Young males ages 10-13 years with mood and developmental disorders are at very high risk for serious self-harm, according to a new study.
Researchers used data on 1,098 children and adolescents hospitalized with a neuropsychiatric event to create four serious self-harm risk profiles.
“These clinical profiles are based on a more comprehensive and flexible framework that complement previous assessments and can help identify children at elevated risk for a self-harm event,” authors wrote in “Characteristics Associated with Serious Self-Harm Events in Children and Adolescents,” (Sekmen M, et al. Pediatrics. May 1, 2023).
Previous studies have shown that a psychiatric diagnosis was present in nearly 90% of children who died by suicide, and many of these children had multiple psychiatric conditions. Authors said they aimed to look at the interaction between psychiatric conditions instead of looking at them separately.
The children in the study ranged in age from 5-17 years and were treated for a neuropsychiatric event at Monroe Carell J. Children’s Hospital at Vanderbilt in Nashville, Tenn., or Children’s Hospital of Colorado in Aurora, Colo., from April 2016 to March 2020. About 37% (406 patients) were diagnosed with a self-harm event.
The group deemed very high risk for self-harm included males ages 10-13 years with mood and developmental disorders. Diagnoses in this group include anxiety, depression, bipolar disorder, attention-deficit/hyperactivity disorder, trauma-related disorders, autism spectrum disorder, intellectual disability and conduct disorders. A previous study found suicide rates nearly tripled in this age group from 2007-’17. While this group was comprised of males, authors also noted females ages 10-14 years saw a 20% increase in emergency department (ED) visits for self-harm from 2009-’15.
The high-risk group includes females ages 14-17 years with a combination of anxiety, depression, substance and trauma disorders. This group includes girls with personality and eating disorders but not behavioral or developmental disorders. A previous study found a 51% increase in suicide attempts among adolescent girls from 2019-’21.
The moderate-risk group was considered the baseline for the study population and included children and adolescents with psychiatric diagnoses but not depressive disorders. Research has found about 50%-65% of adolescents who attempt suicide have a depressive disorder.
The low-risk group includes children ages 5-9 years without a prior psychiatric diagnosis. Because these children had been hospitalized for a neuropsychiatric event to be included in the study, their risk of self-harm likely still is higher than the general population, authors said.
The study had several limitations including that it did not consider medication use, previous suicidal behavior, family and social support, race or insurance, according to the authors. They called for more research with a larger population to confirm the findings.
The AAP has been sounding the alarm on mental health issues among children and adolescents. In 2021, the AAP and its partners declared a national emergency in children’s mental health citing the serious toll of the COVID-19 pandemic on top of existing challenges. Last fall, they renewed their call for federal action.
In the Blueprint for Youth Suicide Prevention, the AAP and its partners recommend screening all youths ages 12 years and older for suicide risk and screening those 8-11 years when clinically indicated. Additional AAP tools and resources are available below to help pediatricians address youth mental health concerns.
Resources
- S. Substance Abuse and Mental Health Services Administration’s 988 Suicide & Crisis Lifeline is available at https://www.988lifeline.org or by texting or calling 988.
- Blueprint for Youth Suicide Prevention
- AAP suicide prevention resources
- AAP statement of endorsement Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management
- AAP clinical report Promoting Optimal Development: Screening for Behavioral and Emotional Problems
- Bright Futures health promotion and prevention initiative
- Information for parents from HealthyChildren.org on medication safety
- CDC suicide prevention resources
