Changes in suicidal behavior in child psychiatric inpatients

Suicidal thoughts and behaviors in preadolescents: Findings and replication in two population-based samples

INTRODUCTION

Given increasing concern in suicide in preadolescent children, this study aimed to characterize and identify potential indicators of risk for suicidal ideation (SI) and suicide attempts (SAs) in this population.

METHODS

Data were drawn from two population-based samples of preadolescents: the 2007 and 2010 Minnesota Student Survey and analyses were restricted to 11- and 12-year-olds. Sociodemographic characteristics, childhood maltreatment, parental relations, peer relations, and school climate were examined in relation to past-year SI and SA. To examine correlates of SI, unconfounded by risk for SA, individuals with a history of SA were excluded from SI analyses. Correlates of SA were examined among individuals with past-year SI. Logistic regression analyses were conducted with past-year SI and SA as criterion variables.

RESULTS

Results from the 2007 and 2010 data sets were highly consistent. The prevalence of past-year SI was 9.28% and 9.25% in 2007 and 2010, respectively. Of the total sample, 1.90% and 1.87% reported a past-year SA (17.00% and 16.78% of those with past-year SI). Overall, effect sizes were generally modest to medium. The strongest effects were observed for sexual and physical abuse, parental support, and perceived safety at school (ps < .001). In multivariate analyses of SI and SA, sexual and physical abuse had the largest effect sizes (ORSI  = 2.18 [95% CI = 1.90-2.51] to 2.96 [95% CI = 2.69-3.26]; ORSA  = 1.55 [95% CI = 1.29-1.86] to 2.26 [95% CI = 1.82-2.80]).

CONCLUSIONS

SI and SA occur at a concerning rate among preadolescent children. Screening for childhood sexual and physical abuse may be important for identifying those at risk for these clinical outcomes.

Prevalence and clinical correlates of self-harm and suicidality during admission of children in a mental health inpatient unit

Background

Self-harm and suicidality are common presentations in children and adolescents requiring a mental health inpatient admission. Although there are several studies on adolescents, there is relatively limited research into childhood self-harm and suicidality during such admissions.

Methods

A retrospective electronic file review was conducted on all children discharged from a national mental health inpatient children’s unit over a 6-year period. Several independent variables were compared between self-harm/suicidal and non-self-harm/non-suicidal children. Separate analyses investigated changes in self-harm/suicidality, functional outcomes, and risk assessment ratings between admission and discharge.

Results

A total of 105 children were included in this study. During admission, 65.7% of them reported self-harm thoughts, 61% engaged in self-harm, 50.5% expressed suicidal thoughts, and 14.3% engaged in suicidal behavior. Thoughts and acts of self-harm were associated with previous self-harm, longer admissions, and Attention Deficit Hyperactivity Disorder. Suicidality overlapped with self-harm and was strongly predicted by previous self-harm. The prevalence of self-harm and suicidal thoughts and acts significantly decreased during admission. Children in the non-self-harm group had marginally better functional outcomes upon discharge compared to those in the self-harm group. Children and parents/caregivers were similarly satisfied with treatment, irrespective of children’s self-harm/suicidality.

Conclusions

Self-harm and suicidality were widespread among children admitted to hospital. Better understanding of the mechanisms and factors related to self-harm and suicidality in this age group could help mitigate associated risks and improve existing safety strategies.

Psychosocial Correlates of Suicide Ideation: A Comparison of Chinese and U.S. Rural Women

China is the only country in the world where the suicide rate for women is higher than that for men. In particular there is current concern about a high suicide rate for women living in rural areas. In this study, two samples of young women ages 20 to 35, one from rural China ( n=52) and one from rural United States ( n=52) were interviewed as to suicide ideation and suicide risk, as related to psychosocial variables of self-esteem, coping, social support, and attitudes toward suicide. Significant mean differences were obtained between samples on all eleven variables. The pattern of intercorrelations between variables showed both similarities and differences in the two samples. A stepwise multiple-regression analysis indicated that the same four variables, albeit in different order, were predictive of suicide: these variables were self-esteem, instrumental support, the attitude that suicide is morally bad, and an overall rating of coping.

Characteristics of 61 Mexican American Adolescents Who Attempted Suicide

A total of 61 Mexican American adolescents who were consecutively admitted to an inpatient psychiatric unit after a suicide attempt were studied. They were given structured interviews to study their demographic, personal, and family characteristics. The intent of the suicide attempts was measured with the Pierce Suicide Intent Scale. Compared to subjects in the low-intent group, those in the high-intent group showed a history of more frequent previous suicide attempts (p < .03), had lived with both biological parents for a longer time (p < .04), usually had at least one biological parent at home at the time of the suicide attempts (p < .001), and had lived in the United States for a shorter period of time (p < .04). Psychosocialfactors including the phenomenon of acculturation are reviewed in the discussion of these results.

Self-Reported Psychopathology, Trauma Symptoms, and Emotion Coping Among Child Suicide Attempters and Ideators: An Exploratory Study of Young Children

This study examined self-reported psychopathology, trauma symptoms, and emotion coping in 7 to 12 year old children with suicidal ideation and attempts. This study compared 70 psychiatric inpatient children with current suicidal ideation to 59 psychiatric inpatient children with recent suicide attempts on measures of depression, anxiety, anger, emotional intelligence, and family/contextual factors. Results revealed greater self-reported anger as well as psychological distress associated with traumatic experiences (dissociation, anger, depression), among children who attempted suicide, in addition to increased reports of special education utilization, when compared to ideators only. These relationships were not affected by age or gender. Overall, the findings suggest self-reports of younger children who attempt suicide share similarities with older children and adolescent attempters, when compared with ideators who do not attempt. Implications for assessment and treatment are discussed.

Are Suicidal Phenomena in Children Different to Suicidal Phenomena in Adolescents? A Six-Year Review

BACKGROUND

  There has been little published about the nature and frequency of suicidal phenomena in children compared to that of adolescents.

METHOD

  Standardised information on all presentations with suicidal phenomena to the Children's University Hospital, Dublin from 2002 to 2008 were retrospectively analysed from a centralised database.

RESULTS

  During the time period of the study, 401 young people presented for assessment, of whom 21.9% (N = 88) were under 12 years of age. Children differed from adolescents in terms of gender distribution, method of self-harm, and risk factors present.

CONCLUSION

  Children under 12 are capable of displaying suicidal phenomena and differ considerably to adolescents in this regard.

The involuntary treatment of adolescent psychiatric inpatients--a nation-wide survey from Finland

This national cross-sectional study investigates the prevalence rates, regional differences and factors associated with the involuntary inpatient treatment of adolescents in Finland on a chosen day in 2000. The proportion of inpatients with involuntary legal status was 29.5% (n=82) giving a prevalence rate of 2.5 per 10,000/12-17 years old inhabitants. Forty-eight per cent of involuntarily inpatients were 16-17 years old and 62% had psychotic disorders. Twenty-six per cent of inpatients with involuntary legal status were voluntarily admitted. Regional differences of involuntary treatment were rather modest. Psychotic disorders, suicidal acts, and substance use disorders were independently associated with involuntary legal status. There is a need for further studies to investigate the long-term effects of involuntary treatment on the adolescents' subsequent well-being. Further studies on alternatives methods for involuntary treatment are warranted, likewise the clinical guidelines for involuntary treatment practices.

Psychometric properties and clinical utility of the scale for suicide ideation with inpatient children

The purpose of the current study was to examine the psychometric properties and clinical utility of the Scale for Suicide Ideation (SSI) for children. The SSI was administered to 100 children who were hospitalized. Data were not used from 13 subjects due to the presence of a psychotic disorder or IQ less than 70, leaving 87 participants. The SSI was examined regarding its internal consistency, concurrent validity, construct validity, and factor structure when used with children. Based on the findings, the SSI appears to have adequate psychometric properties and can be used by clinicians and researchers examining children in an inpatient setting. Recommendations for clinicians are included to help make the SSI more functional in use for children.

The prevalence of suicidal behavior among preadolescent children who are psychiatric inpatients

The prevalence of suicidal behavior displayed by preadolescent children hospitalized on inpatient psychiatric units is estimated to range between 18% and 80% of the population. The current study provides an independent estimate of the prevalence of this problem. A semistructured interview was used to assess suicidal behavior displayed by 61 admissions to a child psychiatric inpatient unit between April 1988 and September 1989. According to the Pfeffer Spectrum of Suicidal Behavior Scale, 63% of the sample engaged in some form of suicidal behavior. Preadolescents and their parents reported similar rates of suicidal thoughts, threats and attempts. The dangerousness of recent suicidal behavior was not found to differ by age, sex, legal custody status or socioeconomic status.

The relationship of suicidality and psychiatric diagnosis in hospitalized pre-adolescent children

Two structured interview measures of suicidal behavior were administered to 43 child psychiatric inpatients between the ages of 7 and 11 and their parents. DSM-III-R diagnoses were assigned to the children, with twenty-six Axis I and Axis II diagnostic categories represented. Generally, the interview measures of suicidal behavior were found to be unrelated to psychiatric diagnosis. The results suggest that to better understand pre-adolescent suicidal behaviors, it may be more useful to examine associations between these behaviors and the biopsychosocial dimensions that underlie the diagnostic categories.

Suicidal behavior among psychiatric outpatient children: an estimate of prevalence

The prevalence of suicidal behaviors displayed by pre-adolescent psychiatric outpatients has been estimated to range between 25 percent and 33 percent of the outpatient population. The current study assessed suicidal behaviors displayed by 40 children aged 12 and younger who were evaluated in a psychiatric outpatient service. According to the Pfeffer Spectrum of Suicidal Behavior Scale, 15 percent of the sample had recently engaged in some form of suicidal behavior and almost 3 percent had made a suicide attempt that was viewed as realistically endangering life.

Suicidal behavior among psychiatric inpatient children: an estimate of prevalence

The prevalence of suicidal behavior among pre-adolescent child psychiatric inpatients has been estimated to range between 18 and 80 percent of the inpatient population. This study is a chart review of the documentation of suicidal behaviors displayed by 45 consecutive child psychiatric inpatient admissions. According to the Pfeffer Spectrum of Suicidal Behavior Scale, 31 percent of the sample had recently engaged in some form of suicidal behavior and 9 percent had made a life-threatening attempt.