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Suicidal Behavior in Children: Issues and Implications for Elementary Schools

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Abstract

Youth suicide is massive public health problem. Although adolescent suicide has received greater attention in the professional literature, suicidal behavior in the form of suicidal ideation, suicide threats and/or plans, suicide attempts, and suicide does occur in preadolescent children. This article provides an overview of suicidal behavior in children, including the scope of the problem, developmental issues, risk factors, warning signs, and protective factors. Given that children spend much of their time in elementary schools, and that schools are considered appropriate and logical venues for suicide prevention efforts, the implications of child suicidal behavior for elementary schools and school-based mental health professionals are discussed.

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References

  • Alvarez, M. E., & Anderson-Ketchmark, C. (2010). Review of an evidence-based school social work intervention: Check and Connect. Children and Schools, 32, 125–127.

    Google Scholar 

  • Anestis, M. D., Law, K. C., Hyejin, J., Houtsma, C., Khazem, L. R., & Assavedo, B. L. (2017). Treating the capability for suicide: a vital and understudied frontier in suicide prevention. Suicide and Life-threatening Behavior, 47, 523–537.

    PubMed  Google Scholar 

  • Aseltine, R. H., & DeMartino, R. (2004). An outcome evaluation of the SOS suicide prevention program. American Journal of Public Health, 94, 446–451.

    PubMed  PubMed Central  Google Scholar 

  • Barber, B. K., & Schluterman, J. M. (2008). Connectedness in the lives of children and adolescents: a call for greater conceptual clarity. Journal of Adolescent Health, 43, 209–216.

    Google Scholar 

  • Barrio, C. A. (2007). Assessing suicide risk in children: guidelines for developmentally appropriate interviewing. Journal of Mental Health Counseling, 29, 50–66.

    Google Scholar 

  • Berman, A. L. (2009). School-based suicide prevention: research advances and practice implications. School Psychology Review, 38, 233–238.

    Google Scholar 

  • Blum, R. W., & Libbey, H. P. (2004). Wingspread declaration on school connections. Journal of School Health, 74, 233–234.

    Google Scholar 

  • Brent, D. A., Perper, J. A., Moritz, G., Allman, C., Friend, A., Roth, C., et al. (1993). Psychiatric risk factors for adolescent suicide: a case-control study. Journal of the American Academy of Child and Adolescent Psychiatry, 146, 459–463.

    Google Scholar 

  • Bridge, J. A., Asti, L., Horowitz, L. M., Greenhouse, J. B., Fontanella, C. A., Sheftal, A. H., et al. (2015). Suicide rates among elementary school-aged children in the United States from 1993 to 2012. Journal of the American Medical Association Pediatrics, 169, 673–677.

    PubMed  Google Scholar 

  • Brock, S. E., & Jimerson, S. R. (Eds.). (2012). Best practices in school crisis prevention and intervention (second ed.). Bethesda: NASP Publications.

    Google Scholar 

  • Brock, S. E., Nickerson, A. B., Louvar Reeves, M. A., Conolly, C. N., Jimerson, S. R., Pesce, R. C., & Lazzaro, B. R. (2016). School crisis prevention and intervention: the PREPaRE model. Bethesda: NASP Publications.

    Google Scholar 

  • Buhrmester, D. (1990). Intimacy of friendship, interpersonal competence, and adjustment during pre-adolescence and adolescence. Child Development, 61, 1101–1111.

    PubMed  Google Scholar 

  • Canetto, S. S., & Sakinofsky, I. (1998). The gender paradox in suicide. Suicide and Life-threatening Behavior, 28, 1–23.

    PubMed  Google Scholar 

  • Cook, C. R., Frye, M., Slemrod, T., Lyon, A. R., Renshaw, T. L., & Zhang, Y. (2015). An integrated approach to universal prevention: independent and combined effects of PBIS and SEL on youths’ mental health. School Psychology Quarterly, 30, 166–183.

    PubMed  PubMed Central  Google Scholar 

  • Crocker, A. D., & Hakim-Larson, J. (1997). Predictors of pre-adolescent depression and suicidal ideation. Canadian Journal of Behavioral Science, 29, 76–82.

    Google Scholar 

  • Curtin, S. C., Warner, M., & Hedegaard, H. (2016). Increase in suicide in the United States, 1999–2014. NCHS data brief, no. 241. Hyattsville: National Center for Health Studies.

    Google Scholar 

  • Drapeau, C. W., & McIntosh, J. L. (for the American Association of Suicidology). (2017) U.S.A. suicide 2016: official final data. Washington: American Association of Suicidology, downloaded from http://www.suicidology.org

  • Fite, P. J., Stoppelbein, L., Greening, L., & Preddy, T. M. (2011). Associations between relational aggression, depression, and suicidal ideation in a child psychiatric impatient sample. Child Psychiatry and Human Development, 42, 666–678.

    PubMed  Google Scholar 

  • Forman, S. G., & Oliveira, P. (2018). Intervention planning and implementation. In S. L. Grapin & J. H. Kranzler (Eds.), School psychology: professional issues and practices (pp. 115–130). New York: Springer.

    Google Scholar 

  • Fowler, J. C. (2012). Suicide risk assessment in clinical practice: pragmatic guidelines for imperfect assessments. Psychotherapy, 49, 81–90.

    PubMed  Google Scholar 

  • Franklin, J. C., Ribeiro, J. D., Bentley, K. H., Huan, X., Musacchio, K. M., Chang, B. P., Fox, K. R., Kleiman, E. M., Jaroszewski, A. C., & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: a meta-analysis of 50 years of research. Psychological Bulletin, 43, 187–232.

    Google Scholar 

  • Freedenthal, S. (2018). Helping the suicidal person: tips and techniques for professionals. New York: Routledge Press.

    Google Scholar 

  • Garafolo, R., Wolf, S. C., Wissow, L. S., Woods, E. R., & Goodman, E. (1999). Sexual orientation and risk of suicide attempts among a representative sample of youth. Archives of Pediatrics and Adolescent Medicine, 153, 487–493.

    Google Scholar 

  • Giannetta, M. M., Betancourt, L. M., Brodsky, N. L., Wintersteen, M. B., Romer, D., Gianetta, J. M., & Hurt, H. (2012). Suicidal ideation and self-harm behavior in a community sample of preadolescent youth: a case-control study. Journal of Adolescent Health, 50, 524–526.

    Google Scholar 

  • Goldstein, T. R., Birmaher, B., Axelson, D., Ryan, N. D., Strober, M. A., Gill, M. K., Valeri, S., Chiappetta, L., Leonard, H., Hunt, J., Bridge, J. A., Brent, D. A., & Keller, M. (2005). History of suicide attempts in pediatric bipolar disorder: factors associated with increased risk. Bipolar Disorders, 7, 525–535.

    PubMed  PubMed Central  Google Scholar 

  • Greening, L., Stoppelbein, L., Fite, P., Dhossche, D., Erath, S., Brown, J., Cramer, R., & Young, L. (2008). Pathways to suicidal behaviors in childhood. Suicide and Life-Threatening Behavior, 38, 35–45.

  • Greening, L., Stoppelbein, L., Fite, P., Dhossche, D., Erath, S., Brown, J., et al. (2010). Aggression and the risk for suicidal behaviors among children. Suicide and Life-threatening Behavior, 40, 337–345.

    PubMed  Google Scholar 

  • Haas, M. (2018). Interviewing for assessment: a practical guide for school psychologists and school counselors. Hoboken: John Wiley & Sons.

    Google Scholar 

  • Jobes, D. A. (2016). Managing suicidal risk: a collaborative approach (second ed.). New York: Guilford Press.

    Google Scholar 

  • Joiner, T. (2010). Myths about suicide. Cambridge: Harvard University Press.

    Google Scholar 

  • Kilmes-Dougan, B., Free, K., Ronsaville, D., Stilwell, J., Welsh, C. J., & Radke-Yarrow, M. (1999). Suicidal ideation and attempts: a longitudinal investigation of children of depressed and well mothers. Journal of the American Academy of Adolescent Psychiatry, 38, 651–659.

    Google Scholar 

  • Klonsky, E. D., & May, A. M. (2015). The three-step theory (3ST): a new theory of suicide rooted in the “ideation-to-action” framework. International Journal of Cognitive Therapy, 8, 114–129.

    Google Scholar 

  • Klonsky, E. D., Qui, T., & Saffer, B. Y. (2017). Recent advances in differentiating suicide attempters from suicide ideators. Current Opinion in Psychiatry, 30, 15–20.

    PubMed  Google Scholar 

  • Kovacs, M., Goldston, D., & Gatsonis, C. (1993). Suicidal behaviors and childhood-onset depressive disorders: a longitudinal investigation. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 8–20.

    PubMed  Google Scholar 

  • Larzelere, R. E., Andersen, J. J., Ringle, J. L., & Jorgensen, D. D. (2004). The child suicide risk assessment: a screening measure of suicide risk in pre-adolescents. Death Studies, 28, 809–827.

    PubMed  Google Scholar 

  • Lieberman, R., Poland, S., & Kornfeld, C. (2014). Best practices in suicide prevention and intervention. In P. L. Harrison & A. Thomas (Eds.), Best practices in school psychology: system-level services (pp. 273–288). Bethesda: National Association of School Psychologists.

    Google Scholar 

  • Lin, F. G., Lin, J. D., Hsieh, Y. H., & Chang, C. Y. (2014). Quarrelsome family environment as an enhanced factor on child suicidal ideation. Research in Developmental Disabilities, 35, 3245–3253.

    PubMed  Google Scholar 

  • Liu, X., Gentzler, A. L., Tepper, P., Kiss, E., Kothencne, V. O., Tamas, Z., et al. (2006). Clinical features of depressed children and adolescents with various forms of suicidality. Journal of Clinical Psychiatry, 67, 1442–1450.

    PubMed  Google Scholar 

  • LoMurray, M. (2005). Sources of strength facilitators guide: Suicide prevention peer gatekeeper training. Bismarck: The North Dakota Suicide Prevention Project.

    Google Scholar 

  • Low, S., Cook, C. R., Smolkowski, K., & Butain-Ricklefs, J. (2015). Promoting social-emotional competence: an evaluation of the elementary version of Second Step. Journal of School Psychology, 53, 463–477.

    PubMed  Google Scholar 

  • Marraccini, M. E., & Brier, Z. M. F. (2017). School connectedness and suicidal thoughts and behaviors: a systematic meta-analysis. School Psychology Quarterly, 32, 5–21.

    PubMed  PubMed Central  Google Scholar 

  • Mayes, S. D., Calhoun, S. L., Baweja, R., Feldman, L., Syed, E., Gorman, A. A., Montaner, J., Annapareddy, J., Gupta, N., Bello, A., & Siddiqui, F. (2015). Suicide ideation and attempts are associated with co-occurring oppositional defiant disorder and sadness in children and adolescents with ADHD. Journal of Psychopathology and Behavioral Assessment, 37, 274–282.

    Google Scholar 

  • Mazza, J. J. (2006). Youth suicidal behavior: A crisis in need of attention. In F.A. Villarruel & T. Luster (Eds.), Adolescent mental health (pp. 156–177). Westport, CT: Greenwood Publishing Group.

  • Mazza, J. J., & Reynolds, W. M. (2001). An investigation of psychopathology in nonreferred suicidal and nonsuicidal adolescents. Suicide and Life-Threatening Behavior, 31, 282–302.

  • Mazza, J. J., Catalano, R. F., Abbott, R. D., & Haggerty, K. P. (2011). An examination of the validity of retrospective measures of suicide attempts in youth. Journal of Adolescent Health, 49, 532–537.

    Google Scholar 

  • Mazza, J. J., Dexter-Mazza, E. T., Miller, A. L., Rathus, J. H., & Murphy, H. E. (2016). DBT skills in schools: Skills Training for Emotional Problem Solving for Adolescents (STEPS-A). New York: Guilford Press.

    Google Scholar 

  • McConaughy, S. H. (2013). Clinical interviews for children and adolescents: assessment to intervention (second ed.). New York: Guilford Press.

    Google Scholar 

  • Merrell, K. W., & Gueldner, B. A. (2010). Social and emotional learning in the classroom: promoting mental health and academic success. New York: Guilford Press.

    Google Scholar 

  • Miller, D. N. (2011). Child and adolescent suicidal behavior: school-based prevention, assessment, and intervention. New York: Guilford Press.

    Google Scholar 

  • Miller, D. N. (2018). Understanding and preventing youth suicide: ideation-to-action theories of suicidal behavior and their implications for school-based suicide prevention. In P. Terry & R. Price (Eds.), Understanding suicide: perspectives, risk factors and gender differences (pp. 165–186). Hauppauge: Nova Science.

    Google Scholar 

  • Miller, D. N., & Mazza, J. J. (2018). School-based suicide prevention, intervention, and postvention. In A. Leschied, D. Saklofske, & G. Flett (Eds.), The handbook of school-based mental health promotion: an evidence-informed framework for implementation. New York: Springer.

    Google Scholar 

  • Mishara, B. L. (1999). Conceptions of death and suicide in children ages 6–12 and their implications for suicide prevention. Suicide and Life-threatening Behavior, 29, 105–118.

    PubMed  Google Scholar 

  • Nock, M. K., & Kazdin, A. E. (2002). Examination of affective, cognitive, and behavioral factors and suicide-related outcomes in children and young adolescents. Journal of Clinical Child and Adolescent Psychology, 31, 48–58.

    PubMed  Google Scholar 

  • Pfeffer, C. R. (1985). Suicidal fantasies in normal children. Journal of Nervous and Mental Disease, 173, 78–84.

    PubMed  Google Scholar 

  • Pfeffer, C. R. (1986). The suicidal child. New York: Guilford Press.

    Google Scholar 

  • Pfeffer, C. R. (1989). Preoccupations with death in “normal” children: the relationship to suicidal behavior. Omega, 20, 205–212.

    Google Scholar 

  • Pfeffer, C. R. (2001). Youth suicide: prevention through risk management. Clinical Neuroscience Research, 1, 362–365.

    Google Scholar 

  • Pfeffer, C. R., Adams, D., Weiner, A., & Rosenberg, J. (1988). Life event stresses on parents of suicidal children. International Journal of Family Psychiatry, 9, 341–350.

  • Renaud, J., Berlim, M. T., McGirr, A., Tousignant, M., & Turecki, G. (2008). Current psychiatric morbidity, aggression/impulsivity, and personality dimensions in child and adolescent suicide: a case-control study. Journal of Affective Disorders, 105, 221–228.

    PubMed  Google Scholar 

  • Reynolds, W. M. (1991). A school-based procedure for the identification of students at-risk for suicidal behavior. Family & Community Health, 14, 64–75.

    Google Scholar 

  • Reynolds, W. M., & Mazza, J. J. (1999). Assessment of suicidal ideation in inner-city children and young adolescents: reliability and validity of the Suicidal Ideation Questionnaire-JR. School Psychology Review, 28, 17–30.

    Google Scholar 

  • Ridge Anderson, A., Keyes, G. M., & Jobes, D. A. (2016). Understanding and treating suicidal risk in young children. Practice Innovations, 1, 3–19.

    Google Scholar 

  • Rudd, M. D. (2008). Suicide warning signs in clinical practice. Current Psychiatry Reports, 10, 87–90.

    PubMed  Google Scholar 

  • Russell, S. T. (2003). Sexual minority youth and suicide risk. American Behavioral Scientist, 46, 1241–1257.

    Google Scholar 

  • Salzinger, S., Rosario, M., Feldman, R. S., & Ng-Mak, D. S. (2007). Adolescent suicide behavior: association with preadolescent physical abuse and selected risk and protective factors. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 859–866.

    PubMed  Google Scholar 

  • Sarkar, M., Byrne, P., Power, L., Fitzpatrick, C., Anglim, M., Boylan, C., & Morgan, S. (2010). Are suicidal phenomena in children different to suicidal phenomenon in adolescents? A six-year review. Child and Adolescent Mental Health, 15, 197–203.

    PubMed  Google Scholar 

  • Shaffer, D., & Craft, L. (1999). Methods of adolescent suicide prevention. Journal of Clinical Psychiatry, 60, 70–74.

    PubMed  Google Scholar 

  • Shaffer, D., Gould, M. S., Fisher, P., Trautman, P., Moreau, D., Klienman, M., et al. (1996). Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 53, 339–348.

    PubMed  Google Scholar 

  • Shafii, M., Carrigan, S., Whittinghill, J. R., & Derrick, A. (1985). Psychological autopsy of completed suicide in children and adolescents. American Journal of Psychiatry, 142, 1061–1064.

    PubMed  Google Scholar 

  • Shafii, M., Stelz-Lenursky, J., Derrick, A. M., Beckner, C., & Whittinghill, J. R. (1988). Comorbidity of mental disorders in the post-mortem diagnosis of completed suicide in children and adolescents. Journal of Affective Disoders, 15, 227–233.

    Google Scholar 

  • Sheftal, A. H., Asti, L., Horowitz, L. M., Felts, A., Fontanella, C. A., Campo, J. V., & Bridge, J. A. (2016). Suicide in elementary school-aged children and early adolescents. Pediatrics, 138, 1–10. https://doi.org/10.1542/peds.2016-0436.

    Article  Google Scholar 

  • Shinn, M. R., & Walker, H. M. (Eds.). (2010). Interventions for achievement and behavior problems in a three-tier model including RTI. Bethesda: National Association of School Psychologists.

    Google Scholar 

  • Simon, R. I. (2007). Gun safety management for patients at risk for suicide. Suicide and Life-threatening Behavior, 37, 518–526.

    PubMed  Google Scholar 

  • Taussig, H. N., Harpin, S. B., & Maguire, S. A. (2014). Suicidality among preadolescent children in fostercare. Child Maltreatment, 19, 17–26.

  • Tishler, C. L., Staats Reiss, N., & Rhodes, A. R. (2007). Suicidal behavior in children younger than twelve: a diagnostic challenge for emergency department personnel. Academic Emergency Medicine, 14, 810–818.

    PubMed  Google Scholar 

  • Tucker, R. P., Crowley, K. J., Davidson, C. L., & Gutierrez, P. M. (2015). Risk factors, warning signs, and drivers of suicide: what are they, how do they differ, and why does it matter? Suicide and Life-threatening Behavior, 45, 679–689.

    PubMed  Google Scholar 

  • Underwood, M., & Kalafat, J. (2009). Lifelines: a suicide prevention program. Center City: Hazelden Publishing.

    Google Scholar 

  • Vinas, F., Canals, J., Gras, M. E., Ros, C., & Domenech-Liaberia, E. (2002). Psychological and family factors associated with suicidal ideation in pre-adolescents. The Spanish Journal of Psychology, 5, 20–28.

    PubMed  Google Scholar 

  • Wagner, B. (1997). Family risk factors for child and adolescent suicidal behavior. Psychological Bulletin, 121, 246–298.

    PubMed  Google Scholar 

  • Wagner, B. M., Silverman, M. A. C., & Martin, C. E. (2003). Family factors in youth suicidal behaviors. Behavioral Scientist, 46, 1171–1191.

    Google Scholar 

  • Walsh, C. G., Ribeiro, J. D., & Franklin, J. C. (2017). Predicting risk of suicide attempts over time through machine learning. Clinical Psychological Science, 5, 457–469.

    Google Scholar 

  • Waters, S., & Cross, D. (2010). Measuring students’ connectedness to school, teachers, and family: validation of three scales. School Psychology Quarterly, 25, 164–177.

    Google Scholar 

  • Weinstein, S. M., Van Meter, A., Katz, A. C., Peters, A. T., & West, A. E. (2015). Cognitive and family correlates of current suicidal ideation in children with bipolar disorder. Journal of Affective Disorders, 173, 15–21.

    PubMed  Google Scholar 

  • Weller, E. B., Young, K. M., Rohrbaugh, A. H., & Weller, R. A. (2001). Overview and assessment of the suicidal child. Depression and Anxiety, 14, 157–163.

    PubMed  Google Scholar 

  • Westefeld, J. S., Bell, A., Bermingham, C., Button, C., Shaw, K., Skow, C., Stinson, R. D., & Woods, T. (2010). Suicide among preadolescents: a call to action. Journal of Loss and Trauma, 15, 381–407.

  • Whalen, D. J., Dixon-Gordon, K., Belden, A. C., Barch, D., & Luby, J. L. (2015). Correlates and consequences of suicidal cognitions and behaviors in children ages 3 to 7 years. Journal of the American Academy of Child & Adolescent Psychiatry, 54, 926–937.

    Google Scholar 

  • Wise, A. J., & Spengler, P. M. (1997). Suicide in children younger than age fourteen: clinical judgment and assessment issues. Journal of Mental Health Counseling, 19, 318–335.

    Google Scholar 

  • World Health Organization. (2014). Preventing suicide: a global imperative. Geneva: Author.

    Google Scholar 

  • Wyman, P. A. (2014). Developmental approach to prevent adolescent suicides: research pathways to effective upstream preventive interventions. American Journal of Preventive Medicine, 47, 251–256.

    Google Scholar 

  • Wyman, P. A., Gaudieri, P. A., Schmeelk-Cone, K., Cross, W., Brown, C. H., Sworts, et al. (2009). Emotional triggers and psychopathology associated with suicidal ideation in urban children with elevated aggressive-disruptive behavior. Journal of Abnormal Child Psychology, 37, 917–928.

    PubMed  PubMed Central  Google Scholar 

  • Youth suicide warning signs: Healthcare professionals (n.d.). Retrieved from http://www.youthsuicidewarningsigns.org/healthcare-professionals

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    David N. Miller

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Miller, D.N. Suicidal Behavior in Children: Issues and Implications for Elementary Schools. Contemp School Psychol 23, 357–366 (2019). https://doi.org/10.1007/s40688-018-0203-0

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