In the United States, the 4th leading cause of death among children age 5-14 years is suicide. In this study, Peyre and colleagues compared risk factors for suicide attempt, including psychiatric disorders, traumatic experiences, family psychiatric history, and sociodemographic factors, in children (<13 years old) and adolescents (age 13-17 years). Using data from a nationally representative survey of the US adult population (National Epidemiologic Survey on Alcohol and Related Conditions), the authors found that childhood maltreatment was more strongly related to suicide attempt in children than in adolescents. On the other hand, a major depressive episode was more strongly associated with suicide attempt among adolescents. The incidence of first suicide attempt was much greater in adolescents versus children; however, first attempt at suicide during childhood was more robustly associated with increased risk of lifetime recurrence of suicide attempt. Suicide attempt during childhood or adolescence was associated with increased risk for adulthood psychiatric disorders and poor social functioning, with greater risk for those whose first attempt was during childhood. Studies such as this one will hopefully increase our ability to predict and prevent suicide in both children and adolescents. Importantly, any child or adolescent who attempts suicide should be assessed for childhood maltreatment.
|Hypothetical relationship among childhood maltreatment, puberty, and suicide in children and adolescents. Abuse or neglect during childhood can affect the functioning of the hypothalamic-pituitary-adrenal (HPA) axis, particularly via epigenetic modifications to the genes involved in glucocorticoid signaling. Aberrant HPA axis functioning significantly increases the risk of developing psychiatric illnesses (e.g., mood disorders). Some children (age <13 years) may consequently be particularly vulnerable to risk of suicidality. In some adolescents who were mistreated as children, the onset of hormonal changes during puberty may be the impetus that induces suicide attempt. "Resilient" children and adolescents (due to environmental, biological, and additional genetic factors) are less likely to attempt suicide.
Peyre H et al. J Clin Psychiatrist 2017;doi.org/10.4088/JCP.16m10876.
Neuroscience Education Institute. You Ruined Me; 2015.