatric treatment.

METHOD

Ninety children, 4 to 7 years of age in a Pediatric Partial Hospital Program (PPHP), were studied. A diagnosis of autism or a significant language delay were exclusion citeria. Most children were male (74 %) and White (63 %); 8 % were Black, and 26 % were multiracial or endorsed other races;18 % were Latine. Caregivers completed diagnostic interviews about their child as well as psychiatric history screening and measures of their own depression and STB. Children were administered lab tasks tapping cognitive and emotional risk factors as well as a death understanding interview.

RESULTS

Approximately 44 % of children had a history of STB, as reported by a caregiver. Both MDD and PTSD were associated with increased rates of STB in univariate analyses but neither ODD or ADHD differentiated the groups. Preschoolers with a history of STB demonstrated a greater understanding of death and dampened positive emotion in interactive play compared to those without a history of STB. In multivariate analyses, older age, a PTSD diagnosis, and dampened positive emotion differentiated children with a history of STB from those without a history of STB.

CONCLUSION

Continued refinement of the clinical assessment of STB in young children referred for mental health care is important given the high rates of STB found in this study. A PTSD diagnosis appears especially important to consider in understanding STB in this age group as is the child's ability to experience positive emotion.

Intersectional marginalized identities as predictors of time until first reported suicide attempt among preadolescent youth using survival analysis

BACKGROUND

Suicide attempts and deaths among children are increasing in the United States, yet suicide in this preadolescent population remains understudied. A clearer understanding of which youth experience early onset of suicidal behavior is crucial for predicting risk and identifying youth best suited to early intervention. This paper examines how intersectional marginalized identities may predict the onset of suicidal behaviors among preadolescent youth.

METHODS

The Adolescent Brain and Cognitive Development (ABCD) Study is a prospective cohort study with annual assessments of youth ages 9 and 10 and their caregivers. Lifetime suicide attempts and preparatory suicidal behaviors were assessed annually. Survival models examined overall trends and demographic differences in the onset of suicidal behaviors.

RESULTS

The final sample included 11,223 participants (mean age = 9.9 years old, SD = 7.5 months). 5,280 (47%) reported a minoritized racial/ethnic identity, and 1,410 (12.6%) were categorized as sexual or gender minorities. 208 suicide attempts and 143 instances of preparatory suicidal behaviors were reported across the study period. An interaction effect was found such that youth who hold multiple minoritized identities (i.e., sexual and gender minority youth from minoritized racial/ethnic backgrounds) were at elevated risk for onset of both suicide attempts (HR = 2.97, 95% CI = 1.59-5.56, p = .001) and preparatory suicidal behaviors (b = 3.09, 95% CI = 1.38-6.93, p = .006).

CONCLUSIONS

Intersectional marginalized identities were associated with earlier onset of suicide attempts and preparatory suicidal behaviors. Findings suggest that early interventions for minoritized youth may be important to reduce the rapidly increasing suicide rate among preadolescent youth.

A network and mediation analysis on the associations between family environment and suicidal ideation in adolescents in a psychiatric clinical setting

Background

Family environmental factors are known to contribute to adolescent suicidal ideation (SI), but how these factors interact and relate to SI needs further investigation.

Aims

To examine how family factors interact with each other and are associated with adolescent SI in a psychiatric clinical setting, using network analysis with regularization methods.

Method

Utilizing a quantitative research design, this study analyzed data from 293 adolescents aged 12 to 18 years seeking care in a psychiatric hospital. Data collection involved standardized interviews and self-report measures to assess SI, anxiety, depression, and various family environmental factors. Network analysis with regularization methods, including LASSO regression, was employed to elucidate the relationships among these variables.

Results

Over 40% of adolescents reported SI, with positive relationship quality(RQ) significantly reducing SI. Network analysis indicated that family economic status did not directly relate to SI but through RQ. Additionally, anxiety was found to mediate the relationship between RQ and SI significantly, with a mediation effect of 53.34%. Parental marital status directly related to SI, whereas parental education level, particularly mothers', was not directly associated with SI or other mental health outcomes.

Conclusions

This study reveals the complex interplay between family environmental factors and psychiatric symptoms in adolescents, highlighting family relationship quality as a critical risk mechanism. These findings underscore the importance of family-centered interventions and public mental health policies to reduce suicidal ideation in adolescents.

Association between auditory P300 event-related potential and suicidal thoughts and behaviors in first-episode antipsychotic-naïve patients with schizophrenia

OBJECTIVE

Suicidal thoughts and behaviors (STBs) are critical concern in schizophrenia (SZ). Concurrent changes in event-related potential (ERP), particularly the P300 (P3) components, have been observed in SZ patients, but the association between these changes and STBs remains unclear. This study aims to explore the relationships between P3 components and STBs in first-episode antipsychotic-naïve SZ (FEAN-SZ) patients.

METHODS

The study included 321 FEAN-SZ patients and 146 healthy controls (HC). Sociodemographic data, clinical assessments, and ERP P3 components (N1, P3a, and P3b) were collected. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS), while depressive symptoms were evaluated with the Hamilton Depression Scale (HAMD).

RESULTS

Compared to HC, FEAN-SZ patients exhibited lower N1 and P3 amplitudes and longer latencies (all ps < 0.001). Patients with STBs exhibited higher scores on negative, general psychopathology, PANSS total and HAMD, decreased N1 and P3a amplitudes, as well as prolonged P3a and P3b latencies compared to those without STBs (all ps < 0.001). The P3a latency predicted the general psychopathology scores (β = 0.103, p < 0.001), and the N1 amplitude predicted the HAMD scores (β = -1.057, p = 0.001), both exclusively within the STBs group. Logistic regression analysis identified that N1 amplitude (Beta = -0.132, p = 0.018, OR = 1.02, 95%CI = 1.01-1.04) and HAMD scores (Beta = 0.068, p = 0.001, OR = 1.07, 95%CI = 1.03-1.11) as independent predictors of STBs in FEAN-SZ patients. Combining these variables yielded an area under the receiver operating characteristic (AUCROC) curve of 0.840 for distinguishing between patients with and without STBs.

CONCLUSIONS

FEAN-SZ patients with STBs have lower P3 amplitude and longer latency. The N1 amplitude and depressive levels are associated with STBs in FEAN-SZ patients. The N1 amplitude may serve as an early biological marker for STBs in SZ patients.

Preschool-Onset Major Depressive Disorder as a Strong Predictor of Suicidal Ideation and Behaviors Into Preadolescence

OBJECTIVE

Suicidal thoughts and behaviors (STBs) in children are an escalating public health concern. This study focused on 1 understudied candidate risk factor, namely, preschool-onset major depressive disorder (PO-MDD), as a predictor of persistent and emerging STBs from early childhood into preadolescence.

METHOD

Participants were 137 children 8 to 12 years of age who met criteria for PO-MDD when they were 3 to 6 years of age, and a nondepressed sample of 53 age-, income-, and sex-matched peers. STBs were reported by caregivers (preschool, preadolescence) and children (preadolescence) using age-appropriate diagnostic interviews.

RESULTS

By preadolescence, children who had PO-MDD were 7.38 times more likely than their peers to have endorsed STBs after early childhood (p < .001; 67.9% vs 22.6%), including 6.71 times more likely to have engaged in suicide behaviors/attempts (p = .012; 21.9% vs 3.8%); they were also 8.98 times more likely to have endorsed STBs over the prior month (p = .005; 26.3% vs 3.8%). Similar findings emerged when limiting the PO-MDD group to children without preschool STBs, and when controlling for externalizing comorbidities, implicating PO-MDD as a unique diagnostic predictive risk factor. However, children who had PO-MDD with STBs were 3.46 times more likely than children who had PO-MDD without STBs to endorse later STBs (p = .018; 83.1% vs 54.2%), indicating substantial continuity of preschool STBs alongside strikingly high rates of emerging STBs into preadolescence.

PLAIN LANGUAGE SUMMARY

This longitudinal study explores preschool onset major depressive disorder (PO-MDD) as a predictor of having suicidal thoughts or attempting suicide by age 12. 137 children aged 8 to 12 years who met criteria for PO-MDD when they were 3 to 6 years of age and 53 non-depressed peers were included in the study. The study found that preadolescents who had experienced preschool-onset depression were 6.14 times more likely to experience active suicidal thoughts and 8.03 times more likely to have made a suicide attempt by age 12 when compared to preadolescents who did not experience preschool depression. Results suggest that children with preschool-onset depression would likely benefit from increased suicide screening, proactive safety planning and early interventions.

CONCLUSION

PO-MDD is a strong risk factor for the emergence and persistence of STBs into preadolescence. Children with PO-MDD would likely benefit from increased suicide screening, proactive safety planning, and early interventions.

Maternal suicide risk predicts preschooler emotional and behavioral problems

Maternal history of suicidal thoughts and behaviors (STBs) has been identified as a robust risk factor for offspring emotional and behavioral problems, including risk for offspring STBs. The impact of maternal history of STBs has been well-documented in adolescent and young adult samples, with emerging research highlighting the need to examine early clinical correlates of risk in young children, prior to the emergence of STBs. In an extension of prior work, the current study examined associations between maternal history of STBs and previously identified emotional and behavioral correlates of STBs (negative affect, internalizing problems, attention problems, aggressive behavior) in young children. These associations were examined in a mother-preschooler sample (n = 158, mean preschooler age=41.52 months) with approximately half of mothers endorsing a history of STBs and 20 % of the sample scoring at the threshold that indicates suicide risk. In multivariate models, maternal history of STBs was significantly associated with preschooler aggressive behavior, assessed via mother- (β=0.19) and teacher-report (β=0.21), as well as mother-reported negative affect (β=0.22). Results document a link between maternal history of STBs and increased risk for heightened negative affect and aggressive behavior at home and school during the sensitive preschool period. Findings are discussed within the context of enhancing models of intergenerational transmission suicide risk.

Research, practice, and data informed investigations of child and youth suicide: A science to service and service to science approach

BACKGROUND

Suicide rates for children and adolescents have been increasing over the past 2 decades. In April 2023, the National Institute of Mental Health (NIMH) convened a two-day workshop to address child and youth suicide.

PURPOSE

The workshop focus was to discuss the state of the science and stimulate a collaborative response between researchers, death investigators, and data collection teams to build a science to service and service to science approach toward understanding - and ultimately preventing - this growing problem of child and youth suicide.

HIGHLIGHTS

Topics that meeting participants highlighted as worthy of further consideration for research and practice were: increasing awareness among death investigators, medical examiners, and coroners that child suicide deaths under age 10 years do occur and should be investigated and documented accordingly; emphasizing the value of science based protocols for child and youth death investigations to enhance consistency of approaches; and articulating needs for postvention services to suicide loss survivors.

OUTCOMES

The importance of collecting an accurate and complete cause and manner of death (i.e., unintentional, suicide, homicide, undetermined) among all child decedents, and demographic information such as race, ethnicity, and sexual/gender minority status was underscored as critical for enhanced surveillance. For prevention efforts, approaches to assessing and understanding suicidal thoughts and behaviors among diverse groups of children, and the variability in proximal and distal risk factors are needed to inform opportunities for preventive interventions for diverse communities. The need for consistent measures and processes to improve death investigations, fatality review committees, and coordination between data collection systems and agencies was also raised.

PRACTICAL APPLICATIONS

Collaborations among researchers, death investigators, and data collection teams can help to fully describe the child and youth suicide crisis and provide actionable information for new research, and prevention and response efforts.

Mental health of South Korean adolescents in the COVID-19 Era: Web-based survey focused on suicide-related factors

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has negatively impacted many aspects of life. Measures for preventing the spread of COVID-19 (e.g., school lockdowns, remote and hybrid classes, group and outdoor activity restrictions, and social distancing in the classroom and meal time) could have led to adolescents to experience anxiety and depressive symptoms. Such mental health impacts could increase the risk of suicidal ideation in this population. Moreover, according to a report by the Organization for Economic Co-operation and Development, although the total number of suicide deaths in South Korea decreased in 2021, the suicide rate of those aged 10-29 years increased. One factor affecting the result is adolescent mental health by COVID-19. This study examines the mental health status of South Korean adolescents amid the prolonged COVID-19 pandemic, and identifies and analyzes predictors of suicidal ideation, suicide planning, and suicide attempts.

METHODS

The study used data from 54,948 adolescents who participated in the 2020 Korea Youth Risk Behavior Web-based Survey. Based on their responses to suicide-related questions, the sample was divided into a healthy group, suicide-ideation group, suicide-planning group, and suicide-attempt group. The descriptive statistics of these groups were then analyzed. An analysis of covariance, post-hoc tests, and multiple logistic regression analysis were performed on the four groups.

RESULTS

Overall, 6.9% of the participants reported suicidal ideation, 2.2% reported planning suicide, and 1.9% reported attempting suicide in the previous 12 months.

CONCLUSIONS

During the prolonged COVID-19 pandemic, there is a strong need for various individualized programs that identify and intervene to support adolescents at risk of suicide by accurately assessing their mental health risk factors, such as stress, sadness and despair, loneliness, and generalized anxiety disorder. Accordingly, it is necessary to develop and distribute a mental health and well-being curriculum, strengthen suicide prevention programs and support services, expand mental health diagnostic tests, and school-based mental health programs.

Early childhood sleep problems predict increased risk for the later development of suicidal thoughts

Suicidal thoughts and behaviors in youth are an escalating and immediate public health concern. To better understand youth suicidal thoughts and behaviors, it is important to identify risk factors in early childhood that predict the later emergence of youth suicidal thoughts and behaviors. Research with adults and adolescents has identified sleep disturbances as a risk factor for suicidal thoughts and behaviors, but this has yet to be examined in early childhood. Using a prospective, 17-year longitudinal design, the current study explored the association between early childhood sleep disturbances and concurrent and later suicidal thoughts and behaviors (in separate models) across childhood and adolescence. Results indicate that sleep problems in early childhood are associated with increased probability for suicidal thoughts after age 8, even when controlling for prior and concurrent depression severity. Our findings suggest that early childhood sleep difficulties warrant increased clinical attention and management, as they may contribute to the maintenance and exacerbation of suicidal thoughts over time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Future Directions in Understanding and Interpreting Discrepant Reports of Suicidal Thoughts and Behaviors Among Youth

Both the quality and utility of youth suicide research depend on how we assess our outcomes of interest: suicidal thoughts and behaviors (STBs). We now have access to more STB assessments than ever before, with measures for youth that vary in what exact experiences are asked about, how such measures elicit information, when and how frequently measures are administered, and who the informants are. This growing armamentarium of assessments has the potential to improve the study and treatment of STBs among youth, but it hinges on meaningful interpretation of assessment responses. Interpretation can be especially challenging when different STB assessments yield conflicting information. Determining how to manage discrepant reports of STBs is a pivotal step toward achieving meaningfully comprehensive STB assessment batteries. Here, we outline several discrepant reporting patterns that have been detected, discuss the potential significance of these observed discrepancies, and present initial steps to formally investigate discrepant reports of STBs among youth. Developing coherent, interpretable, and comprehensive batteries assessing STBs among youth would address a fundamental step to uncovering etiology, improving clinical decision-making and case management, informing intervention development, and tracking prognosis.

Distinct trajectories of suicidal behaviors throughout the university stage and associated risk and protective factors: A large-scale prospective study

BACKGROUND

Suicide is a major public health concern, especially among adolescents and young adults. Although research has begun to explore the developmental trajectories of suicide-related outcomes, most have thus far focused on children and adolescents. The current study extends existing literature by identifying subgroup trajectories and related factors of college students over a two-year period.

METHODS

The data used in this study was obtained from an ongoing longitudinal study in Guangdong, China. A total of 3871 students participated in assessments performed at three time points at one-year assessment intervals. Growth mixture modeling (GMM) was used to estimate trajectory classes for suicidal behaviors, followed by multivariable logistic regression to explore the association between predictive factors and classes.

RESULTS

GMM analyses extracted two distinct trajectories of suicidal behaviors: a low-decreasing group (n = 3669, 94.8 %) and a high-increasing group (n = 202, 5.2 %). Multivariate logistic regression analyses revealed that depressive symptoms, non-suicidal self-injury, hopelessness, and childhood emotional abuse served as risk factors for the high-increasing group, while reasons for living served as protective factors.

CONCLUSIONS

Psychological interventions aimed at reducing the influence of risk factors and bolstering reasons to live may help to decrease the risk of suicide behaviors in college students.

Editorial: The Enigma of Suicide Risk in Childhood and Its Evolution Across Development

The problem of suicide can appear incomprehensible at any stage of the life cycle, but little is more puzzling than suicidal thinking and behavior in young children. Despite preadolescent suicide being rare in comparison to suicide later in life, it is the fifth leading cause of death for children ages 5 to 12 in the United States¹ and a serious public health problem deserving of study. The study of preadolescent suicide risk also has potential to inform our understanding of suicide across the lifespan. In an important effort to expand our limited understanding of the developmental aspects of suicidal thoughts and behaviors (STBs), Whalen and colleagues² report on the longitudinal trajectories of STBs for a sample of more than 300 preschool children recruited between the ages of 3 and 6 years and followed prospectively through age 17 years. Longitudinal studies allow researchers to collect more detailed information than could be obtained from a single cross-sectional survey and can offer insights into how psychopathology and associated risks evolve over time. This study is relatively unique in prospectively assessing STBs and associated risk and protective factors from the preschool period through adolescence.

Hispanic Child Suicides in the United States, 2010-2019

Suicides in Hispanic adolescents have been increasing significantly. Less clear is the extent of suicides in Hispanic children younger than 12 years of age. The purpose of this study was to explore the trends and methods of suicides in Hispanic children from 2010 to 2019 (latest data available across the United States). Suicide is the 7th leading cause of death for Hispanic children. Hispanic child suicides statistically significantly increased during the decade. From 2010 to 2019, Hispanic child suicide rates increased by 92.3%. The suicide deaths were primarily in boys (59.6%) and among those 10-12 years of age (94.9%). Hispanic child suicides were most common in the West and South and least common in the Northeastern US The method used to commit suicide was overwhelmingly (76-85%) hanging/strangulation/suffocation. To help assure Hispanic children flourish and mature into healthy adults, it is essential that policymakers commit more resources for access to healthcare for all youths and that research funding for minorities include research regarding Hispanic children's suicide risk factors, protective factors, and effective interventions to reduce suicides of Hispanic children.