In yesterday’s post about bullying, I briefly talked about last week’s tragic suicide of 11-year old Carl Joseph Walker-Hoover. This morning I was doing some additional reading on suicide and came across a very interesting article about the childhood factors that predict suicide among teenagers and young adults. As I mentioned yesterday, suicide is one of the leading causes of death among adolescents, and many researchers have worked hard to try to identify the factors that contribute to the high rate of suicide in this age group. However, most of this research has involved conducting “psychological autopsies” of suicide victims. A Psychological autopsy involves a detailed examination of the victim’s past psychological profile, including family factors, history of psychological problems, etc. The problem is that the ‘retrospective’ nature of this research may lead to some biased results, as many of these results have been based upon “after-the-fact” interviews with family members, friends, and teachers.
A review of: Sourander, A., Klomek, A., Niemela, S., Haavisto, A., Gyllenberg, D., Helenius, H., Sillanmaki, L., Ristkari, T., Kumpulainen, K., Tamminen, T., Moilanen, I., Piha, J., Almqvist, F., & Gould, M. (2009). Childhood Predictors of Completed and Severe Suicide Attempts: Findings From the Finnish 1981 Birth Cohort Study Archives of General Psychiatry, 66 (4), 398-406 DOI: 10.1001/archgenpsychiatry.2009.21
In contrast, the prestigious journal Archives of General Psychiatry recently published a large longitudinal study that examined the childhood predictors of suicide in teens and young adults. This large prospective study included 5,302 children born in Finland in 1981. The authors used data obtained during a comprehensive assessment conducted when the children were 8 years old, to examine which factors predicted the possibility of suicide in subsequent years (up to age 24). The authors examined: 1) parents and teachers reports of conduct, hyperactivity, and emotional problems, 2) children self-report of their own depressive symptoms, and 3) a number of family and environmental factors (parental psychopathology, family structure, etc).
Rates of Suicide: By the age of 24, 54% (n=13) of all male deaths were due to suicide. Other causes of death for the males included unintentional injury/accidents (29%) and homicide (13%). In contrast, only 13% of the female deaths were due to suicide. Among the girls, the most common causes of death were unintentional injuries (44%), physical illness (31%), and homicide (13%). These findings are consistent with previous research on teen suicide indicating that while females have higher rates of suicide attempts, males have more completed suicides. That is, it appears that when males attempt to commit suicide they usually use more lethal means leading to death. Some researchers have also argued that this sex difference may be due to the way males and females process and show their emotions. For example, males usually hide their distress and often family members express surprise after a suicide because they did not see signs of distress. However, females may be more likely to express this distress, possibly prompting parents and teachers to provide assistance before the distress leads to a serious suicide attempt.
Predictors of Suicide: Among males, 78% of those who committed suicide screened positive for behavioral/emotional problems at age 8. In contrast, only 12% of the females who completed suicide screened positive for problems when they were young. Specifically, for males conduct and emotional problems at age 8 significantly predicted future suicide. Attention/hyperactivity did not predict suicide.
Surprisingly, self report of depressive symptoms did not predict suicide. It is likely that parents and teachers are more sensitive to the type of emotional problems during this age period. This may also be a function of the instruments used. The authors assessed depressive symptoms with the Child Depression Inventory. This scale is sensitive to symptoms of depression in children, but the scale is less sensitive to more general sub-clinical internalizing symptoms. Our laboratory (led by the creator of the CDI) has conducted extensive research using the CDI and has shown that this scale may not capture subtle, yet clinically meaningful internalizing symptoms, among non-depressed children. Thus, this may explain why parental report of kids’ distress was a better predictor of later the risk for suicide than the kids’ reports of their own symptoms using the CDI.
However, the most surprising finding was that none of the factors examined predicted female suicide. That is, psychological distress or other family factors at age 8 were not associated with later risk for suicide among girls. Thus, it is possible that the nature of suicide attempts vary between males and females, in that male suicide may reflect long-lasting psychopathology (identified as early as age 8). In contrast, female suicide may reflect more current distress that may not be present, or easily noted, in childhood.
In sum, the results of this study have clear clinical implications. It appears that conduct and emotional problems in middle childhood predicts later suicide risk for boys. Fortunately, this also means that early identification and treatment of these
risk factors may help reduce the rates of suicide among male adolescents and young adults. Unfortunately however, our understanding of early predictors of female suicide continues to be limited.
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