Impulsivity May Be Strong Contributor To Childhood Suicides

Although suicide in elementary school–aged children is quite rare, suicide is the 10th leading cause of death in this age group, according to the Centers for Disease Control and Prevention (CDC).

Some evidence, including a report released by the CDC earlier this year, suggests these numbers may also be on the rise; the report found that the suicide rate in children aged 10 to 14 has significantly risen since 1999 (Psychiatric News, July 15).

Yet few studies have centered on childhood suicide, leaving a large knowledge gap in understanding risk factors and precipitating events in these children that can aid prevention and intervention efforts.

A study published September 18 in Pediatrics addressed this gap, making use of surveillance data available through the National Violent Death Reporting System (NVDRS) to compare the circumstances of suicide between children (5 to 11 years) and young adolescents (12 to 14). In total, data were available from 17 states during the study period of 2003-2012 and comprised 87 suicides in children and 606 in young adolescents.

The authors identified many similarities between the age groups, but also several differences, including a confirmation of previous findings that a disproportionate number of elementary school-aged suicides are carried out by black children; 36.8 percent of all childhood suicide decedents were black compared with 11.6 percent of adolescent decedents.

Elementary school–aged children were also more likely to die by suicide at home and report family problems as opposed to relationship problems. That was not suprising, the authors noted, as most younger children spend more time with family and do not develop romantic relationships until adolescence.

More intriguing was the association between mental health diagnoses and suicidal behaviors in the children, said David Fassler, M.D., a clinical professor of psychiatry at the University of Vermont College of Medicine and a child and adolescent psychiatrist.

Both age groups had a similar prevalence of psychiatric diagnoses in the suicide decedents (around 34 percent), but the specific diagnoses differed.

“While early adolescents had higher rates of depression, children in the younger age group were more likely to have had previous diagnoses of ADHD,” said Fassler, who was not part of this study.

Among young adolescents who died by suicide, depression was diagnosed in 65 percent of those with a psychiatric condition, followed by attention-deficit disorder or attention-deficit/hyperactivity disorder (ADD/ADHD) at 29 percent. This was flipped in elementary school–aged children, with 59 percent having an ADD/ADHD diagnosis and 33 percent having depression.

“Assuming the diagnoses are accurate, this result would suggest that suicide in young children may be more related to impulsive behavior, a hypothesis that warrants further research,” Fassler said.

In the article, the study authors, led by Arielle Sheftall, Ph.D., a postdoctoral fellow at Nationwide Children’s Hospital in Columbus, Ohio, described how these findings highlight a need for future studies to examine whether a developmental progression of vulnerability to suicide exists as children age, starting with impulsive responses as the prominent influence that gradually transitions to depressed mood and emotional distress.

APA President Maria A. Oquendo, M.D., cautioned, however, that these findings should not be overgeneralized.

“This study is interesting since impulsivity is a predicating factor for suicide across the lifespan, but not all impulsive suicide attempts are made by people with impulsive behavior, and likewise many people with impulsive disorders do methodically plan a suicide,” she said. “One risk factor alone does not tell the whole story.”

Nonetheless, Oquendo noted that the information gleaned from this work was valuable in adding to the collected knowledge about risk factors and suicide precipitators. “One of the best methods to monitor suicidal ideation in clinical settings is to use structured assessments that identify risk factors and incorporate them into electronic health records, enabling these measures to be tracked and updated over time,” she said.

This study was supported by grants from the CDC and National Institute of Mental Health. ■