Severity of suicidal behaviors in childhood: Sex, race, and ethnic differences in the ABCD Study

• In Event: Responding to the alarming rise of suicide in youth under the age of 12

Abstract

Introduction: Although suicidal ideation (SI) and suicide attempts (SAs) are the strongest predictors of suicide, little is known about the course and severity of these suicidal behaviors in childhood.
Aims: Our study described the prevalence, incidence, and transitions of SI and SAs and examined sex and racial/ethnic differences among children enrolled in three yearly assessments of the Adolescent Brain Cognitive Development (ABCD) Study. Severity of SI (i.e., passive, non-specific active, and active) among those who attempted suicide was also examined.
Study population: Our sample included 9,923 children (9-10 years old; 48.6% female; 54.5% White, 11.9% Black, 23.2% Hispanic/Latinx and 10.4% Other Race at baseline) who answered all the questions about SI and SAs from the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-5) at each yearly assessment (83.5% of total sample).
Methods: Outcomes included passive SI (i.e., wish to be dead), non-specific active SI (i.e., desire to kill oneself without plan/intent/method), active SI (i.e., desire to kill oneself with at least a plan, intent, or method) and SAs. Analyses were adjusted for ranked propensity weights.
Results: Over three years, 17.8% of the children thought about suicide and 2.2% attempted suicide. Passive (6.9%) and non-specific active (6.4%) were the most severe forms of SI reported. Among children without lifetime SI and SAs at baseline (n = 9,057), 9.8% started thinking about suicide and 0.9% attempted suicide at follow up. Among children with SI only (without suicide attempts) at baseline (n = 789), 5.6% attempted suicide at follow up. Boys (vs. girls) reported more SI at baseline (Rao-Scott X2 = 4.91, p = .027). Black children (vs. White; Rao-Scott X2 = 2.87, p = .036) and girls (vs. boys; Rao-Scott X2 = 13.3, p < .001) were more likely to start thinking about suicide over time. Black children (vs. White) endorsed more non-specific active SI across assessments (Rao-Scott X2 = 2.54, p = .007). There were neither sex nor racial/ethnic differences in SAs. Among children who attempted suicide at each assessment or across assessments or who transitioned from SI to SAs, non-specific active was the form of SI more frequently identified, followed by active SI, no SI (especially prevalent at younger ages).
Discussion: Over the first three years of the ABCD Study, 2.2% of the children attempted suicide and almost 18% reported SI. Based on our findings, clinicians conducting risk assessments with children should consider not only active SI but also less severe forms of SI that do not necessarily include a plan, a method or intent, especially among boys and Black children, who are at higher risk of dying by suicide than girls and White peers, respectively, in this age group. Close monitoring is needed for children with SI to prevent their transition to SAs. The assessment of common precipitants (e.g., arguments with parents, school sanctions) and risk factors (e.g., impulsivity, aggressiveness, ADHD) commonly identified in childhood suicides is warranted.

Authors

• Ana Ortin Peralta, Yeshiva University
  Presenting Author

• Arielle H Sheftall

• Abigail Osborn

• Carly Schuller

• Regina Miranda