Do preschoolers have suicidal thoughts?

A recent study published in Medscape indicated that 1 of every 10 children between ages 3 and 7 years of age exhibit suicidal behaviors and/or suicidal thoughts (SI).  The premise that children as young as preschool age may have suicidal thoughts and/or behaviors can be shocking to some.

While it demonstrates the quite valid need for attention to the mental health of young children and the early identification and intervention of social-emotional challenges for youngsters, there are a number of considerations when reading this article:

• Do young children understand the concepts of “death,” “wanting to die,” “heaven,” or wanting to hurt themselves.  These are abstract concepts that unlikely to be fully understood both on a cognitive and emotional level.   When heaven is described to a 3-year old, it is often described as a magical, wonderful place, in which you can be with people who have passed away.    Preschool-aged children often engage in developmentally-appropriate “good guy-bad guy” (i.e., “superhero”) play in which themes of being “dead” and being “killed” are plentiful.  Parents (who were the reporters in this study) may misunderstand children’s intentions during such play.
• Limitations of the study:  This study noted several limitations (as all scientific research studies have to some extent) that should be considered.  First, there was a small number of young children found to display suicidal ideas and behaviors.  Second, there was a recruitment bias, as the children were selected for the study based on having higher symptoms of depressive symptoms.  Third, the authors noted that the use of parent reporting may have presented a reporter bias.
• On a related note, the finding that “Early-childhood SI was more common in boys and was highly associated with a variety of maternal psychopathology” is not unsurprising.  Mothers who display more depressive symptoms are more likely to report depressive symptoms in their  children.  This may be related to the both genetic and environmental components of depression, as well as the generally well-accepted finding that those with depression tend to view the world as more negative.  Thus, mothers who are experiencing depression may be more likely to either notice depressive symptoms or perceive their children’s behaviors or demeanor as indicative of depression.
• This poses another implication of the study, as we understand that children of parents with psychopathology are in need of early support to promote their own psychosocial development.  Children who observe their parents to struggle with depression may be subject to their parents’ modeling of depressive symptoms.  This is especially the case for young children who likely do not realize that their parents’ struggles are not the norm.  Their parents’ symptoms may serve as models as to how they view the world and cope with stressors.  Thus, if a parent is likely to speaking negatively about him/herself or show pessimism about the world, his/her child may be more likely to do so as well.

Taken together, this study poses an important recommendation for more closely researching depressive symptomotology in young children.   The following will yield a better understanding of these children’s needs:

• Recruit children from a broader population, including children and parents who have not previously been identified as having mental health challenges.
• In addition to using parent report measures, include teacher report measures whenever possible, and/or conduct a direct assessment of the children, either through direct interviewing and/or projective psychological assessment tools.