Characteristics and Precipitating Circumstances of Suicide Among Children Aged 5 to 11 Years in the United States, 2013-2017

Key Points

Question

What characteristics and precipitating circumstances are associated with childhood suicide?

Findings

In this multistate population-based qualitative study, childhood suicide was associated with multiple risk factors including mental health, prior suicidal behavior, trauma, and family or peer relation issues, with most suicides occurring by hanging or suffocation in the decedent’s bedroom. Firearms were the second most prevalent suicide method, and among cases with detailed information, all children obtained guns stored unsafely in the home.

Meaning

The findings underscore the importance of early suicide prevention efforts that include improvements in suicide risk assessment, family relations, and lethal means restriction, particularly safe firearm storage.

Abstract

This qualitative study assesses characteristics and precipitating circumstances of suicide among children aged 5 to 11 years in the US.

Abstract

Importance

Suicide is the eighth leading cause of death among children aged 5 to 11 years, with rates increasing during the past decade. A better understanding of factors associated with childhood suicide can inform developmentally appropriate prevention strategies.

Objective

To examine characteristics and precipitating circumstances of childhood suicide.

Design, Setting, and Participants

This qualitative study examined restricted-use data from the National Violent Death Reporting System (NVDRS) regarding child suicide decedents aged 5 to 11 years in the US from 2013 to 2017. The NVDRS is a state-based surveillance system that collects data on suicide and violent deaths in 50 states, with restricted-use data available from 37 states. Details and context related to suicide deaths were identified through a content analysis of case narratives from coroner or medical examiner and law enforcement reports associated with each incident.

Exposures

Characteristics and precipitating circumstances associated with suicide cited in the coroner, medical examiner, and law enforcement case narratives.

Main Outcomes and Measures

Suicide incidence and risk factors for suicide including mental health, prior suicidal behavior, trauma, and peer, school, or family-related problems.

Results

Analyses included 134 child decedents (101 [75.4%] males; 79 [59.0%] White individuals; 109 [81.3%] non-Hispanic individuals; mean [SD] age, 10.6 [0.8] years). Most suicides occurred in the child’s home (95.5% [n = 128]), and more specifically in the child’s bedroom. Suicide by hanging or suffocation (78.4% [n = 105]) was the most frequent method, followed by firearms (18.7% [n = 25]). Details on gun access were noted in 88.0% (n = 22) of suicides by firearm, and in every case, the child obtained a firearm stored unsafely in the home. Findings revealed childhood suicide was associated with numerous risk factors accumulated over time, and suggest a progression toward suicidal behavior, especially for youth with a history of psychopathology and suicidal behavior. An argument between the child and a family member and/or disciplinary action was often a precipitating circumstance of the suicide.

Conclusions and Relevance

This qualitative study found that childhood suicide was associated with multiple risk factors and commonly preceded by a negative precipitating event. Potential prevention strategies include improvements in suicide risk assessment, family relations, and lethal means restriction, particularly safe firearm storage. Future research examining the myriad aspects of childhood suicide, including racial/ethnic and sex differences, is needed.