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Lombera MA, Marshall AD, Such S, Jackson Y. Measurement Models of Child Maltreatment and Associations With Suicidal Ideation Endorsement by Youth in Foster Care: A Multiverse Analytic Approach. CHILD MALTREATMENT 2024; 29:700-713. [PMID: 37917022 PMCID: PMC11063127 DOI: 10.1177/10775595231210017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Youth suicidal ideation is a prevalent experience, particularly among youth exposed to maltreatment, with a variety of indicators such as youth statements of ideation. To better understand suicidal ideation, and the associations with youth mental health outcomes, a fruitful path may be through the study of the dimensions (e.g., severity, frequency) of maltreatment exposure. While there exists extensive work on methods to best operationalize casefile records of maltreatment, such work has not been undertaken for youth self-reports, which are an important indicator of youth functioning following exposure. To address the lack of clarity of how to best operationalize youth self-reports of maltreatment, a multiverse analytic approach was taken to operationalize severity and frequency in a sample of 471 8- to 17-year-old children in foster care. We examined differences across measurement models and the models' associations with caregiver reports of youth suicidal ideation statements. Results indicate that the operationalizations used to define maltreatment resulted in differing measurement models that further differed in their associations with reports of youth suicidal ideation. This study highlights the importance of how researchers operationalize their data and the role dimensions of maltreatment have in further elucidating differential outcomes for youth exposed to maltreatment.
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Affiliation(s)
| | - Amy Dyanna Marshall
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Sara Such
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Yo Jackson
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
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Yang C, Huebner ES, Tian L. Longitudinal associations among basic psychological need satisfaction at school, self-esteem, and suicidal ideation from middle childhood to early adolescence: Disentangling between‑ and within‑person associations. J Adolesc 2024; 96:1590-1602. [PMID: 38922699 DOI: 10.1002/jad.12366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 06/03/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION The current study aimed to examine the longitudinal associations among basic psychological need satisfaction at school (BPNSS), self-esteem, and suicidal ideation (SI), including whether self-esteem functioned as a mediator of the relations between BPNSS and SI at the within-person level after disentangling between- and within-person associations encompassing middle childhood to early adolescence. METHODS A total of 650 Chinese students (53.54% boys, Mage = 9.95, SD = 0.75 at Time 1) completed measures on four occasions across 1.5 years, using 6-month intervals. Random intercept cross-lagged panel models were applied to disaggregate between- and within-person effects, thus providing greater confidence in elucidating the causal relations among study variables. RESULTS The results showed that at the within-person level: (a) BPNSS negatively predicted SI; (b) BPNSS positively predicted self-esteem; (c) Self-esteem negatively predicted SI; and (d) BPNSS indirectly predicted SI via self-esteem. CONCLUSION These findings advanced the literature by demonstrating longitudinal associations among BPNSS, self-esteem, and SI at the within-person level, and highlighting the significance of distinguishing between- and within-person effects in developing prevention and intervention programs aimed at reducing SI over time from middle childhood to early adolescence.
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Affiliation(s)
- Chi Yang
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents (South China Normal University), Ministry of Education, Guangzhou, P.R. China
- School of Psychology, South China Normal University, Guangzhou, P.R. China
| | - E Scott Huebner
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Lili Tian
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents (South China Normal University), Ministry of Education, Guangzhou, P.R. China
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Hennefield L, Whalen DJ, Tillman R, Barch DM, Luby JL. Preschool-Onset Major Depressive Disorder as a Strong Predictor of Suicidal Ideation and Behaviors Into Preadolescence. J Am Acad Child Adolesc Psychiatry 2024; 63:919-930. [PMID: 38070867 PMCID: PMC11156793 DOI: 10.1016/j.jaac.2023.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/28/2023] [Accepted: 11/30/2023] [Indexed: 12/27/2023]
Abstract
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.
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Affiliation(s)
| | - Diana J Whalen
- Washington University School of Medicine, St. Louis, Missouri
| | - Rebecca Tillman
- Washington University School of Medicine, St. Louis, Missouri
| | - Deanna M Barch
- Washington University School of Medicine, St. Louis, Missouri; Washington University in St Louis, St. Louis, Missouri
| | - Joan L Luby
- Washington University School of Medicine, St. Louis, Missouri
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Lawrence-Sidebottom D, Huffman LG, Beam AB, McAlister K, Guerra R, Parikh A, Roots M, Huberty J. Using a Digital Mental Health Intervention for Crisis Support and Mental Health Care Among Children and Adolescents With Self-Injurious Thoughts and Behaviors: Retrospective Study. JMIR Form Res 2024; 8:e54816. [PMID: 39151166 PMCID: PMC11364954 DOI: 10.2196/54816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/16/2024] [Accepted: 06/17/2024] [Indexed: 08/18/2024] Open
Abstract
BACKGROUND Self-injurious thoughts and behaviors (SITBs) are increasing dramatically among children and adolescents. Crisis support is intended to provide immediate mental health care, risk mitigation, and intervention for those experiencing SITBs and acute mental health distress. Digital mental health interventions (DMHIs) have emerged as accessible and effective alternatives to in-person care; however, most do not provide crisis support or ongoing care for children and adolescents with SITBs. OBJECTIVE To inform the development of digital crisis support and mental health care for children and adolescents presenting with SITBs, this study aims to (1) characterize children and adolescents with SITBs who participate in a digital crisis response service, (2) compare anxiety and depressive symptoms of children and adolescents presenting with SITBs versus those without SITBs throughout care, and (3) suggest future steps for the implementation of digital crisis support and mental health care for children and adolescents presenting with SITBs. METHODS This retrospective study was conducted using data from children and adolescents (aged 1-17 y; N=2161) involved in a pediatric collaborative care DMHI. SITB prevalence was assessed during each live session. For children and adolescents who exhibited SITBs during live sessions, a rapid crisis support team provided evidence-based crisis support services. Assessments were completed approximately once a month to measure anxiety and depressive symptom severity. Demographics, mental health symptoms, and change in the mental health symptoms of children and adolescents presenting with SITBs (group with SITBs) were compared to those of children and adolescents with no SITBs (group without SITBs). RESULTS Compared to the group without SITBs (1977/2161, 91.49%), the group with SITBs (184/2161, 8.51%) was mostly made up of adolescents (107/184, 58.2%) and female children and adolescents (118/184, 64.1%). At baseline, compared to the group without SITBs, the group with SITBs had more severe anxiety and depressive symptoms. From before to after mental health care with the DMHI, the 2 groups did not differ in the rate of children and adolescents with anxiety symptom improvement (group with SITBs: 54/70, 77% vs group without SITBs: 367/440, 83.4%; χ21=1.2; P=.32) as well as depressive symptom improvement (group with SITBs: 58/72, 81% vs group without SITBs: 255/313, 81.5%; χ21=0; P=.99). The 2 groups also did not differ in the amount of change in symptom severity during care with the DMHI for anxiety (t80.20=1.37; P=.28) and depressive (t83.75=-0.08; P=.99) symptoms. CONCLUSIONS This study demonstrates that participation in a collaborative care DMHI is associated with improved mental health outcomes in children and adolescents experiencing SITBs. These results provide preliminary insights for the use of pediatric DMHIs in crisis support and mental health care for children and adolescents presenting with SITBs, thereby addressing the public health issue of acute mental health crisis in children and adolescents.
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Affiliation(s)
| | | | | | | | | | - Amit Parikh
- Mental Fitness Clinic, Los Angeles, CA, United States
| | | | - Jennifer Huberty
- Bend Health, Inc, Madison, WI, United States
- FitMinded Inc, LLC, Phoenix, AZ, United States
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Zalewski M, Byrd AL, Vine V, Hernandez AC, Stepp SD. Maternal suicide risk predicts preschooler emotional and behavioral problems. Psychiatry Res 2024; 337:115969. [PMID: 38772159 PMCID: PMC11189097 DOI: 10.1016/j.psychres.2024.115969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 02/27/2024] [Accepted: 05/14/2024] [Indexed: 05/23/2024]
Abstract
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.
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Affiliation(s)
| | - Amy L Byrd
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Vera Vine
- Queens University, Kingston, ON K7L 3N6, Canada
| | | | - Stephanie D Stepp
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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Yang C, Huebner ES, Tian L. Prediction of suicidal ideation among preadolescent children with machine learning models: A longitudinal study. J Affect Disord 2024; 352:403-409. [PMID: 38387673 DOI: 10.1016/j.jad.2024.02.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Machine learning (ML) has been widely used to predict suicidal ideation (SI) in adolescents and adults. Nevertheless, studies of accurate and efficient models of SI prediction with preadolescent children are still needed because SI is surprisingly prevalent during the transition into adolescence. This study aimed to explore the potential of ML models to predict SI among preadolescent children. METHODS A total of 4691 Chinese children (54.89 % boys, Mage = 10.92 at baseline) and their parents completed relevant measures at baseline and the children provided 6-month follow-up data for SI. The current study compared four ML models: Random Forest (RF), Decision Tree (DT), Support Vector Machine (SVM), and Multilayer Perceptron (MLP), to predict SI and to identify variables with predictive value based on the best-performing model among Chinese preadolescent children. RESULTS The RF model achieved the highest discriminant performance with an AUC of 0.92, accuracy of 0.93 (balanced accuracy = 0.88). The factors of internalizing problems, externalizing problems, neuroticism, childhood maltreatment, and subjective well-being in school demonstrated the highest values in predicting SI. CONCLUSION The findings of this study suggested that ML models based on the observation and assessment of children's general characteristics and experiences in everyday life can serve as convenient screening and evaluation tools for suicide risk assessment among Chinese preadolescent children. The findings also provide insights for early intervention.
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Affiliation(s)
- Chi Yang
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents, South China Normal University, Ministry of Education, Guangzhou 510631, People's Republic of China; School of Psychology, South China Normal University, Guangzhou 510631, People's Republic of China
| | - E Scott Huebner
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA
| | - Lili Tian
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents, South China Normal University, Ministry of Education, Guangzhou 510631, People's Republic of China.
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Lévy-Bencheton J, Chaste P, Sansen M. Link between neurodevelopmental disorders and suicidal risk in children. L'ENCEPHALE 2024:S0013-7006(24)00042-3. [PMID: 38523026 DOI: 10.1016/j.encep.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Suicide represents a significant public health issue among children and adolescents. However, in this population, while the literature seems to support a link between suicidal risk and neurodevelopmental disorders, there are still few studies on the subject. The psychopathological description of children who have realized a suicide attempt with a high potential for lethality, which can be defined as "serious", appears to resemble that of children who have died by suicide. This study aimed to characterize the dimensional aspects of the neurodevelopmental profile of a population of children and adolescents hospitalized at Necker-Enfants-Malades Hospital for a serious suicide attempt. METHODS This is an observational, prospective, and single-center study. Questionnaires for collecting general information and dimensional scales of neurodevelopment (Autism-Tics, ADHD, and Other Comorbidities Inventory, Social Responsiveness Scale, and Conners-3 for parents) were used. This study included 21 patients aged 9 to 15 years at the time of their hospitalization. RESULTS The results supported the presence of at least one neurodevelopmental disorder (autistic traits, attention-deficit/hyperactivity disorder, learning disorder, or motor disorder) in 70% (n=14) of the subjects, and at least one behavioral disorder (oppositional defiant disorder, conduct disorder) in 65% (n=13) of these subjects. CONCLUSION The observed frequency of traits indicative of neurodevelopmental disorders in our population was higher than that observed in the general population, without the presented symptoms being eligible for categorical diagnosis. Considering the dimensional aspects of neurodevelopmental symptoms would therefore enable better identification of children at suicidal risk and more tailored interventions to contribute to the prevention of suicide in children.
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Affiliation(s)
- Julie Lévy-Bencheton
- Child psychiatry department, Necker-Enfants-Malades Hospital, 75015 Paris, France.
| | - Pauline Chaste
- Child psychiatry department, Necker-Enfants-Malades Hospital, 75015 Paris, France
| | - Mélisande Sansen
- Child psychiatry department, Necker-Enfants-Malades Hospital, 75015 Paris, France
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Gosling CJ, Caparos S, Pinabiaux C, Schwarzer G, Rücker G, Agha SS, Alrouh H, Ambler A, Anderson P, Andiarena A, Arnold LE, Arseneault L, Asherson P, Babinski L, Barbati V, Barkley R, Barros AJD, Barros F, Bates JE, Bell LJ, Berenguer C, van Bergen E, Biederman J, Birmaher B, B⊘e T, Boomsma DI, Brandt VC, Bressan RA, Brocki K, Broughton TR, Bufferd SJ, Bussing R, Cao M, Cartigny A, Casas AM, Caspi A, Castellanos FX, Caye A, Cederkvist L, Collishaw S, Copeland WE, Cote SM, Coventry WL, Debes NMM, Denyer H, Dodge KA, Dogru H, Efron D, Eller J, Abd Elmaksoud M, Ercan ES, Faraone SV, Fenesy M, Fernández MF, Fernández-Somoano A, Findling R, Fombonne E, Fossum IN, Freire C, Friedman NP, Fristad MA, Galera C, Garcia-Argibay M, Garvan CS, González-Safont L, Groenman AP, Guxens M, Halperin JM, Hamadeh RR, Hartman CA, Hill SY, Hinshaw SP, Hipwell A, Hokkanen L, Holz N, Íñiguez C, Jahrami HA, Jansen PW, Jónsdóttir LK, Julvez J, Kaiser A, Keenan K, Klein DN, Klein RG, Kuntsi J, Langfus J, Langley K, Lansford JE, Larsen SA, Larsson H, Law E, Lee SS, Lertxundi N, Li X, Li Y, Lichtenstein P, Liu J, Lundervold AJ, Lundström S, Marks DJ, Martin J, Masi G, Matijasevich A, Melchior M, Moffitt TE, Monninger M, Morrison CL, Mulraney M, Muratori P, Nguyen PT, Nicholson JM, Øie MG, O'Neill S, O'Connor C, Orri M, Pan PM, Pascoe L, Pettit GS, Price J, Rebagliato M, Riaño-Galán I, Rohde LA, Roisman GI, Rosa M, Rosenbaum JF, Salum GA, Sammallahti S, Santos IS, Schiavone NS, Schmid L, Sciberras E, Shaw P, Silk TJ, Simpson JA, Skogli EW, Stepp S, Strandberg-Larsen K, Sudre G, Sunyer J, Tandon M, Thapar A, Thomson P, Thorell LB, Tinchant H, Torrent M, Tovo-Rodrigues L, Tripp G, Ukoumunne O, Van Goozen SHM, Vos M, Wallez S, Wang Y, Westermaier FG, Whalen DJ, Yoncheva Y, Youngstrom EA, Sayal K, Solmi M, Delorme R, Cortese S. Association between relative age at school and persistence of ADHD in prospective studies: an individual participant data meta-analysis. Lancet Psychiatry 2023; 10:922-933. [PMID: 37898142 DOI: 10.1016/s2215-0366(23)00272-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND The youngest children in a school class are more likely than the oldest to be diagnosed with ADHD, but this relative age effect is less frequent in older than in younger school-grade children. However, no study has explored the association between relative age and the persistence of ADHD diagnosis at older ages. We aimed to quantify the association between relative age and persistence of ADHD at older ages. METHODS For this meta-analysis, we searched MEDLINE, Embase, CINAHL, PsycINFO, and PubPsych up to April 1, 2022, with terms related to "cohort" and "ADHD" with no date, publication type, or language restrictions. We gathered individual participant data from prospective cohorts that included at least ten children identified with ADHD before age 10 years. ADHD was defined by either a clinical diagnosis or symptoms exceeding clinical cutoffs. Relative age was recorded as the month of birth in relation to the school-entry cutoff date. Study authors were invited to share raw data or to apply a script to analyse data locally and generate anonymised results. Our outcome was ADHD status at a diagnostic reassessment, conducted at least 4 years after the initial assessment and after age 10 years. No information on sex, gender, or ethnicity was collected. We did a two-stage random-effects individual participant data meta-analysis to assess the association of relative age with persistence of ADHD at follow-up. This study was registered with PROSPERO, CRD42020212650. FINDINGS Of 33 119 studies generated by our search, we identified 130 eligible unique studies and were able to gather individual participant data from 57 prospective studies following up 6504 children with ADHD. After exclusion of 16 studies in regions with a flexible school entry system that did not allow confident linkage of birthdate to relative age, the primary analysis included 41 studies in 15 countries following up 4708 children for a period of 4 to 33 years. We found that younger relative age was not statistically significantly associated with ADHD persistence at follow-up (odds ratio 1·02, 95% CI 0·99-1·06; p=0·19). We observed statistically significant heterogeneity in our model (Q=75·82, p=0·0011, I2=45%). Participant-level sensitivity analyses showed similar results in cohorts with a robust relative age effect at baseline and when restricting to cohorts involving children with a clinical diagnosis of ADHD or with a follow-up duration of more than 10 years. INTERPRETATION The diagnosis of ADHD in younger children in a class is no more likely to be disconfirmed over time than that of older children in the class. One interpretation is that the relative age effect decreases the likelihood of children of older relative age receiving a diagnosis of ADHD, and another is that assigning a diagnostic label of ADHD leads to unexplored carryover effects of the initial diagnosis that persist over time. Future studies should be conducted to explore these interpretations further. FUNDING None.
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Ortin-Peralta A, Sheftall AH, Osborn A, Miranda R. Severity and Transition of Suicidal Behaviors in Childhood: Sex, Racial, and Ethnic Differences in the Adolescent Brain Cognitive Development (ABCD) Study. J Adolesc Health 2023; 73:724-730. [PMID: 37389520 PMCID: PMC10527698 DOI: 10.1016/j.jadohealth.2023.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/03/2023] [Accepted: 05/25/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE To examine the prevalence, incidence, and transitions of suicide ideation and attempts and sex and racial/ethnic differences among children enrolled in three yearly assessments of the Adolescent Brain Cognitive Development Study. The forms of suicidal ideation (SI) (no SI, passive, nonspecific active, and active) among those who attempted suicide were also described. METHODS A subsample of 9,923 children (9-10 years old at baseline, 48.6% female) completed the KSADS-5 questions about suicide ideation and attempts in three yearly assessment (83.5% of baseline sample). RESULTS Almost 18% of the children reported suicidal ideation and 2.2% a suicide attempt at one of the three assessments. Passive (6.9%) and nonspecific active (6.4%) were the most frequent forms of suicidal ideation reported. Of the children with suicidal ideation at baseline, 5.9% first attempted suicide in the two subsequent years. Boys (vs. girls) reported more suicidal ideation at baseline. Black children (vs. White and Hispanic/Latinx) and girls (vs. boys) were more likely to start thinking about suicide over time. Black children (vs. White) reported more suicide attempts at baseline and across assessments. More than half of the children who attempted suicide at any assessment reported nonspecific active suicidal ideation (desire to kill oneself without plan/intent/method) as the most severe form of ideation. DISCUSSION Findings suggest a high prevalence of suicidal ideation among children in the US. When conducting risk assessments, clinicians should consider both active and nonspecific active suicidal ideation. Early intervention with children who are thinking about suicide may reduce their risk for attempting suicide.
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Affiliation(s)
- Ana Ortin-Peralta
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York; Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York.
| | - Arielle H Sheftall
- Department of Psychiatry, The University of Rochester Medical Center, Rochester, New York
| | - Abigail Osborn
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - Regina Miranda
- Department of Psychology, Hunter College, City University of New York, New York, New York; The Graduate Center, City University of New York, New York, New York
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Hughes JL, Horowitz LM, Ackerman JP, Adrian MC, Campo JV, Bridge JA. Suicide in young people: screening, risk assessment, and intervention. BMJ 2023; 381:e070630. [PMID: 37094838 DOI: 10.1136/bmj-2022-070630] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Suicide is the fourth leading cause of death among young people worldwide and the third leading cause of death among those in the US. This review outlines the epidemiology of suicide and suicidal behavior in young people. It discusses intersectionality as an emerging framework to guide research on prevention of suicide in young people and highlights several clinical and community settings that are prime targets for implementation of effective treatment programs and interventions aimed at rapidly reducing the suicide rate in young people. It provides an overview of current approaches to screening and assessment of suicide risk in young people and the commonly used screening tools and assessment measures. It discusses universal, selective, and indicated evidence based suicide focused interventions and highlights components of psychosocial interventions with the strongest evidence for reducing risk. Finally, the review discusses suicide prevention strategies in community settings and considers future research directions and questions challenging the field.
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Affiliation(s)
- Jennifer L Hughes
- Big Lots Behavioral Health Services at Nationwide Children's Hospital, Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Lisa M Horowitz
- Office of the Clinical Director, Intramural Research Program, National Institutes of Mental Health, NIH, Bethesda, MD, USA
| | - John P Ackerman
- Big Lots Behavioral Health Services at Nationwide Children's Hospital, Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Molly C Adrian
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - John V Campo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey A Bridge
- Departments of Pediatrics and Psychiatry and Behavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center College of Medicine, Columbus, OH, USA
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Wiglesworth A, Falke CA, Fiecas M, Luciana M, Cullen KR, Klimes-Dougan B. Brain signatures in children who contemplate suicide: learning from the large-scale ABCD study. Psychol Med 2023; 53:2164-2173. [PMID: 37310327 PMCID: PMC10106301 DOI: 10.1017/s0033291721004074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Suicide is the second-leading cause of death in youth. Understanding the neural correlates of suicide ideation (SI) in children is crucial to ongoing efforts to understand and prevent youth suicide. This study characterized key neural networks during rest and emotion task conditions in an epidemiologically informed sample of children who report current, past, or no SI. METHODS Data are from the adolescent brain cognitive development study, including 8248 children (ages 9-10; mean age = 119.2 months; 49.2% female) recruited from the community. Resting-state functional connectivity (RSFC) and activation to emotional stimuli in the salience (SN) and default mode (DMN) networks were measured through fMRI. Self-reported SI and clinical profiles were gathered. We examined the replicability of our model results through repeated sub-sample reliability analyses. RESULTS Children with current SI (2.0%), compared to those without any past SI, showed lower DMN RSFC (B = -0.267, p < 0.001) and lower DMN activation in response to negative as compared to neutral faces (B = -0.204, p = 0.010). These results were robust to the effects of MDD, ADHD, and medication use. Sub-sample analysis further supported the robustness of these results. We did not find support for differences in SN RSFC or in SN activation to positive or negative stimuli for children with or without SI. CONCLUSIONS Results from a large brain imaging study using robust statistical approaches suggest aberrant DMN functioning in children with current suicide ideation. Findings suggest potential mechanisms that may be targeted in suicide prevention efforts.
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Affiliation(s)
| | - Conner A. Falke
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Mark Fiecas
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Monica Luciana
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Kathryn R. Cullen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
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12
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Trivedi C, Nandakumar AL, Yousefzadehfard Y, Goriparthi TSK, Chaudhari G, Vora D, Mansuri Z, Jain S. Suicide Risk Among Adolescents With ADHD: An Overview From the National Inpatient Sample Data Set. J Nerv Ment Dis 2023; 211:216-220. [PMID: 36108281 DOI: 10.1097/nmd.0000000000001587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Studies have shown an association between attention deficit hyperactivity disorder (ADHD) and suicide; however, it has not been studied from inpatient hospitalization data among adolescents. For this study, data from the National Inpatient Sample data set were used. Based on the diagnosis of ADHD, the patient sample was stratified into two groups. Study group was composed of patients with ADHD, and control group was selected by propensity score matching (1:1), which composed of patients without ADHD. The primary outcome was suicidal ideation/attempt between the groups. Prevalence of SI was 25.1% in patients with ADHD versus 10.3% among patients without ADHD. Prevalence of SA was also very high (8.0% vs 3.9%) among patient with ADHD compared with non-ADHD group. After controlling for covariates, ADHD was a strong predictor of suicidal ideation/attempt with an odds ratio of 2.18. It is important to screen for suicidality in patient with ADHD given the high prevalence of suicidality.
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Affiliation(s)
- Chintan Trivedi
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa
| | | | - Yashar Yousefzadehfard
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa
| | | | - Gaurav Chaudhari
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa
| | - Darshini Vora
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa
| | - Zeeshan Mansuri
- Department of Psychiatry, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Shailesh Jain
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa
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13
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Van Hove L, Baetens I, Van Leeuwen K, Roelants M, Roeljan Wiersema J, Lewis SP, Heath N. Passive Suicidal Ideation in Childhood. CRISIS 2023; 44:100-107. [PMID: 34915734 DOI: 10.1027/0227-5910/a000835] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: A growing body of empirical research shows that suicidal behaviors are prevalent in childhood. Yet, few studies have examined risk factors related to suicidal ideation (SI) among children aged 12 and younger. Aims: The current study addresses this gap. Method: A questionnaire was filled out by 1,350 Flemish primary caregivers (94.7% mothers) of 9-year-old children (50.4% boys, Mage = 9.45). Their responses were analyzed using logistic regression and independent samples t tests. Results: The presence of passive SI was reported in 10.5% of the children. A psychiatric, developmental, or behavioral condition (or multiple conditions), a learning disorder, impulsivity, aggression, and experiencing multiple stressful family life events were discovered as potential risk factors of passive SI in childhood. Limitations: The cross-sectional nature of this study meant that causality could not be inferred. In addition, it was based on reports of primary caregivers, rather than on reports from the children themselves. Conclusion: These new empirical findings can be used for the development of prevention programs and be taken into account in risk assessments of SI in clinical practice. Confirmation of our findings in a longitudinal child-reported study is needed.
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Affiliation(s)
- Lisa Van Hove
- Faculty of Psychology and Educational Sciences, Free University of Brussels, Belgium
| | - Imke Baetens
- Faculty of Psychology and Educational Sciences, Free University of Brussels, Belgium
| | | | - Mathieu Roelants
- Department of Public Health and Primary Care, KU Leuven, Belgium
| | - J Roeljan Wiersema
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | | | - Nancy Heath
- Faculty of Education, McGill University, Montreal, QC, Canada
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14
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Silver J, Olino TM, Carlson GA, Dougherty LR, Klein DN. Utility of self- and parent-reported suicidal ideation in early childhood: Prediction of suicidal ideation and psychopathology in adolescence. Suicide Life Threat Behav 2023; 53:89-99. [PMID: 36239390 DOI: 10.1111/sltb.12924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/22/2022] [Accepted: 09/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The rates of suicide in youth have increased dramatically, leading to increased interest in routinely screening youth for suicidality. However, data on suicidal ideation (SI) in younger children are sparse, especially with brief self-report measures that can easily be used for screening non-referred samples. METHODS We evaluated a community sample of 497 6-year-old children and their parents and followed them into adolescence. SI was assessed via child self-report at ages 6 and 9 using an item from the Children's Depression Inventory, and via parent-report at age 6 using an item from the Early Childhood Inventory. Child psychopathology and functioning were assessed via semi-structured interviews every 3 years from age 6 through 15. RESULTS Child endorsement of SI at age 6 did not predict later psychopathology or functioning. Child endorsement of SI at age 9 was associated with attention deficit hyperactivity disorder (ADHD) and disruptive behavior disorders (DBD) diagnoses across the adolescent follow-up assessments. Parent endorsement of child SI predicted an increased likelihood of later SI and non-suicidal self-injury, a higher rate of DBD and externalizing symptoms, and poorer global functioning in adolescence. CONCLUSIONS Our results support recommendations against administering SI screening measures to children under the age of 10.
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Affiliation(s)
| | | | | | - Lea R Dougherty
- University of Maryland College Park, College Park, Maryland, USA
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15
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Hoyniak CP, Whalen D, Hennefield L, Tillman R, Barch DM, Luby JL. Early childhood sleep problems predict increased risk for the later development of suicidal thoughts. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:13-25. [PMID: 36265054 PMCID: PMC9870931 DOI: 10.1037/abn0000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
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).
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16
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Randall AB, van der Star A, Pennesi JL, Siegel JA, Blashill AJ. Gender identity-based disparities in self-injurious thoughts and behaviors among pre-teens in the United States. Suicide Life Threat Behav 2022; 53:241-249. [PMID: 36562588 DOI: 10.1111/sltb.12937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/26/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Transgender individuals are at heightened risk for self-injurious thoughts and behaviors (SITBs). Evidence suggests that middle childhood-aged transgender individuals experience elevated rates of non-suicidal self-injury (NSSI) and passive suicidal ideation (SI), compared to cisgender children. Little is known about gender identity-based disparities in SI more broadly and suicidal behavior (SB) in children aged 9 and 10. The aim of this study was to examine gender identity-based disparities in SITBs among children in middle childhood (pre-teens) in a US-based sample. METHODS Using data from the 3.0 baseline release of the Adolescent Brain Cognitive Development (ABCD) study, logistic regression models, unadjusted and adjusted for covariates, were performed to examine gender identity-based disparities in SITBs. RESULTS In a model adjusted for birth sex, race/ethnicity, and household income, transgender children were at significantly higher odds for current (adjusted odds ratio [AOR] = 6.34) but not lifetime NSSI compared with cisgender children. Transgender children were at significantly higher odds for current and lifetime SI (AOR = 13.03; AOR = 5.39, respectively) and SB (AOR = 14.21; AOR = 12.64, respectively) compared with cisgender children. CONCLUSIONS Gender identity-based disparities in SITBs may be present as early as age 9 and 10, demonstrating the need for SITB prevention and intervention efforts specific to transgender children.
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Affiliation(s)
- Alyson B Randall
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Arjan van der Star
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Jamie-Lee Pennesi
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Jaclyn A Siegel
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Aaron J Blashill
- Department of Psychology, San Diego State University, San Diego, California, USA.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
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17
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Price JH, Khubchandani J. Firearm Mortality Among Pre-school Age Children, 2010–2020. J Community Health 2022; 48:414-419. [DOI: 10.1007/s10900-022-01180-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
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18
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Viswanathan M, Wallace IF, Cook Middleton J, Kennedy SM, McKeeman J, Hudson K, Rains C, Vander Schaaf EB, Kahwati L. Screening for Depression and Suicide Risk in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 328:1543-1556. [PMID: 36219399 DOI: 10.1001/jama.2022.16310] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Depression, suicidal ideation, and self-harm behaviors in youth are associated with functional impairment and suicide. Objective To review the evidence on screening for depression or suicide risk in children and adolescents to inform the US Preventive Services Task Force (USPSTF). Data Sources PubMed, Cochrane Library, PsycINFO, CINAHL, and trial registries through July 19, 2021; references, experts, and surveillance through June 1, 2022. Study Selection English-language, randomized clinical trials (RCTs) of screening for depression or suicide risk; diagnostic test accuracy studies; RCTs of psychotherapy and first-line pharmacotherapy; RCTs, observational studies, and systematic reviews reporting harms. Data Extraction and Synthesis Two reviewers assessed titles/abstracts, full-text articles, and study quality and extracted data; when at least 3 similar studies were available, meta-analyses were conducted. Main Outcomes and Measures Test accuracy, symptoms, response, remission, loss of diagnosis, mortality, functioning, suicide-related events, and adverse events. Results Twenty-one studies (N = 5433) were included for depression and 19 studies (N = 6290) for suicide risk. For depression, no studies reported on the direct effects of screening on health outcomes, and 7 studies (n = 3281) reported sensitivity of screening instruments ranging from 0.59 to 0.94 and specificity from 0.38 to 0.96. Depression treatment with psychotherapy was associated with improved symptoms (Beck Depression Inventory pooled standardized mean difference, -0.58 [95% CI, -0.83 to -0.34]; n = 471; 4 studies; and Hamilton Depression Scale pooled mean difference, -2.25 [95% CI, -4.09 to -0.41]; n = 262; 3 studies) clinical response (3 studies with statistically significant results using varying thresholds), and loss of diagnosis (relative risk, 1.73 [95% CI, 1.00 to 3.00; n = 395; 4 studies). Pharmacotherapy was associated with improvement on symptoms (Children's Depression Rating Scale-Revised mean difference, -3.76 [95% CI, -5.95 to -1.57; n = 793; 3 studies), remission (relative risk, 1.20 [95% CI, 1.00 to 1.45]; n = 793; 3 studies) and functioning (Children's Global Assessment Scale pooled mean difference, 2.60 (95% CI, 0.78 to 4.42; n = 793; 3 studies). Other outcomes were not statistically significantly different. Differences in suicide-related outcomes and adverse events for pharmacotherapy when compared with placebo were not statistically significant. For suicide risk, no studies reported on the direct benefits of screening on health outcomes, and 2 RCTs (n = 2675) reported no harms of screening. One study (n = 581) reported on sensitivity of screening, ranging from 0.87 to 0.91; specificity was 0.60. Sixteen RCTs (n = 3034) reported on suicide risk interventions. Interventions were associated with lower scores for the Beck Hopelessness Scale (pooled mean difference, -2.35 [95% CI, -4.06 to -0.65]; n = 644; 4 RCTs). Findings for other suicide-related outcomes were mixed or not statistically significantly different. Conclusion and Relevance Indirect evidence suggested that some screening instruments were reasonably accurate for detecting depression. Psychotherapy and pharmacotherapy were associated with some benefits and no statistically significant harms for depression, but the evidence was limited for suicide risk screening instruments and interventions.
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Affiliation(s)
- Meera Viswanathan
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Ina F Wallace
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Jennifer Cook Middleton
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Sara M Kennedy
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Joni McKeeman
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Kesha Hudson
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Caroline Rains
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Emily B Vander Schaaf
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill
| | - Leila Kahwati
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
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19
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Barch DM, Hennefield L, Herzberg MP. What Makes a Useful "Predictor" of Risk for Suicide Attempt? JAMA Psychiatry 2022; 79:948-950. [PMID: 36044232 PMCID: PMC9994208 DOI: 10.1001/jamapsychiatry.2022.2031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St Louis, St Louis, Missouri
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
- Department of Radiology, Washington University in St Louis, St Louis, Missouri
| | - Laura Hennefield
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Max P Herzberg
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
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20
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McRae E, Stoppelbein L, O’Kelley S, Smith S, Fite P. Pathways to Suicidal Behavior in Children and Adolescents: Examination of Child Maltreatment and Post-Traumatic Symptoms. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:715-725. [PMID: 35958716 PMCID: PMC9360295 DOI: 10.1007/s40653-022-00439-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 05/12/2023]
Abstract
Suicide in youth exacts significant personal and community costs. Thus, it is important to understand predisposing risk factors. Experiencing adverse childhood experiences (ACEs), such as child maltreatment (CM-ACE), and the presence of post-traumatic stress disorder has been identified as a risk factor of suicidal behaviors among adults. Theoretical models of suicide suggest that the presence of painful experiences such as CM-ACEs increase the risk of suicidal behaviors. The relation between child maltreatment, post-traumatic stress symptom clusters (PTSS) and suicidal behaviors has not been explicitly examined among youth. The present study examined the relations between CM-ACEs, PTSS clusters, and suicidal behaviors in a clinical population of children. Children, male, ages 6 to 14, enrolled in a residential treatment program completed self-report measures to evaluate variables of interest. Path analyses revealed statistically significant direct effects of CM-ACEs and PTSS clusters on suicidal behaviors. Significant total indirect effects and marginally significant individual indirect effects of intrusion and avoidance symptoms were observed for the relation between CM-ACEs and suicidal behavior. Findings suggest that symptoms associated with specific PTSS clusters might help explain the relation between CM-ACEs and suicidal behavior, and therefore, present important implications for clinical practice and future research.
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Affiliation(s)
- Elizabeth McRae
- The University of Alabama at Birmingham, Birmingham, Alabama US
| | | | - Sarah O’Kelley
- The University of Alabama at Birmingham, Birmingham, Alabama US
| | - Shana Smith
- Jacksonville State University, Jacksonville, Alabama US
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21
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Chen J, Huebner ES, Tian L. Longitudinal associations among academic achievement and depressive symptoms and suicidal ideation in elementary schoolchildren: disentangling between- and within-person associations. Eur Child Adolesc Psychiatry 2022; 31:1405-1418. [PMID: 33885993 DOI: 10.1007/s00787-021-01781-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/07/2021] [Indexed: 01/18/2023]
Abstract
Prior cross-sectional and unidirectional longitudinal research has investigated the associations among academic achievement, depressive symptoms, and suicidal ideation without distinguishing between-person effects from within-person effects. Our study aimed to examine the longitudinal relations among academic achievement, depressive symptoms, and suicidal ideation in a sample of elementary school children at the within-person level using cross-lagged panel models (CLPMs) and random intercept cross-lagged panel models (RI-CLPMs). Also, multiple models replicated these findings by using three measures of academic achievement (i.e., objective academic achievement, subjective academic achievement, and teacher-assigned academic achievement). A sample of 715 Chinese elementary schoolchildren completed self-report measures of subjective academic achievement, depressive symptoms, and suicidal ideation on five occasions, using 6-month intervals. Objective academic achievement data were obtained from school records and teacher-assigned academic achievement data were reported by teachers. The results showed that: (a) In CLPMs, objective academic achievement negatively predicted suicidal ideation. However, RI-CLPMs supported the negative effect of suicidal ideation on objective academic achievement. (b) The CLPMs revealed reciprocal associations between subjective and teacher-assigned academic achievement and depressive symptoms, respectively. However, RI-CLPMs only provided support for the negative effect of depressive symptoms on subjective academic achievement. (c) Both the CLPMs and the RI-CLPMs showed bidirectional relations between depressive symptoms and suicidal ideation. These findings highlight that mental health problems (e.g., depressive symptoms and suicidal ideation) serve as antecedents of academic performance and that it is beneficial to distinguish between between-person and within-person effects in research informing the development of prevention and intervention programs.
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Affiliation(s)
- Jiahui Chen
- School of Psychology, South China Normal University, Guangzhou, 510631, People's Republic of China.,Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, Guangzhou, People's Republic of China.,Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, People's Republic of China.,Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, People's Republic of China
| | | | - Lili Tian
- School of Psychology, South China Normal University, Guangzhou, 510631, People's Republic of China. .,Key Laboratory of Brain, Cognition and Education Sciences (South China Normal University), Ministry of Education, Guangzhou, People's Republic of China. .,Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, People's Republic of China. .,Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, People's Republic of China.
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22
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Whalen DJ, Hennefield L, Elsayed NM, Tillman R, Barch DM, Luby JL. Trajectories of Suicidal Thoughts and Behaviors From Preschool Through Late Adolescence. J Am Acad Child Adolesc Psychiatry 2022; 61:676-685. [PMID: 34506928 PMCID: PMC8898992 DOI: 10.1016/j.jaac.2021.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/15/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Suicidal thoughts and behaviors (STBs) represent a significant and escalating public health concern in youth. Evidence that STBs can emerge in the preschool years suggests that some pathways leading to clinically significant STBs begin early in life. METHOD This prospective longitudinal study examined the developmental trajectories of STBs in children from ages 3 to 17, oversampled for preschool-onset depression. RESULTS Three unique trajectories of STBs across childhood and adolescence were identified: low class (n = 273) characterized by low rates of STBs, early-persistent class (n = 21) characterized by steadily increasing STBs, and late-onset class (n = 21) characterized by low rates of STBs through age 10 followed by a dramatic increase from ages 11 to 14 years. Preschool measures of depression symptoms, externalizing symptoms, impulsivity, and lower income relative to needs were associated with both high-risk STB classes. Both high-risk STB classes reported greater functional impairment, more externalizing symptoms, and more cumulative stressful life events in adolescence relative to the low class; the late-onset class also reported poorer academic functioning relative to both the early-persistent and low classes. CONCLUSION A significant minority of this prospectively followed group of preschool children evidenced STBs by and/or after age 10. Although relatively rare before age 10, approximately half of the children who experienced STBs in adolescence first exhibited STBs in early childhood and comprised a trajectory suggesting increasing STBs. In contrast, approximately half of children first exhibited STBs in early adolescence. Early screening and identification of at-risk youth during both preschool and late childhood is important for early intervention regarding STBs.
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Affiliation(s)
- Diana J Whalen
- Washington University School of Medicine in St. Louis, Missouri.
| | | | | | - Rebecca Tillman
- Washington University School of Medicine in St. Louis, Missouri
| | - Deanna M Barch
- Washington University School of Medicine in St. Louis, Missouri; Washington University in St. Louis, Missouri
| | - Joan L Luby
- Washington University School of Medicine in St. Louis, Missouri
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23
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Liang K, Zhao L, Lei Y, Zou K, Ji S, Wang R, Huang X. Nonsuicidal self-injury behaviour in a city of China and its association with family environment, media use and psychopathology. Compr Psychiatry 2022; 115:152311. [PMID: 35395465 DOI: 10.1016/j.comppsych.2022.152311] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/01/2022] [Accepted: 03/22/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION It is not clear whether there are differences in the risk factors for nonsuicidal self-injury (NSSI) between children and early adolescents. Clarifying this question is crucial for identifying actionable prevention strategies for NSSI in these two age groups. METHOD The study, comprising 8611 children and early adolescents (4409 (51.2%) children, 4202 (48.8%) early adolescents), was based on the baseline data of the Chengdu Positive Child Development (CPCD) in China. NSSI behaviours, emotional and behavioural problems and family environment were assessed and obtained via self-reports and parent reports. RESULTS Overall, 2520 (29.26%) participants reported having ever engaged in NSSI. There was a higher lifetime NSSI rate in males than in females during childhood, contrasting with higher NSSI rates in females than in males during early adolescence. Furthermore, NSSI shared similar risk factors, including major family conflict and poor relationships with caregivers, in both age groups. Specifically, in children, the risk of NSSI increased along with thought and attention problems (OR, 95% CI: 1.194, 1.106-1.288 and 1.114, 1.028-1.207, respectively), whereas in early adolescents, it increased with anxiety and depressive problems (OR, 95% CI: 1.259, 1.116-1.422). CONCLUSIONS The findings suggested the need for difference in preventive strategies for NSSI in the two age groups. It may be more efficacious to screen for NSSI in children with thought and attention problems and in early adolescents with anxiety and depressive problems.
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Affiliation(s)
- Kaili Liang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China; Department of Health Policy and Management, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Li Zhao
- Department of Health Policy and Management, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Yalin Lei
- Department of Health-Related Social and Behavioural Sciences, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Kun Zou
- Department of Child, Adolescent and Maternal Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China; West China Research Center for Rural Health Development, Sichuan University, Chengdu, Sichuan 610041, China; Institute for Healthy Cities, Sichuan University, Chengdu, Sichuan 610041, China
| | - Shuming Ji
- Department of Health Policy and Management, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Ruiou Wang
- West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.
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Campo JV, Bridge JA. Editorial: The Enigma of Suicide Risk in Childhood and Its Evolution Across Development. J Am Acad Child Adolesc Psychiatry 2022; 61:604-605. [PMID: 34823026 DOI: 10.1016/j.jaac.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- John V Campo
- Johns Hopkins University School of Medicine and Kennedy Krieger Institute, Johns Hopkins Children's Center, Baltimore, Maryland.
| | - Jeffrey A Bridge
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, and The Ohio State University College of Medicine, Columbus
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Hovmand PS, Calzada EJ, Gulbas LE, Kim SY, Chung S, Kuhlberg J, Hausmann-Stabile C, Zayas LH. System Dynamics of Cognitive Vulnerabilities and Family Support Among Latina Children and Adolescents. Clin Child Fam Psychol Rev 2022; 25:131-149. [PMID: 35244814 PMCID: PMC8948134 DOI: 10.1007/s10567-022-00395-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/28/2022]
Abstract
The paper describes an approach to developing a data-driven development of a feedback theory of cognitive vulnerabilities and family support focused on understanding the dynamics experienced among Latina children, adolescents, and families. Family support is understood to be a response to avoidant and maladaptive behaviors that may be characteristic of cognitive vulnerabilities commonly associated depression and suicidal ideation. A formal feedback theory is developed, appraised, and analyzed using a combination of secondary analysis of qualitative interviews (N = 30) and quantitative analysis using system dynamics modeling and simulation. Implications for prevention practice, treatment, and future research are discussed.
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Affiliation(s)
- Peter S Hovmand
- School of Medicine, Case Western Reserve University, Cleveland, USA.
| | - Esther J Calzada
- Steve Hicks School of Social Work, The University of Texas, Austin, USA
| | - Lauren E Gulbas
- Steve Hicks School of Social Work, The University of Texas, Austin, USA
| | - Su Yeon Kim
- Department of Human Ecology, The University of Texas, Austin, USA
| | | | | | | | - Luis H Zayas
- Steve Hicks School of Social Work, The University of Texas, Austin, USA
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Oppenheimer CW, Glenn CR, Miller AB. Future Directions in Suicide and Self-Injury Revisited: Integrating a Developmental Psychopathology Perspective. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:242-260. [PMID: 35380885 PMCID: PMC9840868 DOI: 10.1080/15374416.2022.2051526] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The recent rise in suicide rates among children and adolescents has made suicide prevention in youth a major focus of government agencies and mental health organizations. In 2012, Nock presented future directions in the study of self-injurious thoughts and behavior (SITBs), highlighting the need to better examine which risk factors are associated with "each part of the pathway" to suicidal and non-suicidal self-injury in order to inform prevention and intervention efforts. Over the past decade, we have made important advances in understanding the development of SITBs and effective interventions. However, there are still major gaps of knowledge in our understanding of how to prevent suicide. Researchers have recently called for more studies focusing particularly on the pathway from suicidal ideation to suicidal behavior. However, we caution against prioritizing only a part of the suicide risk continuum (e.g., the transition from suicidal ideation to suicidal behavior) while minimizing research focusing on earlier developmental points of the pathway to suicide (e.g., the first development of suicidal ideation). We emphasize that childhood and adolescence represent a critical opportunity to intervene and prevent SITBs by altering developmental trajectories toward persistent and escalating SITBs over time. We advocate for integrating a developmental psychopathology perspective into future youth suicide research that focuses on how and when risk for SITBs first emerges and develops across childhood into emerging adulthood. This research is critical for informing interventions aimed at bending developmental pathways away from all SITBs. Here, we describe the need for future research that integrates key developmental psychopathology principles on 1) the identification of the continuum from developmentally typical to atypical as SITBs first emerge and develop, particularly among young children in early to middle childhood, 2) the way in which expressions of and risk for SITBs change across development, 3) how SITBs dynamically move along a continuum from typical to atypical over time, and 4) suicide prevention efforts. We also offer recommendations for future directions that focus on identifying disparities in SITBs occurring among minoritized youth within a developmental psychopathology perspective.
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Affiliation(s)
- Caroline W Oppenheimer
- RTI International, Mental Health Risk and Resilience Program, Research Triangle Park, North Carolina, USA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Catherine R Glenn
- Department of Psychology, Virginia Consortium Program in Clinical Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Adam Bryant Miller
- RTI International, Mental Health Risk and Resilience Program, Research Triangle Park, North Carolina, USA
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina, USA
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Price JH, Khubchandani J. Hispanic Child Suicides in the United States, 2010-2019. J Community Health 2022; 47:311-315. [PMID: 34997530 DOI: 10.1007/s10900-021-01054-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
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.
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Ramadas S, Vijayakumar S. An attempt of lethal self-harm in a 7-year-old child. ARCHIVES OF MENTAL HEALTH 2022. [DOI: 10.4103/amh.amh_71_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hennefield L, Hao JM, Joiner T, Whalen D, Giorio C, Luby JL. Young children with suicidal thoughts and behaviors more likely to resolve conflicts with violence, homicide, or suicide: A study of internal working models using narratives. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2022; 131:26-33. [PMID: 35230126 PMCID: PMC9439584 DOI: 10.1037/abn0000723] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
There is mounting evidence that young children who express suicidal ideation (SI) have a different conceptualization of death than their peers. This study characterizes 3- to 6-year-olds' depictions of violence, death, and suicidal themes in a story completion task as a function of their history of SI. Participants were 228 children with depression (3.0-6.9 years) who completed a comprehensive psychiatric assessment and four story stem narratives. For each narrative, an interviewer began a story with a conflict that the child was encouraged to resolve. Children's resolutions were coded for standard themes and negative atypical themes including violence and homicide, accidental harm or death, and suicidal ideation/acts. Themes were examined as a function of children's SI status: active-SI (n = 25), passive-SI (n = 28), or no history of SI (n = 175). Across the narratives, 89 children described at least one negative atypical theme: violence or homicide (n = 78), accidental harm or death (n = 22), and suicide (n = 13). The responses of children with active-SI included significantly more violence or homicide than children without SI. Moreover, current active-SI predicted suicidal themes. There were no group differences in accidental harm or death, nor in common aggressive or punitive acts (e.g., hitting, yelling, spanking), indicating specificity between active-SI and more intense violence and death-related themes. In sum, young children with active SI are more likely than their depressed peers without SI to incorporate violence, homicide, and suicide into their narratives around conflict resolution. These themes appear more salient to depressed children with SI and pervasive in their thoughts and problem-solving strategies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Diana Whalen
- Washington University School of Medicine, St Louis, MO
| | | | - Joan L. Luby
- Washington University School of Medicine, St Louis, MO
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Marraccini ME, Drapeau CW, Stein R, Pittleman C, Toole EN, Kolstad M, Tow AC, Suldo SM. Characterizing children hospitalized for suicide-related thoughts and behaviors. Child Adolesc Ment Health 2021; 26:331-338. [PMID: 33779031 PMCID: PMC8476654 DOI: 10.1111/camh.12454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite alarming increases in suicide deaths among preadolescent children, knowledge of the precipitants of suicide risk and the characteristics of children who seek treatment for suicidality is limited. This study's purpose is to describe children (ages 6-12) hospitalized for suicide-related concerns and compare demographic and diagnostic differences between children and adolescent (ages 13-18) patients. METHODS This retrospective study analyzed medical records of 502 children and adolescents ages 6-18 admitted for suicide-related risk to one psychiatric inpatient hospital in southeastern United States between 2015 and 2018. RESULTS Patients were predominantly White (63.5%), female (64.5%), and non-Hispanic/Latino (85.1%). We conducted descriptive analyses and a series of logistic regressions comparing children and adolescents with data extracted from discharge summaries, (i.e. primary reasons for admission, environmental stressors, and diagnostic categories). Common environmental stressors included school (63.2%) and family (60.7%), and the most common diagnosis included depressive disorders. Compared to adolescents, children were more likely to be Black (OR = 1.99), male (OR = 1.94), and receive neurodevelopmental disorder (aOR = 3.0) or trauma and stress-related disorder (aOR = 2.6) diagnoses, but less likely to be diagnosed with a depressive disorder (aOR = 0.4). Across both age-groups, Black patients were more likely to be diagnosed with neurodevelopmental disorders and less likely to receive internalizing disorder diagnoses. CONCLUSIONS Characteristics of children hospitalized for suicide-related risk are relatively similar to characteristics of children dying by suicide. Compared to adolescents, hospitalized children are more likely to be Black, male, and have a neurodevelopmental disorder diagnosis. Proactively identifying and providing strengths-based supports for Black boys and families appear critical for suicide prevention in children.
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Affiliation(s)
- Marisa E Marraccini
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Rachel Stein
- School of Education and Human Development, University of Colorado, Denver, Denver, CO, USA
| | - Cari Pittleman
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Emily N Toole
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Molly Kolstad
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amanda C Tow
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shannon M Suldo
- College of Education, University of South Florida, Tampa, FL, USA
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Greenfield B, Jolicoeur-Martineau A, Brown M, Kandiyoti A, Henry M, Sasson T, Ahmadi S, Vivani T, Harnden B, de Castro F, Tran B, Boodaghians L, Weiss M, Atsaidis Z, Wazana A. Frequent follow-up of suicidal youth assessed in the emergency room: Long-term trajectory and predictors of suicidality. Prev Med 2021; 152:106737. [PMID: 34538378 DOI: 10.1016/j.ypmed.2021.106737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022]
Abstract
UNLABELLED Suicide was the second‑leading cause of US deaths in 2018 among 15-24-year-olds. Suicide attempts, a risk factor for completions, and suicide ideation have doubled among pediatric emergency room (ER) patients during the past decade. Borderline Personality Disorder (BPD), a comorbid condition, has a 10% suicide rate. We examined the 4-year outcome of a cohort of suicidal adolescents, many also suffering from BPD and having undergone some form of treatment, to identify baseline factors which could inform intervention that would minimize suicidality 4 years post-discharge. METHODS We conducted a prospective longitudinal study of suicidality at twelve points (four assessment occasions) for 286 suicidal youth presenting to a pediatric ER, most suffering from BPD, with 36 suicide ratings from baseline to 2-, 6- and 48-month follow-up evaluations. We examined the trajectory and predictors of persisting suicidality. RESULTS Suicidality rapidly decreased within 2 months post-ER-discharge, subsequently remaining low throughout 48 months. Baseline functioning, female sex, stressful life events and BPD impulsiveness were most predictive of persisting suicidality at 48-month follow-up. CONCLUSION Most suicidal youth, many meeting BPD criteria, no longer feel suicidal 2 months after ER discharge. Management of participants' baseline poor functioning stressful life events and the impulsiveness component of BPD specifically in females could impact suicidality 4 years later, and guide treatment options. The absence of the BPD cognitive and affective subscales as predictors of suicidality at 4-year follow-up may reflect treatment received. Further investigation of treatment effects is warranted and under way.
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Affiliation(s)
- Brian Greenfield
- Department of Psychiatry, Faculty of Medicine, McGill University, Canada
| | - Alexia Jolicoeur-Martineau
- Mila, University of Montréal, Montréal, QC, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Maria Brown
- Department of Educational & Counselling Psychology, McGill University, Montréal, QC, Canada
| | - Alegra Kandiyoti
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Melissa Henry
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Gerald Bronfman Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; Segal Cancer Centre, Jewish General Hospital, Canada
| | - Tania Sasson
- Department of Physical Medicine & Rehabilitation, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Tania Vivani
- Department of Psychology, Universite de Quebec a Montreal, Montréal, QC, Canada
| | - Bonnie Harnden
- Department of Creative Arts Therapies, Faculty of Fine Arts, Concordia University, Montréal, QC, Canada
| | - Filipa de Castro
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Brian Tran
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Levon Boodaghians
- Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Margaret Weiss
- Child Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA
| | - Zoe Atsaidis
- Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Ashley Wazana
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; Centre for Child Development and Mental Health, Jewish General Hospital, Montréal, QC, Canada.
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32
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Abstract
Suicides are among the 10 leading causes of death in U.S. children 12 years of age and younger. The purpose of this study was to examine trends and methods of suicide in children by race and gender from 2010 to 2019, the most recent years of data available from the Centers for Disease Control and Prevention. Child suicides statistically significantly increased for black (95%), white (158%), male (95%), and female (300%) children during the decade. Additionally, the methods children used to commit suicide did not significantly differ by race or gender. The leading method of suicide used by children was strangulation/suffocation depending on race and gender (67%-85%). The second most common method of suicide was by the use of a firearm, again depending on race and gender (11%-30%). Northeastern states had the fewest child suicides during the decade and Texas and California had the most child suicides. Policymakers need to commit more resources and research funding to better detect risk factors, protective factors, and effective interventions for reducing child suicides.
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Lawrence HR, Burke TA, Sheehan AE, Pastro B, Levin RY, Walsh RFL, Bettis AH, Liu RT. Prevalence and correlates of suicidal ideation and suicide attempts in preadolescent children: A US population-based study. Transl Psychiatry 2021; 11:489. [PMID: 34552053 PMCID: PMC8458398 DOI: 10.1038/s41398-021-01593-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 08/16/2021] [Accepted: 09/01/2021] [Indexed: 12/16/2022] Open
Abstract
The present study evaluated sociodemographic and diagnostic predictors of suicidal ideation and attempts in a nationally representative sample of preadolescent youth enrolled in the Adolescent Brain Cognitive Development Study. Rates and predictors of psychiatric treatment utilization among suicidal youth also were examined. Eleven thousand eight hundred and seventy-five 9- and 10-year-old children residing in the United States were assessed. Children and their parents/guardians provided reports of children's lifetime history of suicidal ideation, suicide attempts, and psychiatric disorders. Parents also reported on sociodemographic characteristics and mental health service utilization. Multivariate logistic regression analyses were employed to evaluate sociodemographic and diagnostic correlates of suicidal ideation, suicide attempts among youth with suicidal ideation, and treatment utilization among youth with suicidal ideation and suicide attempts. Lifetime prevalence rates were 14.33% for suicidal ideation and 1.26% for suicide attempts. Youth who identified as male, a sexual minority, or multiracial had greater odds of suicidal ideation, and sexual minority youth and youth with a low family income had greater odds of suicide attempts. Comorbid psychopathology was associated with higher odds of both suicidal ideation and suicide attempts. In youth, 34.59% who have suicidal ideation and 54.82% who had attempted suicide received psychiatric treatment. Treatment utilization among suicidal youth was lower among those who identified as female, Black, and Hispanic. Suicidal ideation and attempts among preadolescent children are concerningly high and targeted assessment and preventative efforts are needed, especially for males, racial, ethnic, and sexual minority youth, and those youth experiencing comorbidity.
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Affiliation(s)
- Hannah R. Lawrence
- grid.240206.20000 0000 8795 072XDepartment of Psychiatry, McLean Hospital, Belmont, CA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Taylor A. Burke
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Ana E. Sheehan
- grid.33489.350000 0001 0454 4791Department of Psychological and Brain Sciences, University of Delaware, Newark, DE USA
| | - Brianna Pastro
- grid.240206.20000 0000 8795 072XDepartment of Psychiatry, McLean Hospital, Belmont, CA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Rachel Y. Levin
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Rachel F. L. Walsh
- grid.264727.20000 0001 2248 3398Department of Psychology, Temple University, Philadelphia, PA USA
| | - Alexandra H. Bettis
- grid.412807.80000 0004 1936 9916Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN USA
| | - Richard T. Liu
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
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Ruch DA, Heck KM, Sheftall AH, Fontanella CA, Stevens J, Zhu M, Horowitz LM, Campo JV, Bridge JA. Characteristics and Precipitating Circumstances of Suicide Among Children Aged 5 to 11 Years in the United States, 2013-2017. JAMA Netw Open 2021; 4:e2115683. [PMID: 34313741 PMCID: PMC8317003 DOI: 10.1001/jamanetworkopen.2021.15683] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Suicide is the eighth leading cause of death among children aged 5 to 11 years, with rates increasing during the past decade. A better understanding of factors associated with childhood suicide can inform developmentally appropriate prevention strategies. OBJECTIVE To examine characteristics and precipitating circumstances of childhood suicide. DESIGN, SETTING, AND PARTICIPANTS This qualitative study examined restricted-use data from the National Violent Death Reporting System (NVDRS) regarding child suicide decedents aged 5 to 11 years in the US from 2013 to 2017. The NVDRS is a state-based surveillance system that collects data on suicide and violent deaths in 50 states, with restricted-use data available from 37 states. Details and context related to suicide deaths were identified through a content analysis of case narratives from coroner or medical examiner and law enforcement reports associated with each incident. EXPOSURES Characteristics and precipitating circumstances associated with suicide cited in the coroner, medical examiner, and law enforcement case narratives. MAIN OUTCOMES AND MEASURES Suicide incidence and risk factors for suicide including mental health, prior suicidal behavior, trauma, and peer, school, or family-related problems. RESULTS Analyses included 134 child decedents (101 [75.4%] males; 79 [59.0%] White individuals; 109 [81.3%] non-Hispanic individuals; mean [SD] age, 10.6 [0.8] years). Most suicides occurred in the child's home (95.5% [n = 128]), and more specifically in the child's bedroom. Suicide by hanging or suffocation (78.4% [n = 105]) was the most frequent method, followed by firearms (18.7% [n = 25]). Details on gun access were noted in 88.0% (n = 22) of suicides by firearm, and in every case, the child obtained a firearm stored unsafely in the home. Findings revealed childhood suicide was associated with numerous risk factors accumulated over time, and suggest a progression toward suicidal behavior, especially for youth with a history of psychopathology and suicidal behavior. An argument between the child and a family member and/or disciplinary action was often a precipitating circumstance of the suicide. CONCLUSIONS AND RELEVANCE This qualitative study found that childhood suicide was associated with multiple risk factors and commonly preceded by a negative precipitating event. Potential prevention strategies include improvements in suicide risk assessment, family relations, and lethal means restriction, particularly safe firearm storage. Future research examining the myriad aspects of childhood suicide, including racial/ethnic and sex differences, is needed.
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Affiliation(s)
- Donna A. Ruch
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus
| | - Kendra M. Heck
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus
| | - Arielle H. Sheftall
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Cynthia A. Fontanella
- The Ohio State University Wexner Medical Center Department of Psychiatry and Behavioral Health, Columbus
| | - Jack Stevens
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Motao Zhu
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Lisa M. Horowitz
- National Institute of Mental Health, National Institutes of Health, Office of the Clinical Director, Bethesda, Maryland
| | - John V. Campo
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland
| | - Jeffrey A. Bridge
- Center for Suicide Prevention and Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
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Prediction of suicidal ideation and attempt in 9 and 10 year-old children using transdiagnostic risk features. PLoS One 2021; 16:e0252114. [PMID: 34033672 PMCID: PMC8148349 DOI: 10.1371/journal.pone.0252114] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/10/2021] [Indexed: 11/19/2022] Open
Abstract
The objective of the current study was to build predictive models for suicidal ideation in a sample of children aged 9–10 using features previously implicated in risk among older adolescent and adult populations. This case-control analysis utilized baseline data from the Adolescent Brain and Cognitive Development (ABCD) Study, collected from 21 research sites across the United States (N = 11,369). Several regression and ensemble learning models were compared on their ability to classify individuals with suicidal ideation and/or attempt from healthy controls, as assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia–Present and Lifetime Version. When comparing control participants (mean age: 9.92±0.62 years; 4944 girls [49%]) to participants with suicidal ideation (mean age: 9.89±0.63 years; 451 girls [40%]), both logistic regression with feature selection and elastic net without feature selection predicted suicidal ideation with an AUC of 0.70 (CI 95%: 0.70–0.71). The random forest with feature selection trained to predict suicidal ideation predicted a holdout set of children with a history of suicidal ideation and attempt (mean age: 9.96±0.62 years; 79 girls [41%]) from controls with an AUC of 0.77 (CI 95%: 0.76–0.77). Important features from these models included feelings of loneliness and worthlessness, impulsivity, prodromal psychosis symptoms, and behavioral problems. This investigation provided an unprecedented opportunity to identify suicide risk in youth. The use of machine learning to examine a large number of predictors spanning a variety of domains provides novel insight into transdiagnostic factors important for risk classification.
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Geselowitz B, Whalen DJ, Tillman R, Barch DM, Luby JL, Vogel A. Preschool Age Predictors of Adolescent Borderline Personality Symptoms. J Am Acad Child Adolesc Psychiatry 2021; 60:612-622. [PMID: 32950651 PMCID: PMC8056867 DOI: 10.1016/j.jaac.2020.07.908] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/08/2020] [Accepted: 08/27/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Developmental models of borderline personality disorder (BPD) have highlighted the interplay of psychological variables (ie, impulsivity and emotional reactivity) with social risk factors, including invalidating parenting and childhood trauma. Prospective longitudinal studies have demonstrated the association of BPD with social, familial, and psychological antecedents. However, to date, few of these studies have studied the interaction of multiple risk domains and their potential manifestations in the preschool period. METHOD Participants were 170 children enrolled in a prospective longitudinal study of early childhood depression. Participants completed a baseline assessment between ages 3 and 6 years. Psychopathology, suicidality, and self-harm were assessed using a semistructured age-appropriate psychiatric interview before age 8 and self-report after age 8. BPD symptoms were assessed between ages 14 and 19 by self-report. Adverse childhood experiences (ACEs) and peer relationships were reported by parents. Maternal support was assessed using an observational measure between ages 3 and 6. RESULTS Preschool ACEs accounted for 14.9% of adolescent BPD symptom variance in a regression analysis. Controlling for gender and preschool ACEs, preschool and school-age externalizing symptoms, preschool internalizing symptoms, and low maternal support were significant predictors of BPD symptoms in multivariate analyses. Preschool and school-age suicidality composite scores significantly predicted BPD symptoms. CONCLUSION These findings suggest that preschool factors may be early predictors of BPD symptoms. Findings demonstrate that preschoolers with internalizing and externalizing psychopathology, high ACEs, and early suicidality are at greater risk of developing BPD symptoms. However, further research is needed to guide key factors for targeted early intervention.
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Affiliation(s)
- Ben Geselowitz
- Washington University School of Medicine, St. Louis, Missouri
| | - Diana J Whalen
- Washington University School of Medicine, St. Louis, Missouri
| | - Rebecca Tillman
- Washington University School of Medicine, St. Louis, Missouri
| | - Deanna M Barch
- Washington University School of Medicine, St. Louis, Missouri
| | - Joan L Luby
- Washington University School of Medicine, St. Louis, Missouri
| | - Alecia Vogel
- Washington University School of Medicine, St. Louis, Missouri.
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James KM, Kudinova AY, Woody ML, Feurer C, Foster CE, Gibb BE. Children's history of suicidal ideation and synchrony of facial displays of affect during mother-child interactions. J Child Psychol Psychiatry 2021; 62:40-47. [PMID: 32157696 PMCID: PMC7483382 DOI: 10.1111/jcpp.13231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Suicidal thoughts and behavior can begin early in childhood and are a leading cause of death in youth. Although specific mechanisms of risk remain largely unknown, theorists and researchers highlight the importance of the parent-child relationship. The current study focused on one aspect of this relationship: the dynamic exchange of facial affect during interactions. Specifically, we examined the relation between children's history of suicidal ideation (SI) and synchrony of facial expressions during positive and negative mother-child interactions. METHODS Participants were 353 mother-child dyads. Of these, 44 dyads included a child with an SI history. Dyads engaged in positive and negative discussions during which their facial electromyography was recorded from mothers and children to index second-to-second changes in positive (zygomaticus) and negative (corrugator) facial affect. RESULTS Child SI dyads were characterized specifically by reduced synchrony of positive facial affect during the positive discussion compared to dyads without child SI. CONCLUSIONS These findings suggest child SI dyads exhibit reduced synchrony of normative positive expressions during mother-child interactions. If replicated and extended in longitudinal research, these results may help to explain one mechanism of risk among children with SI.
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Affiliation(s)
- Kiera M. James
- Department of Psychology, Binghamton University, State University of New York, Binghamton, NY, USA
| | | | - Mary L. Woody
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cope Feurer
- Department of Psychology, Binghamton University, State University of New York, Binghamton, NY, USA
| | - Claire E. Foster
- Department of Psychology, Binghamton University, State University of New York, Binghamton, NY, USA
| | - Brandon E. Gibb
- Department of Psychology, Binghamton University, State University of New York, Binghamton, NY, USA
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Ayer L, Colpe L, Pearson J, Rooney M, Murphy E. Advancing Research in Child Suicide: A Call to Action. J Am Acad Child Adolesc Psychiatry 2020; 59:1028-1035. [PMID: 32145297 DOI: 10.1016/j.jaac.2020.02.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/14/2020] [Accepted: 02/27/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To highlight the problem of child suicide, summarize what is known and not known about the problem in the empirical literature, and provide recommendations with ethical considerations for future research and practice. METHOD The development of this paper was informed by a meeting of national experts on the topic hosted by the National Institute of Mental Health, as well as by a review of the empirical literature. RESULTS We know something about demographic characteristics that are related to higher child suicide rates, but beyond that we know relatively little about risk factors, prevention, and intervention for suicide risk in children <12 years. It is important for child suicide researchers and practitioners to pay particular attention to ethical issues that may be likely to arise in doing this type of work. CONCLUSION Much more research is needed on child suicide in the areas of measurement, prevention, and intervention in order to advance the field and provide practitioners with the tools that they critically need.
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Affiliation(s)
| | - Lisa Colpe
- National Institute of Mental Health, Rockville, Maryland
| | - Jane Pearson
- National Institute of Mental Health, Rockville, Maryland
| | - Mary Rooney
- National Institute of Mental Health, Rockville, Maryland
| | - Eric Murphy
- National Institute of Mental Health, Rockville, Maryland
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Gigengack MR, Hein IM, van Meijel EPM, Lindeboom R, van Goudoever JB, Lindauer RJL. Accuracy of the Diagnostic Infant and Preschool Assessment (DIPA) in a Dutch sample. Compr Psychiatry 2020; 100:152177. [PMID: 32360141 DOI: 10.1016/j.comppsych.2020.152177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND To prevent negative effects of early-onset psychiatric disorders on children's development, structured diagnostics are needed. However, validated diagnostic instruments (based on DSM-5) for children aged 7 years and younger are scarce. The Diagnostic Infant and Preschool Assessment (DIPA) is a diagnostic interview developed in the USA for measuring 16 psychiatric disorders in young children. The psychometric properties of the American version of the DIPA have been validated. Here we determined the accuracy of the psychometric properties of the Dutch DSM-5 based version of the DIPA for the corresponding population. MATERIAL AND METHODS Psychometric properties of the DSM-5 based version of the DIPA were determined based on a sample of 136 biological, foster, therapeutic foster and adoptive parents of clinically referred children and children involved in a serious accident (aged 1-7 years). In line with the American validation study, we included the following seven DIPA modules: posttraumatic stress disorder (PTSD), major depressive disorder (MDD), attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), separation anxiety disorder (SAD), generalized anxiety disorder (GAD), and obsessive-compulsive disorder (OCD). We administered the DIPA, Trauma Symptom Checklist for Young Children (TSCYC) and Child Behavior Checklist (CBCL). Analyses were conducted with continuous outcomes (number of symptoms) and categorical outcomes (diagnoses). RESULTS The Dutch DSM-5 based version of the DIPA showed good internal consistency and interrater reliability with both continuous and categorical variables. The concurrent validity was good; we found a good concordance between the DIPA and corresponding questionnaires on both the symptom and diagnoses level. In addition, the divergence on symptom level between the DIPA and non-corresponding questionnaires was adequate, which indicated adequate divergent validity. Due to a limited number of positive cases, we could not draw conclusions regarding its psychometric properties in the GAD and OCD modules. CONCLUSIONS Our study shows promising initial results regarding the reliability and validity of the Dutch version of the DIPA, that is based on the DSM-5. Therefore, we recommend the use of the DIPA in research and clinical practice.
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Affiliation(s)
- Maj R Gigengack
- Amsterdam UMC, University of Amsterdam, Department of Child and Adolescent Psychiatry, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; De Bascule, Academic Center for Child and Adolescent Psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands.
| | - Irma M Hein
- Amsterdam UMC, University of Amsterdam, Department of Child and Adolescent Psychiatry, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; De Bascule, Academic Center for Child and Adolescent Psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands.
| | - Els P M van Meijel
- Amsterdam UMC, University of Amsterdam, Department of Child and Adolescent Psychiatry, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; De Bascule, Academic Center for Child and Adolescent Psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands.
| | - Robert Lindeboom
- Amsterdam UMC, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Master Evidence based practice in Health Care, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - Johannes B van Goudoever
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Department of Pediatrics, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Ramón J L Lindauer
- Amsterdam UMC, University of Amsterdam, Department of Child and Adolescent Psychiatry, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; De Bascule, Academic Center for Child and Adolescent Psychiatry, Meibergdreef 5, 1105 AZ, Amsterdam, the Netherlands.
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Dir AL, Allebach CL, Hummer TA, Adams ZW, Aalsma MC, Finn PR, Nurnberger JI, Hulvershorn LA. Atypical Cortical Activation During Risky Decision Making in Disruptive Behavior Disordered Youths With Histories of Suicidal Ideation. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:510-519. [PMID: 32007432 PMCID: PMC10568982 DOI: 10.1016/j.bpsc.2019.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Suicidality is a leading cause of death among adolescents. In addition to other psychiatric conditions, youths with attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (DBDs) are at heightened risk for suicide. Decision-making deficits are a hallmark symptom of ADHD and DBDs and are also implicated in suicidal behavior. We examined behavioral and neural differences in decision making among youths with ADHD and DBDs with (SI+) and without (SI-) histories of suicidal ideation. METHODS The Balloon Analog Risk Task, a risky decision-making task, was completed by 57 youths with ADHD and DBDs (38% SI+) during functional magnetic resonance imaging. Mean stop wager (mean wager at which youths bank money) was the primary measure of risk taking. We conducted whole-brain and region-of-interest analyses in the anterior cingulate cortex and orbitofrontal cortex (OFC) during choice (win vs. inflate) and outcome (inflate vs. explode) contrasts using parametric modulators accounting for probability of balloon explosion. RESULTS There were no differences between SI+ and SI- youths in Balloon Analog Risk Task performance. SI+ youths showed decreasing activation in the right medial frontal gyrus when choosing inflate as explosion probability increased compared with SI- youths. During explosions, SI- youths showed increasing activation in the left OFC as explosions became more likely. SI+ showed increasing left medial OFC activity in response to inflations as explosion probability increased. CONCLUSIONS SI+ youths may show heightened sensitivity to immediate reward and decreased sensitivity to potential loss as evidenced by medial frontal gyrus activity. OFC findings suggest that SI+ youths may be drawn to reward even when there is high probability of loss.
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Affiliation(s)
- Allyson L Dir
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana; Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, Indiana
| | - Christian L Allebach
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Tom A Hummer
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Zachary W Adams
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana; Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, Indiana
| | - Matthew C Aalsma
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, Indiana; Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Peter R Finn
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - John I Nurnberger
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Leslie A Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana.
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Abstract
Preschoolers are presenting in increasing numbers to primary care providers and mental health clinics with emotional and behavioural impairment. Preschoolers in the US have the highest rates of school expulsion of all age groups. Because young children are limited in their capacity to convey distress and internal states, impairment is most often expressed behaviourally. Disruptive behaviour, frequently in the form of aggression or dysregulation, is a final common pathway for many disorders in this age group. Tools and training to diagnose pre-school disorders are limited, and while some effective non-medication interventions exist, the evidence base for medication use in this age group is extremely limited. This article reviews approaches to assessing common pre-school disorders including attention deficit hyperactivity disorder (ADHD), disruptive behaviour disorders, anxiety and mood disorders, perceptual disturbances and psychosis, and trauma related disorders. The evidence base for both therapeutic and psychopharmacologic interventions for these disorders is discussed.
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Affiliation(s)
- Nadia Zaim
- Division of Child and Adolescent Psychiatry, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joyce Harrison
- Division of Child and Adolescent Psychiatry, The Johns Hopkins Hospital, Baltimore, MD, USA.,Department of Psychiatry, Kennedy Krieger Institute, Baltimore, MD, USA
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Liu RT. Prevalence of and Factors Associated With Self-injurious Thoughts and Behaviors in a Nationally Representative Sample of Preadolescent Children in Great Britain. JAMA Pediatr 2020; 174:202-204. [PMID: 31886832 PMCID: PMC6990688 DOI: 10.1001/jamapediatrics.2019.5048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This cross-sectional study examines data from the 1999 and 2004 surveys of Mental Health of Children and Young People in Great Britain to assess the prevalence of self-injurious thoughts and behaviors in a nationally representative sample of preadolescent individuals.
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Affiliation(s)
- Richard T. Liu
- Alpert Medical School, Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island
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Studart-Bottó P, Martins-Junior DF, Sarmento S, Argolo L, Galvão-de-Almeida A, Miranda-Scippa Â. Self-injurious behavior and related mortality in children under 10 years of age: a retrospective health record study in Brazil. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2020; 42:40-45. [PMID: 31389497 PMCID: PMC6986482 DOI: 10.1590/1516-4446-2018-0355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 04/23/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe and analyze data on self-injurious behavior (SIB) and related mortality in children under 10 years old in Brazil. METHODS A descriptive study was performed using secondary public health care data extracted from the Hospital Information System (Sistema de Informações Hospitalares, SIH) and Mortality Information System (Sistema de Informações sobre Mortalidade, SIM) in Brazil. The databases are available for online access at http://datasus.saude.gov.br/. RESULTS In Brazil, according to SIH data, 11,312 hospitalizations of patients under 10 years of age were recorded from 1998 to 2018 as resulting from SIB (ICD-10 X60-X84 codes). Of these, 65 resulted in death. According to the SIM, from 1996 to 2016, 91 deaths related to SIB were recorded, 81 (89%) in children aged 5 to 9 years, nine (9.9%) in children aged 1 to 4 years, and one (1.1%) in a child below 1 year of age. CONCLUSION These results highlight the relevance of creating measures to better understand SIB and related mortality in this age group. They also reveal the vulnerability of children in Brazil and warrant further studies to address these issues.
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Affiliation(s)
- Paula Studart-Bottó
- Ambulatório de Transtorno do Humor e Ansiedade (CETHA), Complexo Hospitalar Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brazil
| | - Davi F. Martins-Junior
- Ambulatório de Transtorno do Humor e Ansiedade (CETHA), Complexo Hospitalar Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brazil
- Departamento de Saúde, Universidade Estadual de Feira de Santana (UEFS), Feira de Santana, BA, Brazil
| | - Stella Sarmento
- Ambulatório de Transtorno do Humor e Ansiedade (CETHA), Complexo Hospitalar Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Lucas Argolo
- Ambulatório de Transtorno do Humor e Ansiedade (CETHA), Complexo Hospitalar Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brazil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Salvador, BA, Brazil
| | - Amanda Galvão-de-Almeida
- Ambulatório de Transtorno do Humor e Ansiedade (CETHA), Complexo Hospitalar Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
- Departamento de Neurociência e Saúde Mental, Faculdade de Medicina, UFBA, Salvador, BA, Brazil
| | - Ângela Miranda-Scippa
- Ambulatório de Transtorno do Humor e Ansiedade (CETHA), Complexo Hospitalar Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brazil
- Departamento de Neurociência e Saúde Mental, Faculdade de Medicina, UFBA, Salvador, BA, Brazil
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Abstract
PURPOSE OF REVIEW We review findings related to predictors, correlates, outcomes, and treatment of preschool depression that have been published in the last 3 years. RECENT FINDINGS Preschool depression displays a chronic course through late adolescence and is associated with temperamental and personality traits, poorer physical health, and negative parenting practices. Preschool depression predicts deficits into adolescence, including social difficulties and blunted neural response to rewards. Depressed preschoolers can experience suicidal ideation and behaviors and display an accurate understanding of the finality of death. A treatment for preschool depression has now been validated that uses the parent-child relationship to enhance emotion development and reduce depressive symptoms. Preschool depression is homotypic with depression that occurs later in life. Future work elucidating mechanisms through which preschool depression develops and informs the sub-groups for which particular treatments may be most effective will have considerable implications for prevention and early intervention.
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Affiliation(s)
- Meghan Rose Donohue
- Department of Psychiatry, Washington University School of Medicine, 4444 Forest Park Avenue, Suite 2500, St. Louis, MO, 63110, USA.
| | - Diana J Whalen
- Department of Psychiatry, Washington University School of Medicine, 4444 Forest Park Avenue, Suite 2500, St. Louis, MO, 63110, USA
| | - Kirsten E Gilbert
- Department of Psychiatry, Washington University School of Medicine, 4444 Forest Park Avenue, Suite 2500, St. Louis, MO, 63110, USA
| | - Laura Hennefield
- Department of Psychiatry, Washington University School of Medicine, 4444 Forest Park Avenue, Suite 2500, St. Louis, MO, 63110, USA
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine, 4444 Forest Park Avenue, Suite 2500, St. Louis, MO, 63110, USA
- Department of Psychology, Washington University, St. Louis, MO, USA
- Department of Radiology, Washington University, St. Louis, MO, USA
| | - Joan Luby
- Department of Psychiatry, Washington University School of Medicine, 4444 Forest Park Avenue, Suite 2500, St. Louis, MO, 63110, USA
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Ortin A, Elkington KS, Eisenberg R, Miranda R, Canino G, Bird HR, Duarte CS. Suicide Attempts and Course of Suicidal Ideation among Puerto Rican Early Adolescents. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 47:1723-1734. [PMID: 31065859 PMCID: PMC8295715 DOI: 10.1007/s10802-019-00554-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Suicidal behavior increases substantially during early adolescence, a critical understudied developmental period. This study reports on the prevalence of suicidal ideation, suicide attempts, and course of suicidal ideation among Puerto Rican early adolescents, a high-risk group for suicidal behavior in adulthood. Gender differences and the prospective association of psychiatric disorders with course of suicidal ideation are examined. Participants were 1228 Puerto Rican adolescents (ages 10-13 at wave 1; 48% female) and parents, selected through probability-based sampling, assessed yearly across three waves. Adolescents and parents reported via Diagnostic Interview Schedule for Children-IV about 12-month suicide attempts and suicidal ideation (further categorized as never present, onset, recurrence, and remission), mood and anxiety disorders; parents reported on disruptive disorders. Over the three waves, 9.5% early adolescents thought about suicide and 2.1% attempted suicide. In adjusted multinomial regression models, compared to those with never present suicidal ideation, female gender was related to onset of suicidal ideation (OR = 2.60; 95% CI, 1.22-5.55). Disruptive disorders were related to onset (OR = 5.80; 95% CI, 2.06-16.32) and recurrence of suicidal ideation (OR = 5.07, 95% CI, 1.14-22.47), mood disorders were related to remission (OR = 14.42, 95% CI, 3.90-53.23), and anxiety disorders to onset of suicidal ideation (OR = 3.68, 95% CI, 1.75-7.73). Our findings inform strategies tailored for early adolescents. To address onset of suicidal ideation, prevention should focus on girls and those with anxiety or disruptive disorders. When ideation is recurrent, interventions oriented to reduce disruptive behavior and its consequences may help achieve remission.
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Affiliation(s)
- Ana Ortin
- Department of Psychology, Hunter College, City University of New York, 695 Park Avenue, Room 611HN, New York, NY, 10065, USA
| | - Katherine S Elkington
- Division of Gender, Sexuality and Health, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Ruth Eisenberg
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer Building, Room 1303, Bronx, NY, 10461, USA
| | - Regina Miranda
- Department of Psychology, Hunter College, City University of New York, 695 Park Avenue, Room 611HN, New York, NY, 10065, USA
- The Graduate Center, City University of New York, 365 5th Avenue, New York, NY, 10016, USA
| | - Glorisa Canino
- Behavioral Sciences Research Institute, Medical Sciences Campus, University of Puerto Rico School of Medicine, Office A928 9th Floor, Rio Piedras, PR, 00935, USA
| | - Hector R Bird
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, Unit 43, New York, NY, 10032, USA
| | - Cristiane S Duarte
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, Unit 43, New York, NY, 10032, USA.
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Zhu X, Tian L, Huebner ES. Trajectories of Suicidal Ideation from Middle Childhood to Early Adolescence: Risk and Protective Factors. J Youth Adolesc 2019; 48:1818-1834. [PMID: 31346925 DOI: 10.1007/s10964-019-01087-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/15/2019] [Indexed: 12/13/2022]
Abstract
Suicidal ideation is considered to be the first step on the pathway to suicide. Despite the fact that suicidal ideation is surprisingly prevalent among preadolescent children in China and elsewhere, and despite its possible increase during the transition into adolescence, its developmental patterns and predictors during this period are unclear, thus precluding a meaningful understanding of its determinants and possible trajectories. Thus, this study aimed to identify suicidal ideation trajectories and multisystemic predictors covering the transition from middle childhood to early adolescence. A total of 715 Chinese elementary school students (Mage = 8.95, SD = 0.71; 54.5% was male) participated in assessments at six time points, using six-month assessment intervals. Growth mixture modeling analyses extracted three distinct trajectories of suicidal ideation: "low-stable" (86.4%), "moderate-increasing" (7.1%) and "high-start" (6.5%). Multivariate logistic regression analyses revealed that social anxiety and academic anxiety served as risk factors for the adverse developmental trajectories of suicidal ideation; whereas self-esteem, life satisfaction, and academic achievement served as protective factors for the positive developmental trajectory of suicidal ideation. The identification of three subgroups with unique predictors highlights the importance of individual difference considerations in understanding the progression of suicidal ideation in childhood and adolescence and the need for specific programs tailored to the unique characteristics of the relevant trajectories. Furthermore, given that suicidal ideation may start in a proportion of middle childhood youths and continue into adolescence, the middle childhood period should provide an important window of opportunity for large-scale screening and prevention of the escalation of suicidality in adolescence.
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Affiliation(s)
- Xinxin Zhu
- School of Psychology, South China Normal University, Guangzhou, 510631, People's Republic of China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, People's Republic of China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, People's Republic of China
| | - Lili Tian
- School of Psychology, South China Normal University, Guangzhou, 510631, People's Republic of China.
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, People's Republic of China.
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, People's Republic of China.
| | - E Scott Huebner
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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Characteristics of Child Psychiatric Outpatients at Highest Risk for Suicidal Thoughts and Behaviors. Child Psychiatry Hum Dev 2019; 50:505-519. [PMID: 30656508 DOI: 10.1007/s10578-018-0858-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
On average, compared to non-referred youth, child psychiatric outpatients show elevated rates of suicidal thoughts and behaviors (STBs), which are predictors of completed suicide. Determining the psychopathology features that associate with highest risk for STBs among youth outpatients may yield opportunities for targeted prevention/intervention. Yet, outpatient studies are limited and have not systematically examined comorbidity and dimensional psychopathology. In 758 youth, aged 6-18, consecutively referred for neuropsychiatric evaluation, we examined the extent to which diagnostic groups, comorbid subgroups and dimensional symptoms associated with STBs. After controlling for comorbidity, mood, anxiety and conduct disorders associated with elevated STB risk. Regarding dimensions, symptoms of depression, aggression and psychosis all contributed to higher STB risk. Although ADHD (as a diagnosis or dimension) did not associate with elevated STB risk independently, ADHD that was comorbid with other conditions did. Suicide prevention/intervention efforts should be investigated in youth outpatients with the highest risk for STBs.
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Hennefield L, Whalen DJ, Wood G, Chavarria MC, Luby JL. Changing Conceptions of Death as a Function of Depression Status, Suicidal Ideation, and Media Exposure in Early Childhood. J Am Acad Child Adolesc Psychiatry 2019; 58:339-349. [PMID: 30768413 PMCID: PMC6401239 DOI: 10.1016/j.jaac.2018.07.909] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/05/2018] [Accepted: 08/15/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study characterized 3- to 6-year-old children's understanding of death as a function of depression status, suicidal ideation (SI), and media consumption. METHOD Participants were 79 children with depression (3.0-6.11 years old) who completed a comprehensive psychiatric assessment and experimenter-led death interview and a comparison group of 60 healthy children (4.0-7.12 years old). The interview assessed children's understanding of 5 concepts of death: universality, applicability, irreversibility, cessation, and causality. Children's mastery of each concept and overall understanding of death was examined as a function of depression and SI status: depressed with SI (n = 22), depressed without SI (n = 57), and healthy (n = 60). Children's observed emotional reactions to hearing about natural death, accidental death, and suicide were assessed by death-themed stories. Parent reports of children's television and videogames/internet consumption assessed links between media exposure and understanding of death. RESULTS Children with depression and SI scored higher on overall understanding of death than those with depression without SI and healthy children. They also exhibited more sad and anxious affect listening to death-themed stories and were more likely to describe death as caused by violence. Across this sample, older children also were more likely to depict death as violent. More television use was associated with less understanding of death, including the concept of irreversibility. CONCLUSION Children with depression and SI have a more advanced understanding of death than their peers, dispelling the myth that these ideations arise in the context of a poor understanding of death. The increase in violence attributions across early childhood could indicate increasing normalization of violence in children's perceptions of death. CLINICAL TRIAL REGISTRATION INFORMATION A Randomized Controlled Trial of PCIT-ED for Preschool Depression; http://clinicaltrials.gov; NCT00595283.
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Affiliation(s)
| | | | - Grace Wood
- Washington University School of Medicine, St. Louis, MO
| | | | - Joan L Luby
- Washington University School of Medicine, St. Louis, MO
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Gleason MM. Editorial: Young Children and Suicidal Ideations: Developmentally Specific Symptoms Call for Developmentally Specific Interventions. J Am Acad Child Adolesc Psychiatry 2019; 58:315-316. [PMID: 30832903 DOI: 10.1016/j.jaac.2018.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/10/2018] [Indexed: 11/29/2022]
Abstract
The field of psychopathology in young children has made substantial strides in the past 3 decades, moving from discussions of whether disorders can be reliably diagnosed to sophisticated analyses of specific symptoms. In this issue, Hennefield et al.1 explore the presentation of suicidal ideations (SIs) in children younger than 7 years. The validity of criteria for major depression in this age group is well established, but suicidality is a newer focus of research that, like the disorder itself, requires careful study to identify developmental similarities with and differences from the presentation in older children and adults.2 Prior reports have suggested that young children with psychiatric disorders talk about suicide at rates of 4% to 13% and that these early SIs predict school-age SI.2-4 Publications about suicidality in children younger than 7 have predictably elicited discussions about the challenges in interpreting the statements and behaviors in a developmentally specific manner.4.
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Paul E, Ortin A. Correlates of Suicidal Ideation and Self-harm in Early Childhood in a Cohort at Risk for Child Abuse and Neglect. Arch Suicide Res 2019; 23:134-150. [PMID: 29281595 DOI: 10.1080/13811118.2017.1413468] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES This study provides prevalence and persistence rates of suicidal ideation and self-harm, and examines how child maltreatment types, mental health symptoms, and age 4 suicidal ideation and self-harm are associated with each suicidal outcome among 6-year-old children. METHODS Participants were 1,090 caregivers assessed when their children were 4 and 6 years old from the Longitudinal Studies of Child Abuse and Neglect. Data were collected from the Child Behavior Checklist, Parent-Child Conflict Tactics Scales, and Child Protective Services. RESULTS Persistence rates within each suicidal outcome were high. Failure to provide -a physical neglect subtype- was the only maltreatment type that independently predicted self-harm. Depressive/anxious symptoms and age 4 suicidal ideation were independently associated with age 6 suicidal ideation, whereas attention problems and age 4 self-harm predicted age 6 self-harm. CONCLUSION Our findings align with the consensus emerging from adolescent studies that risk factors associate differentially with suicidal ideation and self-harm.
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