March 17, 2020
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Researchers identify risk and protective factors for childhood suicidality

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Sophia Frangou

Researchers have identified protective and risk factors associated with childhood suicidality, according to results of a U.S. population-based study published in The Lancet Psychiatry.

“Eight out of 100 young children have suicidal thoughts and some even attempt suicide,” Sophia Frangou, MD, PhD, professor of psychiatry at Icahn School of Medicine at Mount Sinai, told Healio Psychiatry.These children usually experience psychological problems and conflict within their families. At the same time, the risk of such thoughts is lessened when parents are more engaged in their children’s lives and are aware of what their children do and who their friends are. Further, school environment plays a major role, because children who found school to be a positive environment were less likely to think of suicide.”

According to Frangou and colleagues, studies of adults have identified several risk factors for suicidal behaviors and ideas that generally indicate higher levels of medical morbidity, psychosocial adversity and psychopathology. Epidemiological studies have identified similar risk factors among adolescents, including higher levels of psychopathology (ie, impulsive behavior), psychiatric morbidity (ie, anxiety, depression and substance use disorders) and social stressors (ie, interpersonal conflict). However, large-scale epidemiological studies among younger children are lacking.

In the current study, the researchers sought to identify and rank protective and risk factors for childhood suicidal behaviors and thoughts across multiple domains. To do so, they analyzed data of 7,994 unrelated children aged 9 to 10 years who participated in the Adolescent Brain and Cognitive Development (ABCD) study and who had complete data on child-reported and caregiver-reported suicidal behaviors and ideas. Participants in the ABCD study were enrolled at 22 sites, the catchment area of which encompassed more than 20% of the U.S. population in this age group. Frangou and colleagues used multistage sampling to ensure both local randomization and representativeness of sociodemographic variation of the ABCD sample. Further, they evaluated data on suicidal thoughts and behaviors for each child obtained through independent child and caregiver reports, which were based on the computerized Kiddie Schedule for Affective Disorders and Schizophrenia for DSM-5. Using bootstrapped logistic regression, the researchers quantified the association between suicidal behaviors and ideation, with measures of mental and physical well-being, behavior, cognition, and social and family environment in patients from the ABCD study.

Results showed 673 (8.4%) of the children reported any past or current suicidal ideation, 75 (0.9%) reported any past or current suicidal plans and 107 (1.3%) reported any past or current suicidal attempts. Caregivers reported that 650 (8.1%) of the children had any past or current suicidal ideation, 46 (0.6%) had any past or current suicidal plans and 39 (0.5%) had past or current suicidal attempts; however, inter-informant agreement was low. Child psychopathology (OR = 1.7-4.8; 95% CI, 1.5-7.4) and child-reported family conflict (OR = 1.4-1.8; 95% CI, 1.1-2.5) were the most robust risk factors for suicidality, regardless of informant. Greater parental supervision and positive school involvement (for both, OR = 0.8; 95% CI, 0.7-0.9) reduced the risk for child-reported suicidality, whereas higher weekend screen use time (OR = 1.3; 95% CI, 1.2-1.7) increased this risk. Further, the researchers reported a positive association between caregiver-reported suicidality and caregiver educational level (OR = 1.3; 95% CI, 1.1-1.5) and male sex of children (OR = 1.5; 95% CI, 1.1-2). Caregiver-reported suicidality was inversely associated with the number of household cohabitants (OR = 0.8; 95% CI, 0.7-1).

“Suicidal thoughts are a risk for future suicide and, perhaps more importantly, an indicator of risk for many other adverse mental health outcomes in childhood and also in adolescence and adulthood,” Frangou said. “Targeted interventions at school age may have wide-ranging beneficial effects.”

In a related editorial, Rory C. O’Connor, PhD, and Kathryn A. Robb, PhD, both of University of Glasgow in the U.K., noted some limitations of Frangou and colleagues’ research.

“The findings of this study make an important contribution to extending the existing literature on suicidality in younger children; however, they are limited by being cross-sectional and by the small number of children who had formulated a suicide plan or attempted suicide,” they wrote. “Consequently, it was not possible to discern factors that differentiated between suicidal thoughts and suicidal acts. This is unfortunate given the growing recognition that factors associated with the emergence of suicidal thoughts are distinct from those that govern a suicide attempt.”

O’Connor and Robb noted that future research should focus on factors that facilitate or impede the transition from suicidal thoughts to behaviors.

“A more in-depth appreciation of the process of behavioral enaction could lay foundations for the development of suicide prevention interventions targeted at childhood risks,” they wrote. – by Joe Gramigna

Disclosures: Frangou reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. The editorial authors report no relevant financial disclosures.