A Study of Suicidal Ideation and Behavior in Preadolescents

Helene Jackson, PhD

Available data suggest that preadolescent suicidal ideahon may be one of the most common symptomsfound in senously mentally ill young children (Brent et al, 1986; Hendin, 1986; Pfeffer et al, 1979; Pfeffer, 1978; Plutchik and van Pruag, 1990; Shaffer, 1974). Despite reports of a high prevalence of suicidal activity in psychiatnc outpatient children (60%) (Carlson & Cantwell, 1982), few systematic studies of suicidal ideation and behaviors in this population have been conducted.

Awareness of the prevalence and correlates of suicidal thoughts and behaviors among preadolescents is of particular concem to social workers who provide most of the mental health services to children and their families. identified factors that place children at risk for suicidal behavior include mood disorders (Brent et al.,1986; Harnngton et al.,1993; Pfeffer et al.,1988; Pfeffer et al., 1991), prior suicide attempts (Eisenberg, 1984; Weissman, 1974), age (Bolger, Downey, Walker, & Steininger, 1989; Hoberman & Garfinkel, 1988), substance abuse (Hoberman & Garfinkel, 1988), gender (Hendin, 1986), concept of death as transient (Pfeffer et al., 1993), a history of physical and sexual abuse (Briere, 1989; Browne & Finkelhor, 1986; Wozencraft et al., 1991), preoccupation with death (Pfeffer and Trad, 1988), running away (RotheramBorus & Bradley, 1991), assaultive behavior (Pfeffer et al., 1979) conduct disorders (Apter, Bleich, Plutchik, Mendelsohn, & Tyano, 1988), and a broad range of additional psychopathology (Brent et al., 1986).

Parental factors associated with a child's suicidal ideation and/or behavior include parental conflict, major mental illness, separation, substance abuse and death (Dorpat, Jackson and Ripley 1965). Garbanno (1993) proposes that environmental factors such as neighborhood violence, poverty and cultural expectations also can affect an individual's motivation for suicide (Hendin, 1986). Despite these associations, it remains unclear if suicidality is a result of these nsk hctors or the consequence of a combination of other dysfunctional variables such as family structure, the nature and quality of familial and peer relationships, environmental factors and the like. It continues to be difficult to accurately identify or predict the probability of attempted suicide or suicide (Hendin, 1986).

It is difficult for parents to recognize a child's suicidal behavior (Rosenthal & Rosenthal, 1984). Physicians are reluctant to report it, and clinicians hesitate to ask about

suicide directly In the absence of specific instructions and agency support, practitioners may avoid exploring violent behavior, in general, or suicide in particular, as factors that contubute to or are associated with their clients' presenting problem (BreLke, 1987; Jacobson and Richardson, 1987; Post, Willett, Franks, House, Back & Weissberg, 1980; Rotheram-Borus, 1989). Psychiatric evaluations of outpatient psychiatric children do not routinely include assessment of suicide risk or questions about preoccupation with death and self- destructive behavior (Pfeffer et al., 1979). Further, little empincal knowledge exists to guide clinicians in identifiying and assessing this complex, potentially lethal phenomenon. In 1992, Dr Annaclare van Dalen's &BFCS Senior Supervisory/Clinical Social Wor1cer) interest in understanding an observed high rate of suicidal ideation and behaviors among preadolescent clients at one of theJBFCS clinics led her to discussions with Centerfaculty Consistent with the literature, and their similar interests in preadolescent suicidality, Drs. Annaclare van Dalen, HeleneJachson and Peg Hess (CUSSW faculty) collaborated to better understand the observed phenomenon atJBFCS and to develop a study with two main objectives: 1. to test the effects of the routine clinical application of a standardized assessment protocol (Pfeffer 1978) on the identification of preadolescent suicidality and 2. to test the validity of a developmental and ecological model offactors associated with preadolescent suicidality The model that informs the protocol used in the study is derived from developmental and ecological theories. The Mod)fied Pfeffer Suicide Potential Scale (PSPS) (1978; Jackson, Hess, & van Dalen, 1994), designed for use with 6-12 year olds, is an extensive, well developed instrument that generates data on the protective and nsk hctors for, and incidence of, suicidal activity Among hctors expected to be associated with lower risk for preadolescent suicide are positive child attubutes and social and hmily support. The study's sample consists of four groups of 40 preadolescents (total 160) who present for treatment at the JBFCS' Madeleine Borg Community Ser. vices, Pelham and Beatman clinics. At Pelham, data are being obtained using the new assessment procedures. At Beatman, data will be obtained from existing assessment procedures. Baseline data, based on examination of clinic records, will be obtained from both sites and analyzed for the frequency of case finding of suicidal behavior in the designated population.

At this writing, data have been collected on 21 preadolescents and their hmilies. Preliminary analysis shows that approximately half of the preadolescents participating in the study reported suicidal thoughts either currently, or within the six months pnor to their interviews. One had made suicide threats, and one had actually attempted suicide.

The study will examine associations between the independent vanables_childhood traumas, childhood nsk hctors, hmily stressors, child adapative hctors, social supports and hmily supports and suicidal ideation, threats and/or action. It is hypothesized that the independent vanables_childhood traumas, childhood risk factors and family stressors_will be associated with greater nsk for the dependent vanable suicidality Conversely, we hypothesize that the independent vanables_child adaptive hctors, social supports and hmily supports_ will be associated with lesser risk for the dependent vanable suicidality

The literature suggests that the nsk that young children will become suicide "completers" is low. Yet, even conservative estimates of the number of children reported to have suicidal ideation are of concern to all those responsible for the care and protection of preadolescents and their hmilies. This study's findings will have important implications for developing new modes of assessment as well as for implementing prevention and remedial interventions for preadolescent suicide.

Principal Investigator: Helene Jackson, PhD (CUSSW) Co- lnvestigator: Peg Hess, PhD (CUSSW) Clinical Investigator: Annaclare van Dalen, PhD (JBFCS)

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