What Protects Children From Suicidal Ideation? Liking School, Having Parental Supervision

Strong parental supervision and having a positive relationship with school protects children aged 9 to 10 years from suicidal ideation, according to a new study released Thursday.

The analysis of nearly 8000 children found that although 8.4% of them reported suicidal ideation—defined as temporarily or regularly thinking about, considering, or planning suicide—less than 2 in 100 (1.3%), self-reported a suicide attempt. About 1 in 100 had past or current suicidal plans.

However, the report, published in The Lancet Psychiatry, also found that divining the suicide risk in children this young cannot be assessed simply by talking to caregivers. There was low concordance between reports from children and answers from caregivers, usually mothers, who completed the questionnaires; for instance, 20 of 684 children self-reported they had active suicide ideation with a plan, but only 3 of 654 caregiver reports about suicidality said the same.

While “deaths of despair” have been rising for adults and suicide is the second-leading cause of death for pre-adolescents and teens aged 10 to 14 years, the literature on children younger than 10 and suicide ideation is sparse. But childhood suicidal ideas and behaviors are a predictor of adulthood psychiatric illness and death, and an increasing number of children are affected. Over the past decade, the number of emergency department visits and hospitalizations has doubled for kids between 10 and 14 years, the authors wrote, and admissions rose from 0.67% in 2008 to 1.79% in 2015.

The researchers based their findings on data from 7994 children (average age, 9.9 years,;53% male) taking part in the Adolescent Brain Cognitive Development (ABCD) study. Funded by the National Institutes of Health, it is the largest nationally representative sample of 9- to 10-year-olds in the United States.

Caregivers and children were independently asked about current wellbeing and suicidal history as well as personal, family, and social characteristics using questionnaires; the researchers quantified the associations using bootstrapped logistic regression. A majority (6854 children) had never expressed suicidal thoughts or behaviors.

But the low levels of agreement between caregiver and child reports “indicates problems with disclosure and awareness that should be considered when assessing suicide risk in young children,” the study said. The caregiver-reported (654 children) or child-reported (684 children) experiences included 198 cases where caregivers and children were in agreement on reports of suicide ideation.

Protective factors include children liking school and strong parental supervision, possibly because both assist in the development of identity, self-esteem, and resilience, the authors wrote.

Risk factors for suicidal ideation include increased time using computers or other screen-based devices on weekends (odds ratio [OR] 1.3; 95% CI, 1.2-1.7). The effect was more pronounced for boys, but the authors cautioned that more research is needed to understand whether the relationship between screen time and suicide ideation is causal or correlative.

Conflict within the family is another risk factor (OR, 1.4-1.8; 95% CI, 1.1-2.5), as are psychological problems (OR, 1.7-4.8; 95% CI, 1.5-7.4).

Interventions that assist the family, increased engagement with school, and psychological treatment should be optimized, and the researchers suggested that school-based awareness progrms could be the most successful with this population.

Increasingly, schools are stepping up their level of support in this area. For instance, in New Jersey last November, 2 small school districts placed special referendums on the ballot to increase mental health services in their districts; both passed. And in Florida, the state legislature is nearing a vote on passing 2 bills to address students' mental health needs.

In a statement, Sophia Frangou, MD, PhD, from the Icahn School of Medicine at Mount Sinai and co-leader of the research, said that “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 National Suicide Prevention Lifeline is a hotline for individuals in crisis or for those looking to help someone else. To speak with a certified listener, call 1-800-273-8255.

Reference

Janiri D, Doucet GE, Pompili MP, et al. Risk and protective factors for childhood suicidality: a US population-based study [published online March 11, 2020]. Lancet Psychiatry. doi: 10.1016/S2215-0366(20)30049-3.