Emotional Triggers and Psychopathology Associated with Suicidal Ideation in Urban Children with Elevated Aggressive-Disruptive Behavior

Abstract

Abstract8.6% suicidal ideation (SI) was found among 349 urban 6 -9 year olds in the top tercile of aggressivedisruptive behavior. SI was associated with more self-reported depression, ODD, conduct problems, and ADHD symptoms (ES 0.70 -0.97) and 3.5 -5 times more clinically significant symptoms. Parents rated more symptoms in older children associated with SI compared to parents of similar age children without SI, including greater somatic and behavior problems in 8 -9 year olds with SI. Parent ratings did not differentiate SI and non-SI in 6 -7 year olds. SI frequently co-occurred with thoughts about death. Children described anger, dysphoria and interpersonal conflict as motivators/ triggers for SI and worries about safety/health as motivator/triggers for thoughts about death, suggesting that problems managing emotionally challenging situations are a specific factor in initiating SI. Universal and indicated interventions for children to strengthen emotional selfregulation and behavioral control are recommended to complement the current emphasis on suicide prevention among adolescents. Keywords suicidal ideation; urban children; emotional triggers; externalizing problemsThe burden of suicide mortality has shifted increasingly towards younger aged individuals in the last half-century, and suicide is the third leading cause of death for young people ages 10 -24 in the U.S. (Lubell, Kegler, & Karch, 2007). Although there are few deaths from suicide before adolescence, suicidal ideation in 4 th grade was associated with a 1.5 times greater likelihood of making a suicide attempt by age 19 in a large urban cohort (Ialongo et al., 2004). In another epidemiological cohort, children with suicidal ideation before adolescence had higher rates of mood and substance use disorders as adults compared to those whose suicidal ideation began during adolescence (Steinhausen & Winkler, 2004). These associations suggest that targeting early risk factors for suicidal behavior may be an important suicide prevention strategy (Brown, Wyman, Brinales, & Gibbons, 2007). However, little is known about suicidal thinking and behavior in young children.A developmental approach provides a useful framework for examining suicidal behavior across childhood. According to this approach, the manner in which children experience and express specific features of psychopathology depends on their cognitive, physiological, and social developmental level (Cicchetti & Toth, 1998 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript symptom of depression across ages, but the manner in which children express dysphoria varies by age (Weiss & Garber, 2003). Developmental level can also influence the causes and consequences of psychopathology; cognitive factors such as a pessimistic explanatory style for negative life events, for example, may be more predictive of mood disorders for older than younger children (Nolen-Hoeksema, Girgus, & Seligman, 1992). A developmental approach also focuses attention on mechanisms of transmission of risk fac...

Longitudinal Assessment of Self-Harm Statements of Youth in Foster Care: Rates, Reporters, and Related Factors

“…Developmental theorists also note that children lack cognitive understanding of the lethality and finality of death [11]; thus, recent research on suicidality in preadolescents includes assessing for thoughts of self-harm in addition to suicide. In a study of urban children 6–9 years old, Wyman and colleagues [9] found risk factors for self-harm (e.g., depressive symptoms, externalizing problems) similar to those found in older children and adolescents. They concluded that children with difficulty regulating emotions and thoughts about death may develop self-harm or suicidal thoughts if they experience significant stressors [9].…”

“…In a study of urban children 6–9 years old, Wyman and colleagues [9] found risk factors for self-harm (e.g., depressive symptoms, externalizing problems) similar to those found in older children and adolescents. They concluded that children with difficulty regulating emotions and thoughts about death may develop self-harm or suicidal thoughts if they experience significant stressors [9]. There is likely little doubt that youth in foster care have experienced serious stressors, however, thus far, very little research regarding self-harm in preadolescents in out of home care exists, making it difficult to understand the rates, stability, and related factors of self-harm in this important subset of youth.…”

“…The average rate of suicide consideration for middle school youth ranged from 11.6% to 25.4% with females significantly more likely to endorse a serious consideration [8]. Lastly, in an urban community sample of 349 children (ages 6–9 years), 8.6% of the children endorsed having suicidal or self-harm thoughts [9]. In sum, rates of suicidal ideation appeared to decrease as the age of each sample decreased.…”

Mobile Phone Intervention to Reduce Youth Suicide in Rural Communities: Field Test (Preprint)

“…Text4Strength focuses on three core emotion self-regulation skills [59]: (1) monitoring of one's own and others' emotions; (2) reducing escalation of emotions; and (3) building relationships that aid in maintaining control and regaining equilibrium. These skills are critical in adolescent development and the lack of such skills is associated with suicide risk [13].…”

Social Information-Processing Skills and Aggression

“…They also perceive fewer cues, generate fewer solutions, and are more likely to select aggressive responses (Bierman, Smoot, & Aumiller, 1993;Eisenberg et al, 2001;Izard, 2002). Moreover, children with deficits in emotion regulation skills are more likely to display strong affect, which elevates risk for peer rejection and victimization (Eisenberg & Fabes, 1992;Hubbard, 2001;Schwartz et al, 1999) and experience poor overall psychosocial adjustment (Lengua, 2003, Wyman et al, 2009). …”