High Rate of Suicidal Thoughts in Preteens

Michelle E. Grady

August 08, 2019

Up to 18% of preteens between ages 11 and 13 have suicidal thoughts, new research shows.

Results of the three-phase, longitudinal follow-up study showed 15.9% of preadolescent boys and girls experienced suicidal ideation in the first phase and 18.2% and 18.0% in the second and third phases, respectively.

"Despite the global improvement in health, the global rates of suicidal behavior are still high and suicides occur in all the world regions and at all ages," the researchers, led by first author Núria Voltas, PhD, from Rovira i Virgili University in Tarragona, Spain, write.

The investigators also examined risk factors for suicidal ideation in participants and found depressive symptoms, anxiety, and obsessive–compulsive disorder (OCD) were the main risk factors, and that these differed by gender.

"In boys, it is previous depressive symptoms which determine subsequent suicidal ideation," Voltas noted in a release. In girls, it is a combination of anxiety symptoms, OCD, and the family's socioeconomic status, she added.

The study was published online April 22 in Archives of Suicide Research.

Second Leading Cause of Death

Data from the Centers of Disease Control and Prevention (CDC) show that suicide is the second leading cause of death among adolescents and young adults. However, the investigators note few longitudinal studies have examined risk factors that may lead to suicidal thoughts and behaviors.

The investigators note there is a "lack of epidemiological studies about the prevalence rates, risk, and protective factors, as well as other variables that would allow us to better understand this complex and multi-determined phenomenon."

They also point out that there is a lack of clarity in the current literature regarding the definition of suicidality. Thus, in the current study, they considered the term broadly and included "suicidal ideation, suicidal plans, suicidal threats, self-injurious behavior, suicide attempts, and completion of suicide, all of which are considered inside a suicidal behavior spectrum."

The study's primary goals were to determine the prevalence of suicidal ideation and predictive risk factors in early adolescence. The research team studied 720 boys and 794 girls, spread across 13 schools in Reus, Spain.

The young participants were monitored over three developmental periods — at ages 10, 11, and 13.

At the outset of the study, 1514 children with a mean age of 10.2 years responded to a series of psychological tests to determine which children presented emotional symptoms related to depression, anxiety, and OCD.

These tests included the Children's Depression Inventory (CDI) and other psychopathological tests. From their responses, researchers divided participants into two groups — a control group and the group at risk of emotional struggles.

During the first phase, 16% of study participants reported that they had thought about suicide and, of those, 33% reported the same 1 year later.

Children at risk of emotional disorders (n = 405) and a subsample of children deemed not at-risk (n = 157) were assessed 1 year later in the second phase of the study. These included 254 boys and 308 girls (mean age, 11.3 years).

In this phase, the same battery of tests was readministered and a child psychiatrist and two child psychologists made psychiatric diagnoses using the Mini-International Neuropsychiatric Interview for Kids (MINI-Kid).

In the second phase, 21.6% (n = 121) reported they had sought professional help for psychological problems. The prevalence of emotional disorders was 3.4% for depressive disorders, 11.8% for anxiety disorders, and 1.8% for OCD.

Two years later, all second-phase children were invited back to participate in the third, and final, phase of the study. This phase included 245 participants (174 girls, 98 boys; mean age, 13.5 years).  

In both the second and the third phases of the study, 18% reported suicidal ideation as measured by a score of 1 or 2 on item 9 of the CDI. The risk of suicide was determined in a personal interview and was present in 12.2% of children with an average age of 11. The researchers found that severity of suicidal behavior was greater in boys.

Rates of reporting suicidal thoughts were high in all three phases of the study and ranged from 15% to 18%. However, only 0.7% endorsed the item "I want to commit suicide."

The increased prevalence of suicidal thoughts in the second and third phases of the study may be because, from the first to the second phase, the sample was screened for emotional problems. Therefore, the sample in the second phase of the study included participants with a higher risk of presenting emotional disorders vs the first phase sample.

Identification of the risk factors associated with suicidal ideation will "enable us to have greater control over this particular aspect and take prevention measures in preadolescents, who are going through a period of considerable vulnerability," said Voltas.

The investigators acknowledge that the study's limitations include its small sample size in the follow-up phase, no diagnostic interview in the third phase of follow-up, and that the Children's Global Assessment scale (CGAS) was determined mainly from self-report.

Nevertheless, they note that "suicidality is considered a major public health concern that can lead to serious disabilities in the daily lives of individuals who suffer from it.

The study findings, the investigators conclude, highlight the need to carry out effective prevention activities and "avoid the situation of a lot of adolescents struggling with suicidal thoughts and behaviors."

Interpret with Caution

Commenting on the findings for Medscape Medical News, Tyler R. Black, MD, FRCPC, medical director of the CAPE Unit at BC Children's Hospital in Vancouver, Canada, said it is important to consider the questions that were asked when interpreting the data.

"We know that a significant portion of children have suicidal thinking and it's important to define what we mean by that," said Black, who was not involved in the research. "Some have strong suicidal thoughts like 'I want to die' and others have mild thoughts, like 'What would it be like to die.' And so when someone is responding to a survey question, it really matters what questions are being asked.

"In the study, 15% or so of children said they think about suicide but wouldn't do it, and it's hard to know the dangerousness of those thoughts. They could just be wondering about suicide as the word comes up, whereas the smaller percentage, the 0.7% who want to commit suicide, those are the kids we would be concerned about because that's more of an active thought."

One of the primary challenges with the study, said Black, is that the main question asked — which received a 12% to 16% response rate — is a very mild suicide question.

Fewer children reported that they actively wanted to die by suicide. Black said that science is also moving away from categorizing people as high, low, or medium risk for suicide.

"There is simply no way to know who is high, low, or medium risk. Suicide risk should be considered in all people over the age of 10, by all clinicians," he said. "There was a lot of comment in the study about high, low, and medium risk, and science is moving us away from this direction, and looking more at which risk factors make them more suicidal or less suicidal. I liked the comment of the importance of anxiety, depression, and OCD, which is linked to suicide rates."

Finally, Black noted the importance of recognizing that the 1-year persistence of actively wanting to die by suicide persisted in 33%, and the 3-year persistence was 9.3%.

The study was funded by the Spanish Ministry of Health and Consumption and the Spanish Ministry of Science, Innovation, and Universities. Voltas and Black have disclosed no relevant financial relationships.

Archives of Suicide Research. Published online April 22, 2019. Abstract

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