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Original Investigation |

Suicide Trends Among Elementary School–Aged Children in the United States From 1993 to 2012

Jeffrey A. Bridge, PhD1,2; Lindsey Asti, MPH3; Lisa M. Horowitz, PhD, MPH4; Joel B. Greenhouse, PhD5; Cynthia A. Fontanella, PhD6; Arielle H. Sheftall, PhD3; Kelly J. Kelleher, MD1,2; John V. Campo, MD6
[+] Author Affiliations
1The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
2Department of Pediatrics, The Ohio State University College of Medicine, Columbus
3Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
4Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
5Department of Statistics, Carnegie Mellon University, Pittsburgh, Pennsylvania
6Department of Psychiatry, The Ohio State University College of Medicine, Columbus
JAMA Pediatr. 2015;169(7):673-677. doi:10.1001/jamapediatrics.2015.0465.
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Importance  Suicide is a leading cause of death among school-aged children younger than 12 years but little is known about the epidemiology of suicide in this age group.

Objective  To describe trends in suicide among US children younger than 12 years by sociodemographic group and method of death.

Design, Setting, and Participants  Period trend analysis of national mortality data on suicide in children aged 5 to 11 years in the United States from January 1, 1993, to December 31, 2012. Data were analyzed per 5-year periods, between 1993 to 1997 and 2008 to 2012.

Main Outcomes and Measures  Number of suicide deaths and crude suicide rates. Period trends in rates of suicide were estimated using negative binomial regression incidence rate ratios (IRRs).

Results  The overall suicide rate among children aged 5 to 11 years remained stable between 1993 to 1997 and 2008 to 2012 (from 1.18 to 1.09 per 1 million; IRR = 0.96; 95% CI, 0.90-1.03). However, the suicide rate increased significantly in black children (from 1.36 to 2.54 per 1 million; IRR = 1.27; 95% CI, 1.11-1.45) and decreased in white children (from 1.14 to 0.77 per 1 million; IRR = 0.86; 95% CI, 0.79-0.94). The overall firearm suicide rate (IRR = 0.69; 95% CI, 0.57-0.85) and firearm suicide rate among white boys (IRR = 0.72; 95% CI, 0.59-0.88) decreased significantly during the study. The rate of suicide by hanging/suffocation increased significantly in black boys (IRR = 1.35; 95% CI, 1.14-1.61), although the overall change in suicide rates by hanging/suffocation or other suicide methods did not change during the study.

Conclusions and Relevance  The stable overall suicide rate in school-aged children in the United States during 20 years of study obscured a significant increase in suicide incidence in black children and a significant decrease in suicide incidence among white children. Findings highlight a potential racial disparity that warrants attention. Further studies are needed to monitor these emerging trends and identify risk, protective, and precipitating factors relevant to suicide prevention efforts in children younger than 12 years.

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Figure 1.
Suicide Rates Among White and Black Boys Aged 5 to 11 Years in the United States Between 1993 to 1997 and 2008 to 2012

In black boys, the suicide rate increased between 1993 to 1997 and 2008 to 2012 (incidence rate ratio [IRR] = 1.26; 95% CI, 1.07-1.47), whereas suicide rates in white boys decreased during this period (IRR = 0.85; 95% CI, 0.78-0.93). In 1993 to 1997, the IRR of suicide between black and white boys was 0.91 (95% CI, 0.57-1.47). In 2008 to 2012, the IRR of suicide between black and white boys was 2.65 (95% CI, 1.77-3.96).

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Figure 2.
Changes in Methods of Suicide Among Youth Aged 5 to 11 Years in the United States Between 1993 to 1997 and 2008 to 2012

In 1993 to 1997, a total of 1.87 hanging/suffocation suicides (95% CI, 1.33-2.61) occurred for every firearm suicide. In 2008 to 2012, this ratio increased to 6.45 hanging/suffocation suicides (95% CI, 4.03-10.33) for every firearm suicide.

aIncludes poisoning, falling, cutting/piercing, drowning, transportation-related methods, and other means not elsewhere classified.

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Submit a Comment
Suicidal hanging by children in India 10 years ago.
Posted on September 28, 2015
Deepak Herald D’Souza, M.Rajesh, S.Praveen, M.G.Shivaramu, J.Kiran, S.Harish, YP Girish Chandra.
MS Ramaiah Medical College Bengaluru and Yenepoya University Mangaluru, India
Conflict of Interest: None Declared
It is to congratulate the authors lead by Bridge JA et al (1) for the thought provoking paper meant for preventing suicides in children. We felt sad about the increasing suffocation suicide rate in the tender age and would add few points that will show the real situation to be even worse elsewhere in the world. Children, as young as 8 years, have committed suicide by hanging (2). Hanging is the commonest method of suicide in children in many countries (3).
An act of hanging requires a technical preparation, compared to other methods of suicide. Therefore, the Hanging deaths in children are uncommon compared to adults, and they were said to comprise of 1-6% of total hanging cases in previous studies (4-5).
10 years ago, we had done a short study of our records of childhood hanging deaths in MS Ramaiah Hospital Bangalore, India, between January 2001 and August 2004. We also found hanging as the commonest cause of suicide in children aged less than 18 years. These children comprised 10% of the total number of hanging deaths (n=523). Only one victim (male; 9 years) had committed suicide by hanging in the category of below 10 years.
Preventing suicides in children should be done by multiple strategic methods. Thankfully, many countries do not have to tackle the root causes such as poverty and illiteracy. We strongly suggest the inculcation of positive approach in children from the very beginning. Suicidal hanging can be prevented in depressed children by giving personal attention till the child overcomes that depression.

References

1. Bridge JA, Asti L, Horowitz LM, Greenhouse JB, Fontanella CA, Sheftall AH, Kelleher KJ, Campo JV. Suicide Trends Among Elementary School-Aged Children in the United States From 1993 to 2012. JAMA Pediatr. 2015;169(7):673-7.
2. Pakis I, Yayci, Nesime, Karapirli, Mustafa, Yildiz, Nicel, Gunce, Elif, Yilmaz, Riza and Polat, Oguz () 'Childhood deaths due to suicide', Australian Journal of Forensic Sciences. 2010;42(3):191-197.
3. Soole R, Kõlves K, De Leo D. Suicide in Children: A Systematic Review. Arch Suicide Res. 2015;19(3):285-304.
4. Davison A, Marshall TK. Hanging in Northern Ireland--a survey. Med Sci Law. 1986 Jan;26(1):23-8.
5. Wyatt JP, Wyatt PW, Squires TJ, Busuttil A. Hanging deaths in children. Am J Forensic Med Pathol. 1998;19(4):343-346.
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