Suicide In The Children’s Room

15. November 2016
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The majority of children who commit suicide are male and they commit suicide at home. Be that as it may, one third of children make utterances about this intention beforehand. Warning signs include depression, and attention deficit disorder as well.

So far little has been known about the causes and backgrounds of suicides among children. Now a new study has compared data on primary school children (aged 5 to 11 years) with data on young teenagers (aged 12 to 14 years), all of whom had died of suicide, in order to better understand the background to suicides among children.

Children up to the age of eleven taking their own lives is rare – although suicides do also occur in this age group. In 2014, suicide was the tenth most frequently occurring cause of death among American elementary school children. The final 2014 death 2014 death statistics from the American Center for Disease Control and Prevention has shown that the suicide rate among children aged 5 to 11 years is 0.17 out of 100,000 people, while death by suicide in the 12 to 17 year age group stands at 5.18 out of 100,000 people.

Study should illuminate the background to suicides

The researchers led by Arielle Sheftall from Ohio State University in Columbus used data from 2003 to 2012 (USA) from the National Violent Death Reporting System at the Center for Disease Control and Prevention (CDC) – a state data register, in which information on all violent deaths in the US is tabulated. Data from 17 US states was available to them. All the data on children and adolescents aged 5 to 14 years who ended up dying from suicide went into the study. From a total of 693 cases, 606 were adolescents aged 12 to 14 years, 87 were children aged 5 to 11 years. The results appeared in the journal Pediatrics.

In the evaluation process, a few similarities between the age groups showed up: the majority of suicides in both groups involved males, the suicides took place predominantly at home, and about one third of those involved had had a medically diagnosed mental illness. About a third of those involved shortly before the suicide had experienced problems in school; a third had experienced a crisis. Finally, in both groups, around the same proportion of these children and young people had spoken to someone about their suicidal intentions – 29 percent to be exact.

Distinct differences between the age groups

Nonetheless, there were also significant differences between the age groups. Compared to adolescents, the children more often died by hanging, strangulation or suffocation, and in the younger group significantly more of them were male and black. To be precise, 37 percent of the younger, but only 12 percent of the older group of suicide fatalities, were black.

The two groups also differed with regard to their psychiatric diagnoses: among children where a mental illness was found, the most common diagnosis was “attention deficit disorder” (with or without hyperactivity). This was present with 60 percent of the children involved, while 33 percent had been diagnosed with depression. Among the adolescents with a psychiatric diagnosis, in contrast, 66 percent of cases were depression and only 29 percent had an attention deficit disorder (with or without hyperactivity).

The rate of alcohol or substance abuse was low in both groups. However at necropsy 7.5 percent of the adolescents and 3.9 percent of the children were found to have opiates in the body. “This was a surprising and also worrying result, one to which more attention should be paid”, the authors write.

Finally the 5 to 11 year olds significantly more often had relationship problems with family members or friends than did the 12 to 14 year olds, whereas in the older group partner relationship problems had more often occurred.

Prevention strategies adapted to target

“The results suggest that the factors which underlie young adolescent suicide cannot be transferred to the situation involving children of elementary school age”, says Sheftall. Therefore it could be that children who commit suicide react more impulsively to difficulties – interpersonal problems, for example – than do teenagers. “Future studies ought to investigate whether there is a development process in which the risk of suicide in young children is more strongly influenced by impulsive behaviour, and with increasing age by depressive mood and emotional stress”, the researchers write.

Previous prevention approaches to suicide have focused primarily on children and adolescents with depression. The results indicate, however, that specific prevention approaches are necessary for primary school children. “Perhaps with them we need to be more vigilantly looking out for typical behavioural characteristics”, says Jeffrey Bridge, senior author of the study.

Meaningful intervention programs might be those where vulnerable children learn in a manner suitable to children to express their feelings, to make positive human contact and to overcome interpersonal problems. “Young children often lack the words to talk about their feelings or to resolve a conflict via conversation”, Jill Harkavy-Friedman, Vice-President of the American Foundation for Suicide Prevention, says. An example is the “PATHS” program, through which emotional and social skills are developed at primary school age.

Paediatricians should be better informed

Yet it is also important that family members, school personnel and paediatricians be more informed about how to be able to recognise warning signs of an impending suicide and how to respond to it, the authors stress. Such warning signs could manifest, for example, as persistent despondency, a sudden withdrawal from friends and activities, increased aggression and irritability.

“In addition, any utterances which indicate suicidal ideation ought to always be taken seriously – regardless of age”, Harkavy-Friedman stresses. After all, around a third of minors in the study had informed someone of their suicide intent.

Nonetheless many do not talk about such intentions – therefore caregivers should address the issue on its own in a very concrete manner, according to Harkavy-Friedman. “It’s ok to ask a child: ‘Do you sometimes feel as if you no longer wish to be alive?’ “, says the psychologist. “This won’t lead the child to the idea of killing himself or herself, but instead opens up the opportunity to speak on the subject”.

Screening tools might be useful

Paediatricians and other healthcare professionals, in assessing the risk of suicide, could make use of screening tools which take up relatively little time. Studies show that doctors using such methods recognise suicide risk four times as frequently.

Finally, there are programs that can significantly reduce suicidal behaviour, such as the “SOS – Signs of Suicide Prevention Program“. They also contain information for caregivers – ie. family members, paediatricians and teachers – on how to recognise warning signs of suicide and what steps one should take in such a case.

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Medicine, Pediatrics, Research

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1 comment:

mr franklyn nyarko
mr franklyn nyarko

Good article.

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