Laureate Institute for Brain Research, Tulsa, Oklahoma.
Department of Psychology, The University of Tulsa, Tulsa, Oklahoma.
JAMA Netw Open. 2020 Feb 5;3(2):e1920956. doi: 10.1001/jamanetworkopen.2019.20956.
Although suicide is a leading cause of death for children in the United States, and the rate of suicide in childhood has steadily increased, little is known about suicidal ideation and behaviors in children.
To assess the overall prevalence of suicidal ideation, suicide attempts, and nonsuicidal self-injury, as well as family-related factors associated with suicidality and self-injury among preadolescent children.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study using retrospective analysis of the baseline sample from the Adolescent Brain Cognitive Development (ABCD) study. This multicenter investigation used an epidemiologically informed school-based recruitment strategy, with consideration of the demographic composition of the 21 ABCD sites and the United States as a whole. The sample included children aged 9 to 10 years and their caregivers.
Lifetime suicidal ideation, suicide attempts, and nonsuicidal self-injury as reported by children and their caregivers in a computerized version of the Kiddie Schedule for Affective Disorders and Schizophrenia.
A total of 11 814 children aged 9 to 10 years (47.8% girls; 52.0% white) and their caregivers were included. After poststratification sociodemographic weighting, the approximate prevalence rates were 6.4% (95% CI, 5.7%-7.3%) for lifetime history of passive suicidal ideation; 4.4% (95% CI, 3.9%-5.0%) for nonspecific active suicidal ideation; 2.4% (95% CI, 2.1%-2.7%) for active ideation with method, intent, or plan; 1.3% (95% CI, 1.0%-1.6%) for suicide attempts; and 9.1% (95% CI, 8.1-10.3) for nonsuicidal self-injury. After covarying by sex, family history, internalizing and externalizing problems, and relevant psychosocial variables, high family conflict was significantly associated with suicidal ideation (odds ratio [OR], 1.12; 95% CI, 1.07-1.16) and nonsuicidal self-injury (OR, 1.09; 95% CI, 1.05-1.14), and low parental monitoring was significantly associated with ideation (OR, 0.97; 95% CI, 0.95-0.98), attempts (OR, 0.91; 95% CI, 0.86-0.97), and nonsuicidal self-injury (OR, 0.95; 95% CI, 0.93-0.98); these findings were consistent after internal replication. Most of children's reports of suicidality and self-injury were either unknown or not reported by their caregivers.
This study demonstrates the association of family factors, including high family conflict and low parental monitoring, with suicidality and self-injury in children. Future research and ongoing prevention and intervention efforts may benefit from the examination of family factors.
尽管自杀是美国儿童死亡的主要原因，且儿童自杀率一直在稳步上升，但人们对儿童的自杀意念和行为知之甚少。
评估自杀意念、自杀企图和非自杀性自伤的总体发生率，以及与儿童自杀和自伤相关的与家庭相关的因素。
设计、地点和参与者：横断面研究，使用青少年大脑认知发展 (ABCD) 研究的基线样本进行回顾性分析。这是一项多中心调查，采用了基于流行病学的学校招募策略，考虑了 21 个 ABCD 地点和美国的人口构成。样本包括 9 至 10 岁的儿童及其照顾者。
儿童及其照顾者在儿童情绪障碍和精神分裂症 Kiddie 时间表的计算机版本中报告的终生自杀意念、自杀企图和非自杀性自伤。
共纳入 11814 名 9 至 10 岁的儿童（47.8%为女孩；52.0%为白人）及其照顾者。在进行社会人口统计学加权后，大约的流行率为：终生被动自杀意念史 6.4%（95%CI，5.7%-7.3%）；非特定主动自杀意念 4.4%（95%CI，3.9%-5.0%）；主动意念伴方法、意图或计划 2.4%（95%CI，2.1%-2.7%）；自杀企图 1.3%（95%CI，1.0%-1.6%）；非自杀性自伤 9.1%（95%CI，8.1%-10.3%）。在按性别、家族史、内化和外化问题以及相关社会心理变量进行协方差分析后，高家庭冲突与自杀意念（优势比[OR]，1.12；95%CI，1.07-1.16）和非自杀性自伤（OR，1.09；95%CI，1.05-1.14）显著相关，而低父母监督与意念（OR，0.97；95%CI，0.95-0.98）、企图（OR，0.91；95%CI，0.86-0.97）和非自杀性自伤（OR，0.95；95%CI，0.93-0.98）显著相关，这些发现在内部分层复制中是一致的。大多数儿童的自杀意念和自伤报告要么是未知的，要么是他们的照顾者没有报告。
这项研究表明，家庭因素（包括高家庭冲突和低父母监督）与儿童的自杀意念和自伤行为有关。未来的研究和正在进行的预防和干预工作可能受益于对家庭因素的检查。
