Children's understanding of death in relation to child suicidality and homicidality

doi:10.1016/S0272-7358(96)00044-X

Clinical Psychology Review

Volume 17, Issue 1, 1997, Pages 33-45

https://doi.org/10.1016/S0272-7358(96)00044-X Get rights and content

Abstract

This review examines children's understanding of death and how such understanding may be related to the increasing incidence of child suicidality and homicidality. Several factors have been reported to influence children's acquisition of the concepts of death. Those most often reported involved include children's age, cognitive development, and exposure to death; religion and culture appear to play a more minimal role. Most of what we know about how and when children begin to understand death is derived from research with healthy children. Although less robust, the data available from chronically physically ill children and suicidal children indicate some distortions in and less mature concepts of death. These distortions may indeed make death appear more attractive and less permanent to some suicidal children. Despite these provocative findings, no similar investigations have been conducted with homicidal children. Implications of these data for future research and potential intervention are discussed.

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To highlight the problem of child suicide, summarize what is known and not known about the problem in the empirical literature, and provide recommendations with ethical considerations for future research and practice.
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Changing Conceptions of Death as a Function of Depression Status, Suicidal Ideation, and Media Exposure in Early Childhood
2019, Journal of the American Academy of Child and Adolescent Psychiatry
This study characterized 3- to 6-year-old children’s understanding of death as a function of depression status, suicidal ideation (SI), and media consumption.
Participants were 79 children with depression (3.0–6.11 years old) who completed a comprehensive psychiatric assessment and experimenter-led death interview and a comparison group of 60 healthy children (4.0–7.12 years old). The interview assessed children’s understanding of 5 concepts of death: universality, applicability, irreversibility, cessation, and causality. Children’s mastery of each concept and overall understanding of death was examined as a function of depression and SI status: depressed with SI (n = 22), depressed without SI (n = 57), and healthy (n = 60). Children’s observed emotional reactions to hearing about natural death, accidental death, and suicide were assessed by death-themed stories. Parent reports of children’s television and videogames/internet consumption assessed links between media exposure and understanding of death.
Children with depression and SI scored higher on overall understanding of death than those with depression without SI and healthy children. They also exhibited more sad and anxious affect listening to death-themed stories and were more likely to describe death as caused by violence. Across this sample, older children also were more likely to depict death as violent. More television use was associated with less understanding of death, including the concept of irreversibility.
Children with depression and SI have a more advanced understanding of death than their peers, dispelling the myth that these ideations arise in the context of a poor understanding of death. The increase in violence attributions across early childhood could indicate increasing normalization of violence in children’s perceptions of death.
Clinical trial registration information: A Randomized Controlled Trial of PCIT-ED for Preschool Depression; http://clinicaltrials.gov; NCT00595283.
Suicidal thoughts and behaviors in psychiatrically referred young children
2016, Psychiatry Research
Citation Excerpt :
Relatedly, it is not possible to know whether children’s suicidal statements or behaviors, as reported by a caregiver, truly represent suicidal thinking or intent. That is, we did not assess for children’s understanding of death or suicide, nor did we examine children’s understanding of related cognitive concepts (e.g., irreversibility) or experiences thought to influence children’s early understanding of death (e.g., death of family member or pet, family religious beliefs (Cuddy-Casey and Orvaschel, 1997)). It will be important for future research in this area to incorporate a broader range of assessment tools to more fully capture the clinical and developmental complexity of early suicidal thoughts and behavior.
Despite increased awareness of the prevalence and seriousness of mental health problems in early childhood, there have been few empirical studies of suicidal thoughts and behaviors in this age group. This study examined suicidal thoughts and behaviors in 360 preschool-aged children (ages 3 to 7 years) presenting to a psychiatric day treatment program. A semi-structured diagnostic interview (conducted with primary caregivers) was used to assess for child suicidal thoughts and behaviors and psychiatric disorders. Participating mothers also reported on their own psychological distress and family psychiatric history. Forty-eight children (13%) were reported to have suicidal thoughts and behaviors, with suicidal plans or attempts endorsed for 2–3% of the sample. Suicidal thinking and behavior was associated with older child age and with higher rates of concurrent depression, oppositional defiant disorder, and posttraumatic stress disorder in univariate analyses, with age and depression remaining as significant predictors in a multivariate logistic regression model. Findings suggest that suicidal thoughts and behaviors are a significant clinical concern for young children presenting with early psychopathology, particularly depression, with implications for early childhood psychiatric assessment and treatment.
Correlates and Consequences of Suicidal Cognitions and Behaviors in Children Ages 3 to 7 Years
2015, Journal of the American Academy of Child and Adolescent Psychiatry
Despite research documenting the existence of depression and other psychiatric disorders in early childhood, little is known about the nature and consequences of suicidal cognitions and behaviors (SI) in young children ages 3 to 7 years. The identification of trajectories of SI across childhood is a critical step toward preventing childhood suicide.
Participants were 306 children enrolled in a prospective longitudinal investigation of young children and their families. Children and their families completed a baseline assessment between ages 3 and 7 years, and at least 1 follow-up assessment (ages 7–12 years). Child psychopathology, suicidal thoughts, plans, and behaviors were assessed via parent and trained interviewer report before age 9, and also with self-report after age 9. Data on maternal history of psychopathology, as well as maternal and family history of suicide attempts, were also obtained through parent report.
Controlling for a range of clinical and demographic variables, early-childhood SI (as defined as suicidal thoughts, behavior, or any expression of plans/attempts occurring before age 7) and suicidal themes in play were concurrently associated with childhood attention-deficit/hyperactivity (ADHD) and oppositional defiant/conduct disorders (ODD/CD). Early-childhood SI also predicted school-age depression and ODD/CD; however, these findings were no longer significant after controlling for the same diagnoses at the childhood baseline. Longitudinal analysis indicated that early-childhood SI was a robust predictor of school-age SI, even after accounting for psychiatric disorders at both time points.
Extending current research, these findings demonstrate that early-childhood SI confers significant risk for continuation into school-age SI and is concurrently associated with ADHD and ODD/CD. Although the meaning of early-childhood SI remains unclear, results suggest that it is a clinically important phenomenon that should be carefully assessed and taken seriously as a marker of risk for ongoing suicidal ideation/behavior. These findings suggest that early screening for SI in childhood is indicated in clinical settings, particularly in children less than 7 years of age with depression and externalizing disorders.
Life events and suicidal ideation and behavior: A systematic review
2014, Clinical Psychology Review
Citation Excerpt :
In the case of the pre-adolescent samples, the lack of research may be largely accounted for by the rarity of suicidal ideation and behavior in very young children. Indeed, some researchers have asserted that children under the age of 10 do not possess the cognitive capability fully to comprehend the nature of death, and consequently are incapable of truly engaging in suicidal behavior (Cuddy-Casey & Orvaschel, 1997; Nock et al., 2008). Instead, risk of first-onset suicidal behavior tends to emerge around age 12 and to increase sharply over the course of adolescence (Nock et al., 2008, 2013).
Despite the sustained theoretical and empirical interest over the past 40 years in the association between life events and suicidal ideation and behavior, the literature in this area has yet to be systematically reviewed. The current article provides a comprehensive review of the empirical literature pertaining to life events in relation to at least one aspect of suicidal ideation and behavior (i.e., suicidal ideation, plans, attempts, degree of suicidal intent, medical severity of attempt, repeat versus first lifetime attempt status, and death by suicide). A total of 95 articles meeting inclusion criteria were identified by a literature search using Medline and PsycINFO. Evidence for an association between negative life events and suicidal ideation and behavior was generally consistent, with strongest support found for more severe than with less severe forms of suicidal ideation and behavior. Support for an inverse relation between positive events and suicidal ideation and behavior was generally lacking. Although there is general support for life stressors as a risk factor for suicidal ideation and behavior, interpretation of these findings is constrained by methodological limitations prevalent in much of the literature, particularly in the case of suicidal ideation and suicide plans. Recommendations for future research are provided.

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Children's understanding of death in relation to child suicidality and homicidality

Abstract

Journal of Clinical Child Psychology

Affective responses to the concept of death in a population of children and early adolescents

The Journal of Genetic Psychology

Children's concepts of death: A descriptive study

Child Study Journal

The effects of age, object, and cultural/religious background on children's concepts of death

Omega

Developmental aspects of suicidal behavior in children: I

Journal of the American Academy of Child and Adolescent Psychiatry

The concept of death in early childhood

Child Development

Concepts of death, illness and isolation found in children with leukaemia

Child: Care, Health, and Development

Characteristics of adolescents charged with homicide

Behavioral Sciences & The Law

Children's death concepts: Relationship to cognitive functioning, age, experience with death, fear of death, and hopelessness

Journal of Clinical Child Psychology

The child's reality: Three developmental themes

When children kill: The dynamics of juvenile homicide

Suicidal behavior in children

Psychology: A Journal of Human Behavior

New meanings of death

Children's concepts of death: A cross cultural comparison among Muslims, Druze, Christians, and Jews in Israel

Journal of Cross-Cultural Psychology

The concept of death in children

The Journal of Genetic Psychology

The development of children's concepts of death

Death Studies

Interviewing prepubertal children about suicidal ideation and behavior

Journal of the American Academy of Child and Adolescent Psychiatry

Children's concepts of death

The Journal of Genetic Psychology

Childhood, death, and cognitive development

Developmental Psychology

Talking with children about death

American Journal of Orthopsychiatry

The development of the concept of death in children aged 5–9 years

Child: Care, Health, and Development

The development of the subconcepts of death in young children: A short-term longitudinal study

Child Development

The concept of death in Midwestern children and youth

American Journal of the Disabled Child

Children talk about death

Omega