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    Original Investigation
    February 7, 2020

    Prevalence and Family-Related Factors Associated With Suicidal Ideation, Suicide Attempts, and Self-injury in Children Aged 9 to 10 Years

    Author Affiliations
    • 1Laureate Institute for Brain Research, Tulsa, Oklahoma
    • 2Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
    • 3Department of Psychological & Brain Sciences, Washington University in St Louis, St Louis, Missouri
    • 4Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
    • 5Department of Radiology, Washington University in St Louis, St Louis, Missouri
    • 6Department of Human Development and Family Science, Oklahoma State University, Tulsa
    • 7Oxley College of Health Sciences, The University of Tulsa, Tulsa, Oklahoma
    JAMA Netw Open. 2020;3(2):e1920956. doi:10.1001/jamanetworkopen.2019.20956
    Key Points español 中文 (chinese)

    Question  How common is suicidality among preadolescent children, and are certain family factors associated with children’s suicidality?

    Findings  In a cross-sectional analysis of 11 814 children and their caregivers from the baseline sample from the Adolescent Brain Cognitive Development study, the prevalence of suicidal ideation and behaviors among preadolescent children was higher than previously estimated. Family conflict and low parental monitoring were associated with children’s suicidality after statistically controlling for relevant sociodemographic and clinical variables.

    Meaning  These findings highlight the association between family factors and children’s suicidal ideation and behaviors.


    Importance  Although suicide is a leading cause of death for children in the United States, and the rate of suicide in childhood has steadily increased, little is known about suicidal ideation and behaviors in children.

    Objective  To assess the overall prevalence of suicidal ideation, suicide attempts, and nonsuicidal self-injury, as well as family-related factors associated with suicidality and self-injury among preadolescent children.

    Design, Setting, and Participants  Cross-sectional study using retrospective analysis of the baseline sample from the Adolescent Brain Cognitive Development (ABCD) study. This multicenter investigation used an epidemiologically informed school-based recruitment strategy, with consideration of the demographic composition of the 21 ABCD sites and the United States as a whole. The sample included children aged 9 to 10 years and their caregivers.

    Main Outcomes and Measures  Lifetime suicidal ideation, suicide attempts, and nonsuicidal self-injury as reported by children and their caregivers in a computerized version of the Kiddie Schedule for Affective Disorders and Schizophrenia.

    Results  A total of 11 814 children aged 9 to 10 years (47.8% girls; 52.0% white) and their caregivers were included. After poststratification sociodemographic weighting, the approximate prevalence rates were 6.4% (95% CI, 5.7%-7.3%) for lifetime history of passive suicidal ideation; 4.4% (95% CI, 3.9%-5.0%) for nonspecific active suicidal ideation; 2.4% (95% CI, 2.1%-2.7%) for active ideation with method, intent, or plan; 1.3% (95% CI, 1.0%-1.6%) for suicide attempts; and 9.1% (95% CI, 8.1-10.3) for nonsuicidal self-injury. After covarying by sex, family history, internalizing and externalizing problems, and relevant psychosocial variables, high family conflict was significantly associated with suicidal ideation (odds ratio [OR], 1.12; 95% CI, 1.07-1.16) and nonsuicidal self-injury (OR, 1.09; 95% CI, 1.05-1.14), and low parental monitoring was significantly associated with ideation (OR, 0.97; 95% CI, 0.95-0.98), attempts (OR, 0.91; 95% CI, 0.86-0.97), and nonsuicidal self-injury (OR, 0.95; 95% CI, 0.93-0.98); these findings were consistent after internal replication. Most of children’s reports of suicidality and self-injury were either unknown or not reported by their caregivers.

    Conclusions and Relevance  This study demonstrates the association of family factors, including high family conflict and low parental monitoring, with suicidality and self-injury in children. Future research and ongoing prevention and intervention efforts may benefit from the examination of family factors.