Young children who express suicidal thoughts and behaviors appear to have a better understanding of what it means to die than the majority of their peers, according to a new study published in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).
“It’s an uncomfortable topic to contemplate, and in many ways, I think it’s easier to assume that children don’t really know what they’re saying, and therefore they can’t possibly mean the same things that adults mean when they talk about wanting to die,” said lead author Laura Hennefield, Ph.D., a postdoctoral research scholar at Washington University in St. Louis, Missouri.
“We did find, however that even children as young as four years of age who expressed suicidal ideation had a solid understanding of what it means to die. Although it remains unclear how to fully assess risk in these circumstances, our findings highlight the need to take children’s expressions of suicidal thoughts and behaviors seriously.”
The study involved a randomized controlled trial of 139 children ages 4 to 6. This included 22 depressed children with suicidal ideation, 57 depressed children without suicidal ideation, and 60 healthy peers of the same age.
During the pre-treatment evaluation, children completed an experimenter-led death interview to measure their understanding of five concepts of death including:
- universality (all living things eventually die);
- specificity (only living things die);
- irreversibility (death is permanent);
- cessation (upon death bodily processes stop functioning);
- causality (there are events that can cause death).
The findings show that depressed children with suicidal ideation had a better understanding of these death concepts than the other peer groups. Further, 100 percent of depressed children with suicidal ideation were able to describe a reasonable event that could cause death compared to 61 percent of depressed children without suicidal ideation and 65 percent of healthy children.
Surprisingly, the researchers also found that both age and expressing suicidal ideation independently predicted children’s attribution of death to violent causes. In fact, children with suicidal ideation were 3.6 times more likely to describe death as caused by violence than depressed children without suicidal ideation.
“When asked to describe an event that could cause death, older children, and children who expressed suicidal ideation, were much more likely to describe a violent cause such as shooting, stabbing or being poisoned,” said Hennefield.
Senior author Joan Luby, M.D., the study’s principal investigator and director of the Early Emotion Development Program at Washington University School of Medicine, added, “We started this line of inquiry after observing higher than expected rates of suicidal ideation in our treatment study, which was something we had not previously seen in prior studies of preschool depression.”
“This led us to add measures to investigate the meaning of this symptom to help guide caretakers and clinicians to respond,” she said. “Very similar to the past studies of depression in preschoolers conducted in the Early Emotional Development Program and elsewhere, our findings suggest greater emotional awareness and capacities in younger children than previously understood.”