Understanding and Assessing Suicidal Thoughts and Behaviors in School-Age Children: A Longitudinal Approach

We are in a youth mental health crisis with unprecedented and staggeringly high rates of suicidal thoughts and suicide behaviors (STBs) in children. There is increasing evidence that children as young as preschool-aged can experience STBs, and that these early-onset STBs can continue into adolescence and are linked to other mental health struggles. However, little is known about the emergence or expression of these early-onset STBs. We are also lacking tools, such as screening measures, for identifying children who are experiencing STBs and might be at heighted risk for suicide. This is due, at least in part, to clinician and caregiver skepticism regarding the ability for young children to experience STBs and concern that asking children about STBs might generate STBs, despite evidence from slightly older samples that suicide screening is a safe and effective method of detecting suicide risk. The proposed study thus aims to further our understanding and assessment of early-onset STBs in three ways. First, we will examine if children who experience STBs at ages 4-7 (our baseline measure) continue to experience those STBs two years later when they are aged 6-9 years (our follow-up measure). Second, we will examine whether asking children about suicide leads to any changes in STBs across the following two weeks. Third, we will assess the utility of a brief screening measure that we developed to ask caregivers about their child’s STBs, by comparing caregiver responses on the screening measure to those obtained in clinical interviews with caregivers and children. Based on prior data, we hypothesize that 1) the majority of children who experienced STBs at baseline will continue to experience STBs across the following two years, (2) asking children about STBs will not generate new-onset STBs, and (3) the suicide risk screener will show promise (i.e., acceptable survey metrics) for detecting suicide-risk in children aged 6-9 years. To collect this data, we will build on an existing/ongoing study led by the applicant that assesses multiple aspects of suicide-risk in a sample of 4-to 7-year-old children enriched for a history of STBs. To our knowledge, this is the first sample to include young children specifically recruited for a history of STBs, and to directly ask children about their own experiences with STBs, and provides a unique opportunity to address the questions outlined above. The baseline sample will include 225 children from diverse racial and socioeconomic backgrounds, approximately 75 of whom have experienced STBs. The proposed project will follow-up with 125 children from this study 2 years after their baseline assessment, with relevant data combined across timepoints as appropriate. The data generated from this proposal will provide critical new information about the continuity of STBs in childhood, demonstrate the safety profile of asking children directly about suicide, and assess the utility of the caregiver-report suicide screener. This project will also generate a wealth of new preliminary data to further our understanding of childhood STBs with the potential to elucidate risk factors for suicide that can be targeted for preventative intervention.