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

Preschool-Onset Major Depressive Disorder as a Strong Predictor of Suicidal Ideation and Behaviors Into Preadolescence

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.

The Role of Parent-Child Attachment, Hostile Attribution Bias in Aggression: A Meta-Analytic Review

Parent-Child Attachment (PCA) and Hostile Attribution Bias (HAB) are closely related to aggression, but findings regarding their relationships are inconsistent. There is a lack of understanding of the underlying mechanism between PCA and aggression. This review employed meta-analysis approaches to investigate the associations between PCA and aggression, as well as between HAB and aggression, and the mechanism for the PCA-aggression association. An article search was conducted in CNKI, PubMed, PsycINFO, Web of Science, ProQuest, and Google Scholar. Totally, 118 studies involving general populations and those at high risk for aggression were included. Results revealed negative associations between Parent-Child Attachment Security (PCAS) and aggression (ρ = -.267, p < .001) and positive associations between Parent-Child Attachment Insecurity (PCAI) and aggression (ρ = .240, p < .05). HAB and aggression were found to be positively associated (ρ = .303, p < .001). As for the PCAS-aggression association, a larger effect size was found in females than in males. The HAB-reactive aggression association was stronger than the HAB-proactive aggression association. In Eastern culture, the association between HAB and aggression was stronger than in Western culture. HAB mediated the association between PCAS and aggression. Our findings contribute to the understanding of the occurrence and development of aggression by establishing an association between attachment theory and the social information processing model. The practical implications include interventions targeting cultivating PCAS and alleviating HAB, which might serve as effective ways to reduce aggression, yet aggression type, gender, and cultural background should be taken into consideration.

Utility of self- and parent-reported suicidal ideation in early childhood: Prediction of suicidal ideation and psychopathology in adolescence

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.

Future Directions in Understanding and Interpreting Discrepant Reports of Suicidal Thoughts and Behaviors Among Youth

Both the quality and utility of youth suicide research depend on how we assess our outcomes of interest: suicidal thoughts and behaviors (STBs). We now have access to more STB assessments than ever before, with measures for youth that vary in what exact experiences are asked about, how such measures elicit information, when and how frequently measures are administered, and who the informants are. This growing armamentarium of assessments has the potential to improve the study and treatment of STBs among youth, but it hinges on meaningful interpretation of assessment responses. Interpretation can be especially challenging when different STB assessments yield conflicting information. Determining how to manage discrepant reports of STBs is a pivotal step toward achieving meaningfully comprehensive STB assessment batteries. Here, we outline several discrepant reporting patterns that have been detected, discuss the potential significance of these observed discrepancies, and present initial steps to formally investigate discrepant reports of STBs among youth. Developing coherent, interpretable, and comprehensive batteries assessing STBs among youth would address a fundamental step to uncovering etiology, improving clinical decision-making and case management, informing intervention development, and tracking prognosis.

Gender identity-based disparities in self-injurious thoughts and behaviors among pre-teens in the United States

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.