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Do Children Commit Suicide?

Tue, 2008-10-07 16:17 - Kerry

Yes, but sometimes it seems like an accident.

By Christopher Beam
Posted Friday, Oct. 3, 2008, Slate

A 7-year-old Texas boy who was found earlier this year hanging from a hook in his school bathroom did not commit suicide, according to a police report released Thursday. Instead, his shirt had apparently caught on the hook, perhaps during a game of "run and jump." Do kids that young ever kill themselves?

Yes, but rarely. About four children out of every 500,000 below the age of 12 commit suicide annually, according to the Centers for Disease Control and Prevention. The number has doubled since 1979, but in recent years it's been only the 14th leading cause of death for kids in that age group, just after meningitis and anemia.

The numbers are low for several reasons. For one thing, the factors that correlate with suicide—depression, drug use, peer pressure—don't usually hit until puberty. In fact, autopsies of children who kill themselves show that a higher-than-usual proportion are tall for their age—a good proxy for pubertal status. As you'd expect, the suicide rate climbs among adolescents aged 10 to 14 (1.3 per 100,000) and spikes among teenagers 15 to 19 (7.67 per 100,000). Another reason for the low suicide rate among children is parental supervision. The younger the child, the more likely a parent will be nearby to intervene.

There's also a labeling problem—what's a suicide? Child suicides aren't like teen or adult suicides, which usually start with an idea, proceed with a plan, and end with action. Suicide among children is more likely to be spontaneous and less connected to psychiatric disorder or aggression. This is often reflected in the method: Instead of hanging or cutting or using a gun, "suicidal" kids tend to kill themselves by doing things their parents have warned them against, such as running into traffic or jumping out of a window.

As a result, it's often hard to tell the difference between a suicide and an accident. (Official definition of suicide: "Fatal self-inflicted destructive act with explicit or inferred intent to die.") For example, a medical examiner might be presented with the case of an autistic child who jumped off his bunk bed in a hospital, hit his head on the floor, and died. Or a little girl might jump out the window in the course of a fight with her older brother.

The factors that cause children to commit suicide differ slightly from their older counterparts. Depression can play a role, but among the youngest suicides, a predisposition to impulsiveness is just as important. Children who kill themselves often have a mood disorder, ADHD, or a "conduct disorder," which basically means antisocial behavior. Living an in abusive household can lay the groundwork for suicidal behavior, and an incident like getting kicked out of school or a dying relative can trigger it.

Explainer thanks Martin Drell of Louisiana State University and David Shaffer of Columbia University.

Christopher Beam is a Slate political reporter.

Article URL: http://www.slate.com/id/2201530/

Copyright 2008 Washingtonpost.Newsweek Interactive Co. LLC

Comments

Tue, 2008-10-07 16:31 — Kerry

Safety-measures

The factors that cause children to commit suicide differ slightly from their older counterparts. Depression can play a role, but among the youngest suicides, a predisposition to impulsiveness is just as important. Children who kill themselves often have a mood disorder, ADHD, or a "conduct disorder," which basically means antisocial behavior. Living an in abusive household can lay the groundwork for suicidal behavior, and an incident like getting kicked out of school or a dying relative can trigger it.

I was reading the very tragic story about a 9 year old foster-boy named Kerry... a child described by social workers as, a "healthy [and] handsome and friendly little boy who loves to play on his scooter and go rollerblading. He is a sweet child who needs a lot of love and attention."  According to school officials, Kerry was "our highest functioning student both academically and behaviorally".  Although it's reported Kerry told his foster sister he was going to kill himself, no one believed him.  The child, who was never seen as depressed was found in his bedroom:

The 81-pound boy allegedly took an 18-inch white shoelace out of his tennis shoe, created a noose, and then tied the shoelace to the wooden rod running the length of a white, child-size portable closet. At 4-foot, 6-inches, Kerry was taller than the closet rod. So, he leaned his head into the small closet to get the shoelace around his neck before dropping knees-first into the closet, police and coroner's investigators concluded.  [From:  A Child-Suicide in Foster Care", http://www.caichildlaw.org/Misc/2003_2ndPlace2.pdf] 

Later in the article it's noted Kerry was placed on Welbutrin just about two months prior to his death.

Then, barely two months before he died, Kerry began taking a psychotropic medication that had been prescribed by Todd Bollinger, a psychiatrist. The doctor had been recommended by Kerry's DCFS social worker, according to Tucker.

The psychotropic medication Kerry took was called Wellbutrin. It is commonly used to treat depression and, sometimes, attention deficit disorder. It's also given to smokers to help them curb their habit. While one of the side effects listed for Wellbutrin is suicidal ideation, it is unclear whether Kerry was affected.

I can't help but wonder if foster-care kids are at a higher risks for suicide, given the rush to diagnose and medicate those who appear to have a "behavioral disorder"?  [See:  Wrongful Medication Cases and Medication in Foster Care]

Are there any studies that reflect the suicide rate of foster/adopted children, specifically?

Tue, 2008-10-07 20:20 — Niels

suicide studies

I tried to find some studies about the relationship between foster care and suicide and in fact could only find one such study, which claims:

Adolescents involved with foster care were about four times more likely to have attempted suicide in the preceding 12 months

Psychiatric symptoms and substance use disorders in a nationally representative sample of American adolescents involved with foster care, Daniel J Pilowski.

That's very little study, but the fact that several states have suicide prevention programs specifically tailored to the foster care population should indicate that the figures in the above study are no exaggeration. What I would like to know is how much of the suicide rate is attributable to the foster care system itself and how much is related to previous abuse/neglect.

According to a study done by the National Coalition for Child Protection Reform:

Children left in their own homes typically fared far better than comparably maltreated children placed in foster care.

With such a conclusion, I wouldn't be surprised if many of the suicides in foster care are related to the situation the children live under rather than the result of previous maltreatment.

Tue, 2008-10-07 20:29 — Kerry

Interesting...

The nurse-in-me wants to know how many of these suicides relate to the Black Box Warning written on medications given to children.  [This warning is written on ceratin prescription meds so parents can be warned that there are suicidal risks related to the use of that particular medication].

The FDA has required that black box warnings be placed on all antidepressant medications warning they may result in increased risk of suicidal tendencies in children and adolescents.   [From wikipedia:  "Black Box Warning", http://en.wikipedia.org/wiki/Black_box_warning]

 

Tue, 2008-10-07 20:45 — Niels

medication and suicide

I totally understand your concern. The study: Psychotropic Medication Patterns Among Youth in Foster Care concluded:

Of the foster children who had been dispensed psychotropic medication, 41.3% received ≥3 different classes of these drugs during July 2004, and 15.9% received ≥4 different classes. The most frequently used medications were antidepressants (56.8%), attention-deficit/hyperactivity disorder drugs (55.9%), and antipsychotic agents (53.2%). The use of specific psychotropic medication classes varied little by diagnostic grouping. Psychiatrists prescribed 93% of the psychotropic medication dispensed to youth in foster care. The use of ≥2 drugs within the same psychotropic medication class was noted in 22.2% of those who were given prescribed drugs concomitantly.

Despite cases in Florida, Texas, California, Washington, Oregon, Massachusetts and Monroe County, NY which drew attention to the issue of overmedication of psychotropic drugs to children in foster care, the situation overall has not really improved. I am particularly worried about the 40% of the children receiving more than 3 diferent types of drugs. I am not an expert on the subject, but does anyone know how these meds interact and whether they contribute to the mental health of the children or if they are a driving factor behind the suicide rates in foster care.

Tue, 2008-10-07 20:58 — Kerry

Driving forces

I don't know how these sort of meds contribute to the "mental health" of children, but I DO know how these meds contribute to the pockets of those with their own "special interests..."  [See:  "Some Texas foster kid's doctors have drug firm ties"]