News from the American Academy of Child and Adolescent Psychiatry

Suicides Among Very Young Children on the Rise

in Black Children and White Girls

Research in this Area Hindered by Statistical Difficulties and IRB Requirements

by John Otrompke

     Suicides among very young children in the U.S. have been on the increase in certain subgroups since 1993, according to new data from the Centers for Disease Control discussed at the AACAP meeting last week.

    Among children in the U.S. between the ages of five and 11 years old, 657 committed suicide between 93 to 2012, and 87 did so in 2013 and 2014.

While the suicide rate among children has remained stable over the past 20 years, the rate has increased among black children and white girls, according to a poster presented last week at the annual meeting of AACAP in New York (poster 1.55, ‘Suicide Trends Among Young Children in the United States from 1993 to 2014’ [Logan, et al]).

The poster presented the first subgroup analyses of suicides among children in the given age range, according to Kseniya Yershova, PhD, deputy scientific director at the Center for Suicide Risk Assessment at the New York State Psychiatric Institute, who is a co-author.

A Significant Increase in Child Suicides Since 1993

  The rate of suicides among black children increased from 1.37 per million in the first five-year period between 1993 and the end of 1997, to 2.96 per million in the final two-year period from 2013 to 2014, for a incidence rate of 1.24, according to Vladislav Mandzhiyev, a biomedical engineering student and a co-author who co-presented the poster on Wednesday, Oct. 26. The increase was found to be statistically significant (p<.05)

  The suicide rate among white girls also increased to a degree which was statistically significant, going from 0.24 per million in the first five-year period, to 0.75 per million in the two-year period (incidence rate ratio 1.63).

   However, the increase among white girls in the U.S. was masked when the data were analyzed by the moving average method of statistical analysis; instead, the change was only notable when analyzed by period trend analysis.

  Studies of suicides in young children have been complicated by low incidence and high fluctuation, according to the abstract. “Prior authors couldn’t analyze the suicide rate among young girls because there were not enough cases. But when we added two additional years of data compiled by the Centers for Disease Control to the data from 1993 to 2012, we found we could do the analysis,” Yershova explained.

  For white children as a whole, the rate went from 1.14 suicides per million to 0.99 per million, indicating a decrease, according to Mandzhiyev. Historically, the rate of suicides was higher among the white population, the poster said.

Early Identification and Treatment Important

  “Suicide is an expression of extreme suffering. The children are learning to regulate their emotions, so you cannot skip the youngest group. If they go to the emergency room for a toothache, the provider needs to ask about thoughts or feelings about death, even in the little guys. Doctors need to ask about possible risk factors for suicide in the pediatrician’s office,” said Yershova.

  “The children need the support of their parents in learning to regulate their emotions, so providers need to work with their caregivers,” she added.

  Guns, suffocation, and poison are the three most common methods of suicide in the age range, according to Yershova. “In older groups, the availability of prescription drugs, especially pain medication, may also be behind the increase, inasmuch as girls do use poison as a method much more frequently than boys,” she said, noting that poison is much more likely as a suicide method if the poison is not locked up.  

  “It would be nice to know the reasons for the increase, and there is a methodology called the psychological autopsy, in which providers interview the family,” said Yershova.

  However, the practice of psychological autopsy can’t be undertaken universally, as ethics approval is required, she added.