Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada; McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada.
Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada.
Lancet Psychiatry. 2022 Sep;9(9):703-714. doi: 10.1016/S2215-0366(22)00193-6. Epub 2022 Jul 27.
Suicide in children is a pressing public health concern. The increasing number of deaths by suicide and emergency visits for suicidal ideation and self-harm in children might not be fully representative; it is likely that many more children are in distress but do not seek out help. We conducted a systematic review and meta-analysis of existing studies to quantify the prevalence of suicidal ideation and self-harm behaviours among children in the community aged 12 years and younger.
In this systematic review and meta-analysis, we searched PsycINFO, MEDLINE, and Web of Science via OVID from database inception to Feb 28, 2022, for articles published in French or English that reported estimates of prevalence of suicidal ideation (including suicide planning) and self-harm behaviours (namely, self-harm, suicide attempts, and non-suicidal self-injury) in children aged 12 years and younger. Reference lists were also searched; case studies, qualitative studies, and health-care visit studies were excluded. The outcomes were suicidal ideation, suicide plan or attempts, and self-harm. We used a random-effects model to calculate the overall pooled prevalence of suicidal ideation and self-harm behaviours for all timeframes combined and for ever versus the past 12 months for suicidal ideation. We used the Joanna Briggs Institute Critical Appraisal tool to evaluate the risk of bias in each study. This study is registered with PROSPERO, CRD42020179041.
28 articles, encompassing 30 studies overall, met the inclusion criteria, aggregating findings from 98 044 children (of whom 46 980 [50·5%] were girls and 46 136 [49·5%] were boys; six articles did not report sex or gender) aged 6-12 years. The pooled prevalence estimate was 7·5% (95% CI 5·9-9·6) for suicidal ideation from 28 studies and 2·2% (2·0-2·5) for suicide planning from three studies. The pooled prevalence was 1·4% (0·4-4·7) for self-harm from four studies, 1·3% (1·0-1·9) for suicide attempt from six studies, and 21·9% (6·2-54·5) for non-suicidal self-injury from two studies. The prevalence of suicidal ideation was higher in studies that included child-reported outcomes (10·9% [95% CI 8·1-14·5] for child only and 10·4% [6·8-15·5] for child and parent combined) than for parent-only reported outcomes (4·7% [3·4-6·6]; p=0·0004). The prevalence of suicidal ideation and self-harm behaviours was similar in boys and girls (suicidal ideation, 7·9% [95% CI 5·2-12·0] for boys vs 6·4% [3·7-10·7] for girls; self-harm behaviours, 3·5% [1·6-7·2] for boys vs 3·0% [1·4-6·4%] for girls). Detailed ethnicity data were not available. High heterogeneity was identified across estimates (I>90%), which was not well explained by the characteristics of the studies.
A high number of children in the general population can experience suicidal ideation and self-harm behaviours, thus underlining the need for more research on childhood suicide, including developmentally appropriate preventive strategies, such as youth-nominated support teams or dialectical behavioural therapy.
Canada Research Chair in Youth Mental Health and Suicide Prevention.
儿童自杀是一个紧迫的公共卫生问题。儿童自杀死亡人数和因自杀意念和自残而紧急就诊的人数不断增加，可能并不完全具有代表性；很可能有更多的儿童感到痛苦，但没有寻求帮助。我们对现有的研究进行了系统回顾和荟萃分析，以量化 12 岁以下社区儿童自杀意念和自残行为的流行率。
在这项系统回顾和荟萃分析中，我们通过 OVID 在 PsycINFO、MEDLINE 和 Web of Science 中进行了检索，检索时间从数据库建立到 2022 年 2 月 28 日，检索了发表在法语或英语中的文章，这些文章报告了 12 岁以下儿童自杀意念（包括自杀计划）和自残行为（即自我伤害、自杀企图和非自杀性自伤）的估计流行率。还检索了参考文献列表；排除了病例研究、定性研究和医疗就诊研究。结局是自杀意念、自杀计划或企图以及自残。我们使用随机效应模型计算了所有时间点合并以及过去 12 个月与过去 12 个月的自杀意念的总体汇总流行率。我们使用 Joanna Briggs 研究所的批判性评估工具来评估每项研究的偏倚风险。这项研究在 PROSPERO 注册，CRD42020179041。
28 篇文章，共 30 项研究，符合纳入标准，共纳入了 98044 名儿童（其中 46980 名[50.5%]为女孩，46136 名[49.5%]为男孩；有 6 篇文章未报告性别），年龄为 6-12 岁。28 项研究中自杀意念的汇总流行率估计值为 7.5%（95%CI 5.9-9.6），3 项研究中自杀计划的汇总流行率估计值为 2.2%（2.0-2.5）。4 项研究中自残的汇总流行率为 1.4%（0.4-4.7），6 项研究中自杀企图的汇总流行率为 1.3%（1.0-1.9），2 项研究中非自杀性自伤的汇总流行率为 21.9%（6.2-54.5）。包括儿童报告结果的研究（仅儿童为 10.9%[95%CI 8.1-14.5]，儿童和父母共同报告为 10.4%[6.8-15.5]）中的自杀意念流行率高于仅父母报告结果的研究（4.7%[3.4-6.6]；p=0.0004）。男孩和女孩的自杀意念和自残行为流行率相似（男孩自杀意念为 7.9%[95%CI 5.2-12.0]，女孩为 6.4%[3.7-10.7]；男孩自残行为为 3.5%[1.6-7.2]，女孩为 3.0%[1.4-6.4%]）。详细的种族数据不可用。各项评估的异质性很高（I>90%），但这不能很好地解释研究的特征。
很大一部分普通人群中的儿童会经历自杀意念和自残行为，因此需要对儿童自杀进行更多的研究，包括制定适合青少年的预防策略，例如由青少年提名的支持小组或辩证行为疗法。
加拿大青年心理健康和自杀预防青年研究员主席。
