Suicidal Behaviour in Children and Adolescents. Part 1: Etiology and Risk Factors

By Steele, Margaret M.; Doey, Tamison | Canadian Journal of Psychiatry, June 2007 | Go to article overview

Suicidal Behaviour in Children and Adolescents. Part 1: Etiology and Risk Factors


Steele, Margaret M., Doey, Tamison, Canadian Journal of Psychiatry


ABSTRACT

Objective: This is Part 1 of a 2-part review of suicidal behaviour in children and adolescents. Part 1 explores the phenomenology and epidemiology of suicide in children and adolescents.

Method: Systematic review of the literature since 1966. Behaviours included within this spectrum are discussed and differentiated. The literature regarding the impact of demographic, social, and psychological risk factors is summarized.

Results and Conclusions: Suicide rates in youth are declining, but the reasons are speculative. Suicidal behaviour comprises a spectrum with differing frequencies and risk factors. While some risk factors are fixed, such as age and family history, others, such as psychiatric illness and stressors, may be amenable to intervention.

RÉSUMÉ

Objectif : Il s'agit de la première partie d'une étude en 2 parties du comportement suicidaire chez les enfants et les adolescents. La première partie explore la phénoménologie et l'épidémiologie du suicide chez les enfants et les adolescents.

Méthode : Une revue systématique de la documentation depuis 1966. Les comportements qui font partie de ce spectre sont examinés et différenciés. La documentation concernant l'effet des facteurs de risque démographiques, sociaux et psychologiques est résumée.

Résultats et Conclusions : Les taux de suicide chez les jeunes sont en baisse, mais les raisons relèvent de la spéculation.

Le comportement suicidaire comprend un spectre à différentes fréquences et différents facteurs de risque. Même si certains facteurs de risque sont fixes, comme l'âge et les antécédents familiaux, d'autres comme la maladie psychiatrique et les stresseurs peuvent faire l'objet d'une intervention.

(Can J Psychiatry 2007:52[6 Suppl 1]:21S-33S)

Key Words: child, adolescent, suicide, etiology, risk factors

This paper is Part 1 of a 2-part review of the literature on suicide in children and adolescents, covering epidemiology and risk factors. Established principles of conducting a systematic review were followed. The databases searched included the Cochrane Central Register of Controlled Trials (CCTR) and Cochrane Database of Systematic Reviews (with Ovid as the search engine and the truncated key words "suic$ AND treat$ OR interven$"). The time period extended from 1966, prior to which the CCTR recorded no controlled trials for suic$. We searched MEDLINE, EMBASE, and personal databases of colleagues (SUICDATA, YouthSuicRandom2004, and Youth2) of systematically accumulated articles (more than 56 000), mainly from MEDLINE and Web of Science weekly updates, using "suic* or attempt* suic* or self harm or self-harm" as keywords. The resulting yields were assembled in a database labelled SUICDATACPG, from which a subset was selected for relevance via the key words "adolescen*," "youth," and "child*." Subsequently published relevant articles were added to the core database as they appeared.

To establish the context for discussion, Part 1 summarizes known developmental differences in suicidality between children or youth and adults and reviews the epidemiology. The literature on risk and protective factors is also reviewed.

Developmental Differences Between Adults and Youth

Suicide can occur at any age and is a significant public health concern. Developmental factors modify the clinical presentation of suicidal behaviour in children and youth. Before puberty, the prevalence of suicidal behaviour is rare; it increases steeply with age, peaking between the ages of 19 and 23 years.' Suicide is unusual in young children, in part owing to their cognitive immaturity, which prevents them from planning and executing a lethal suicide attempt2: the younger the child, the less complex and more immediately available the method. Precipitants of suicidal behaviour vary with age, with discordant family relationships being a common precipitant for prepubertal children and peer conflicts for adolescents. …

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