CHILDHOOD SUICIDAL BEHAVIOR: A Developmental Perspective

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Recognition of the existence of a high incidence of suicide among youth stimulated study of the developmental characteristics of suicidal behavior. A developmental psychopathologic framework offers opportunities to delineate features of suicide and nonfatal suicidal behavior for distinct age-specific intervals along the human life cycle and to discern continuities and discontinuities in predictors, precipitants, and correlates of suicidal behavior. In addition, it provides insights into designing prevention and intervention strategies for suicidal behavior appropriate to age and context of specific groups of people. This article presents empiric information about the phenomenology of suicidal behavior among prepubertal children, describes early predictors of suicidal behavior apparent in childhood for incidence of suicidal behavior in adolescence, and discusses retrospectively identified risk factors present in the childhoods of youth who commit suicide.

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EPIDEMIOLOGY OF SUICIDE IN YOUNG PEOPLE

Childhood suicide is classified in the United States for age-specific groups of children who are 5 to 14 years old. This is the youngest reported age group of suicide victims and includes prepubertal children (age 5–12 years) and young adolescents (age 13–14 years). The next group involves individuals age 15 to 24 years and includes adolescents (age 15–18 years) and young adults (age 19–24 years). This is considered the youth age group.

In the United States, suicide in 1994 (the latest year of

CHARACTERISTICS OF PREPUBERTAL AND YOUNG ADOLESCENT SUICIDAL BEHAVIOR

Important developmental dimensions of suicidal behavior among prepubertal children, ages 6 to 12 years, and young adolescents, ages 13 to 14 years, involve cognitive maturity, emotional expression, and behavioral components. Environmental–contextual factors, notably effects of familial and extrafamilial influences, affect these developmental dimensions. The interactions of these various factors with specific levels of development characterize suicidal behavior for age-specific groups. These

PREDICTIVE VALIDITY OF PREPUBERTAL SUICIDAL BEHAVIOR AND OTHER PREPUBERTAL RISK FACTORS

The factors described below for prepubertal children can be significant risk indicators for future suicidal behavior. For example, 6% of a community sample of 101 prepubertal children, who were recruited because they did not have a history of psychiatric care or were not in special classes, reported persistent suicidal ideation in a 2-year follow-up assessment.27 The predictive power of prepubertal suicidal tendencies over a lengthy period has been demonstrated in prospective studies.30

IMPLICATIONS FOR INTERVENTION AND PREVENTION

Suicidal behavior can be conceptualized as a developmental problem that has precursors at earlier stages of development and involves complex interactions among cognitive, emotional, behavioral, and environmental factors that produce limited capacities to tolerate or regulate intense dysphoric affects. A suicidal act may represent the child's efforts to diminish intolerable affects or intense unbearable consciousness.14 Therefore, strategies to minimize risk for suicidal behavior should be

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    Address reprint requests to Cynthia R. Pfeffer, MD New York Hospital–Westchester Division, 21 Bloomingdale Road White Plains, New York, 10605

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