A newly published study has revealed new facts about the risk of suicide in young people, with implications for suicide prevention efforts nationwide.

Suicide is a public health crisis affecting the American population, with the overall rate having risen 31% between 2001 and 2017, according to the National Institute of Mental Health. The risk extends to children and adolescents, with suicide now the second-leading cause of death in the U.S. among those aged 10-14 years. The number of emergency clinic visits and hospitalizations for suicidal ideation—thinking about suicide—and suicide attempts in the 10-14 age group has doubled over the last 10 years.

Sophia Frangou, M.D., Ph.D., 2019 winner of the BBRF Colvin Prize for Outstanding Achievement in Mood Disorders Research, led a team of researchers who aimed to learn more about “suicidality” in pre-adolescents, a group that has not received nearly as much attention as adolescents and adults. The term “suicidality” is used in the team’s paper to refer to “a spectrum that spans suicidal ideas, plans, and attempts, some of which may be fatal.” The paper appeared in Lancet Psychiatry.

In addition to her prize, Dr. Frangou, of the Icahn School of Medicine at Mount Sinai, is a 2008 BBRF Independent Investigator and 2002 Young Investigator.

She and her team took advantage of a large sample of children aged 9-10 assembled as part of the National Institute of Health’s Adolescent Brain and Cognitive Development (ABCD) Study. Based on the recruitment of 11,875 9- to 10-year-olds at 22 sites across the nation, ABCD is designed to study mental health trajectories in an ethnically and socio-demographically representative sample of children from the time of recruitment through adolescence to adulthood. It entails periodically collecting information about the participants’ mental and physical wellbeing, and includes brain imaging, behavioral and cognitive testing, and documentation of social and family environments.

The team used a subset of the ABCD study cohort that included a total of 7,994 children, on average 9.9 years old, of whom 53% were male; their data upon entering the ABCD study formed the basis for the analysis. One unique aspect of the study was to compare information about suicidality supplied by children themselves with information provided by their primary caretaker(s).

The number of reports of suicidality looked similar in both sets of reports, but only on the surface. Among the 7,994 participants studied, 684 children self-reported suicidality (either thinking about suicide, or planning or acting upon such thoughts), while suicidality appeared in the reports of 654 caregivers. But the two sets of reports agreed only in 198 individuals. That is, roughly 450 children self-reported suicidality when their caregiver did not, and about the same number of children were cited in caregiver reports but not in those of their children.

Overall, the rate of suicidality was similar in children’s self-reports (8.4% of the total) and in caregiver reports (8.1%), and these numbers in turn were similar to an 8% figure for pre-puberty participants in a recently published study, the researchers noted, of 6,151 Philadelphia youths aged 11-21.

Dr. Frangou and colleagues drew a number of conclusions based on close analysis of their findings. The most important, they said, was that “around 8 in every 100 children in this [9-10] age group experience suicidality,” a fact that they highlight because it has not received nearly as much attention as still higher rates that appear to peak during late adolescence, according to national statistics. More attention should be paid to suicidality in children before puberty, they urged.

A second conclusion is that children and their caregivers tend to give different accounts of suicidality, a fact raising questions about reasons for the disparity. At a minimum, Dr. Frangou’s team reported, “suicidality in children cannot be reliably assessed by parental report alone.”

Other findings may be valuable for future suicide prevention efforts. “Our investigation highlighted child psychopathology [the presence of behavioral and psychiatric issues] and child-reported family conflict as the most robust risk factors for suicidal ideation,” the team said. In contrast, “children reporting higher levels of parental supervision and more school engagement were less likely to ever have engaged in suicidal ideas or behaviors.”

The study was consistent with the team’s hypothesis that “factors relevant to wellbeing in childhood, such as the quality of family life, might be of greater predictive value” in the pre-adolescent age group than the children’s clinical and behavioral information.

The researchers also noted that while suicidality in the ABCD sample was dominated by suicidal thoughts, suicide attempts were rare.

Suicidality was significantly more common in boys, in both self-reported and caregiver-reported surveys. In child reports, but not that of caregivers, two or more hours of screen time on weekends correlated with increased risk of suicidality. Finally, children with more household members showed reduced risk of suicidality, perhaps due to increased opportunities for social and emotional support, whereas risk was comparatively higher in households with a single caregiver. These observations were correlations, but cannot be assumed to reveal a causal relationship, the team cautioned.

The team said their data supported the idea of school-based awareness programs and programs to increase parental awareness of child psychopathology. The team also said that providing parenting education and family support “could be clear and attainable targets” for public health interventions to reduce suicidality in young children.