Understanding the Characteristics of Suicide in Young Children

December 14, 2021 • Research Highlight

The death of a child by suicide is a tragedy, having lasting and profound impacts on family, friends, and the larger community. Researchers supported by the National Institute of Mental Health (NIMH) recently published a study describing the characteristics of suicide in young children and the factors that sometimes precede these tragic events. The findings, published in the Journal of the American Medical Association, help shed light on risk factors and provide an avenue for future research and intervention.

According to the Centers for Disease Control and Prevention (CDC), rates of suicide  attempts and deaths among children have increased in the U.S. over the past decade, and suicide is now the eighth leading cause of death in children age 5–11. Despite these rates, very little research has been conducted on the risk factors for suicide in this age group. Understanding the factors that put a child at risk for suicide is a critical step toward preventing such outcomes and protecting youth.

To answer this urgent need for information, Donna Ruch, Ph.D., and Jeffrey Bridge, Ph.D. , from the Center for Suicide Prevention and Research at Nationwide Children’s Hospital, as well as Lisa Horowitz, Ph.D., M.P.H., of the NIMH Intramural Research Program, and colleagues analyzed data  from 134 children between the ages of 5 and 11 who died by suicide between 2013 and 2017. Those included in the dataset were an average of 10.6 years old and primarily white (59%) and male (75.4%). The researchers examined information such as the method and location of suicide; mental health and substance use concerns; family, school, and peer-related problems; and events that occurred on the day of the suicide. This study provides an in-depth follow-up to a previous NIMH-funded study  published in 2016 led by Arielle Sheftall, Ph.D. , who found that children who died by suicide at younger ages were more likely to be male, Black, and die at home from hanging, strangulation, or suffocation, compared with early adolescents who died by suicide.   

When researchers looked at the characteristics of children who had died by suicide, they found most child suicide deaths occurred in the family home (95.5%) and, more specifically, in the child’s bedroom (65.6%). The most common way children died by suicide was by hanging (78.4%), although a significant number of children died by suicide using a firearm (18.7%). When researchers investigated deaths by firearm, they found that more than half of these deaths involved a handgun (52%), and in all cases in which the details of gun access were known, the firearm used was not stored safely (for example, a gun and ammunition stored in an unlocked nightstand or a loaded gun stored in a common living area). In more than half of cases (58.4%), a parent was home at the time of the child’s death.

Mental health concerns were identified in a third (31.4%) of the suicide deaths examined, with the most common diagnoses being attention-deficit/hyperactivity disorder (ADHD) or depression. Trauma, including suspected or confirmed cases of abuse, neglect, and domestic violence, was seen in more than a quarter (27.1%) of children who died by suicide. Of children who were reported to have experienced trauma, almost half (40.6%) had experienced multiple traumatic events. Family-related problems, such as divorce, custody disputes, parental substance use, or a family history of suicide or mental health concerns, were seen in more than a third (39.8%) of children who died by suicide. School problems, such as expulsion, changing schools, or suspension, were also reported for almost a third (32%) of children who died by suicide.

While a history of suicidal behavior was reported for a minority of children (11.9%), a history of suicidal thoughts was present for almost a quarter (24.3%) of children who died by suicide. While a small number of children made a suicidal statement on the day of their death (11%), most children who died by suicide had made a suicidal statement in the past (79.6%).

Research suggests  young children who attempt suicide are six times more likely than their peers to attempt suicide again in adolescence. To prevent child death and subsequent suicide attempts during the teen years, it is important to intervene as soon as possible to help children at risk. These findings suggest strategies that promote more robust mental health and suicide risk screening in primary care settings, paired with lethal means safety counseling on safe firearm storage and family-based interventions, could help reduce suicide risk in this age group. While more research is needed, the researchers say this study is a first step toward identifying risk factors for suicide in children and determining how to best prevent child deaths.

Reference

Ruch, D. A., Heck, K. M., Sheftall, A. H., Fontanella, C. A., Stevens, J., Zhu, M., Horowitz, L. M., Campo, J. V., & Bridge, J. A. (2021). Characteristics and precipitating circumstances of suicide among children aged 5 to 11 years in the United States, 2013-2017 . JAMA network open, 4(7), e2115683-e2115683.

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