A marked increase in suicidal thoughts and behaviors (STB) among pre-pubertal children over the last decade has been reported by the CDC. Death by suicide in children ages 10-14 more than doubled between 2007 and 2014 with rates of non-lethal self-inflicted injuries doubling during the same period. Despite these dramatic rises in STB rates, there has been little investigation of the prevalence, timing of onset, or correlates and causes of STB or non-suicidal self-injury (NSSI) in pre-pubertal children. In a longitudinal study of preschool depression, we reported that preschool-onset STB shows stability across childhood. Outside of case reports, there are no other published data on STB or NSSI in early childhood. Our findings, taken together with the CDC data, support the critical need for studies of STB and NSSI that start in early childhood to identify the predictors of STB and NSSI in middle childhood and adolescence. In a sample of 3-7 year olds screened for a treatment study of depression we again found alarmingly high rates of NSSI (21.3%) and STB (19.4%) at baseline. Supplemental NIMH funding was awarded to investigate the characteristics and neural and behavioral correlates of STB and NSSI in this depressed sample, and to add age matched healthy controls. We found both common and unique risk factors for STB and NSSI in young children, consistent with the extant adolescent literature. Building on these findings, we propose to follow this well characterized sample into school age and early adolescence to test developmental models of these phenomena. We will investigate the longitudinal course, mediators and moderators, and neural correlates of early onset STB and NSSI. We will conduct behavioral and ERP assessments at two time points, 18-months apart in our sample of N=314 who have data from the preschool period. We will also sample the frequency, intensity, and proximal precipitants of STB/NSSI using weekly mini-assessments (WMA). Building on preliminary findings, we will use ERPs to test hypotheses about RDoC constructs that map to the risk factors that may contribute to STB and NSSI, including responses to negative and positive feedback to reward, errors, and peer rejection. We will test specific hypotheses about both shared risk factors for NSSI and STB (greater depression, peer rejection, adverse life events, and harsh parenting, as well as stronger ERP responses to loss and peer rejection, and blunted ERP responses to wins and social acceptance) as well as risk factors that may be more selective for NSSI (greater shame, irritability, self-criticism and higher pain tolerance) versus STB (reduced belongingness, greater hopelessness and a family history of suicide). Given the young age of the ascertained sample at baseline, we also have the opportunity to investigate differences in risk as a function of developmental stage. The proposed study provides an unprecedented opportunity to follow the largest ever sample of young children with STB and NSSI to investigate developmental trajectories into school age and early adolescence, potentially identifying early developmental targets for earlier intervention.

Public Health Relevance

Suicide is now the 3rd leading cause of death in childhood and the Center for Disease Control has recently reported alarming increases in rates of suicidal ideation in school age girls and African American boys, but little is known about the early developmental risk factors for suicidality. The proposed project will follow a unique sample of healthy children and depressed preschool children, many of whom expressed suicidal thoughts and behaviors (STB) and non-suicidal self-injury (NSSI), into school age and early adolescence to understand the predictors of stable, worsening, or resolving STB and NSSI, adding two additional waves of behavioral assessment, detailed measures of peer and family functioning, weekly mini assessments (WMA) to assess for STB and NSSI in real time, and measures of brain response to reward and peer rejection. This study will provide the first available data on how suicidal thoughts and behaviors expressed early in life change across development, and may also inform when risk or protective factors have their most powerful impact during development to inform the design of early intervention or prevention.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Child Psychopathology and Developmental Disabilities Study Section (CPDD)
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Pacheco, Jenni
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Washington University
Schools of Medicine
Saint Louis
United States
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