Risk Factors and Warning Signs
Suicidal behavior in preschoolers relates to impulsivity, running away, hyperactivity, morbid ideas, high pain tolerance, not crying after injury, and parental neglect.15 A family history of suicidal behavior, exposure to physical and sexual abuse, preoccupation with death, and prior suicide attempts are additional factors to consider.16
Impulsivity is a prominent characteristic of preteen suicides. For children ages 5 to 11, “impulsive responding” to arguments, conflicts, relationship problems with family members and friends, and other adverse environmental and life situations is a trigger for early childhood suicide.17 Children may lack the ability to foresee their lives getting better or to comprehend the temporary nature of some problems.
Notably, mental illness plays a smaller role in suicidal behavior in preadolescents than in older children.18
Misclassification
It can prove difficult to decisively quantify preadolescent suicide because authorities may misclassify young children’s suicides as accidents or otherwise unintentional deaths.19 This represents a particular problem in the black community.20 Preteen suicide victims leave notes less often than teenagers do and have less access to lethal means, such as firearms, which can raise doubts about suicide as the cause of death.21
Misclassification also may result, at least in part, from old beliefs some coroners and medical examiners still share about the suicidal capability of young children. The fact that accidental deaths and unintentional injuries are the leading cause of death in children under age 14 also can influence this judgment.22 Individuals may not readily see preteen deaths by falls and even by hanging as suicides.
Theory
Most models attempting to explain suicide focus on teens, adults, and elders. However, one theoretical paradigm suggests how suicidal behavior may arise in anyone, including young children. The interpersonal-psychological theory explains how overcoming the natural resistance to lethal self-harm can result in a suicide attempt.23
According to this theory, a suicide attempt may occur when two factors exist: 1) an intense desire to die and 2) the capacity for self-harm.24 The former arises from negative self-perceptions, a poor self-image, and unfavorable social comparisons.25 The latter is associated with a high tolerance to pain, diminished fear of severe injury, and lowered fear of death.26 This “acquired capability” becomes established over time through exposure to hurtful, painful, or violent experiences, such as self-injury, physical or sexual abuse, or bullying.27
Circumstances that contribute to suicidality in young children include—
- decreased self-esteem;
- belief that they hold responsibility for some family problem (e.g., divorce);
- feeling worthless or like a burden to the family;
- not feeling valued;28
- violent interactions between parents, which may cause children to believe they are worthless and expendable;29
- bullying and being bullied;30
- parental abuse and neglect, which may produce self-directed aggression;31
- having a sibling who attempted suicide;32 and
- experiencing conflict, aggression, and abuse in the household.33
Suicide threats and attempts relate to antisocial behavior and hostility toward parents in children 5 to 12 years of age.34 Abuse, neglect, or other trauma in the family may produce suicidal behavior in young children. Research shows that witnessing violence promotes suicidal ideation in urban 9- and 10-year-olds.35 Officers called to a household because of domestic violence must keep collateral suicide risk in mind during their investigations.
Bullying can generate an intense desire to die and the development of an acquired capability for lethal self-harm. Both victims and bullies themselves more likely will exhibit suicidal ideation or behavior compared with children not exposed to bullying.36