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

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.

[1]  P. Wyman.  Developmental approach to prevent adolescent suicides: research pathways to effective upstream preventive interventions. , 2014, American journal of preventive medicine.

[2]  David Hemenway,et al.  Public health approach to the prevention of gun violence. , 2013, The New England journal of medicine.

[3]  Gregory M. Zimmerman,et al.  Individual, family background, and contextual explanations of racial and ethnic disparities in youths' exposure to violence. , 2013, American journal of public health.

[4]  J. Serwint,et al.  Secondary Sexual Characteristics in Boys: Data From the Pediatric Research in Office Settings Network , 2012, Pediatrics.

[5]  Jeanne M. Poduska,et al.  The Good Behavior Game and the Future of Prevention and Treatment , 2011, Addiction science & clinical practice.

[6]  J. Greenhouse,et al.  Changes in suicide rates by hanging and/or suffocation and firearms among young persons aged 10-24 years in the United States: 1992-2006. , 2010, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[7]  J. Greenhouse,et al.  Suicide trends among youths aged 10 to 19 years in the United States, 1996-2005. , 2008, JAMA.

[8]  J. Anthony,et al.  The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts. , 2008, Drug and alcohol dependence.

[9]  M. Oquendo,et al.  Completed suicide in childhood. , 2008, The Psychiatric clinics of North America.

[10]  Angel R. Rhodes,et al.  Suicidal behavior in children younger than twelve: a diagnostic challenge for emergency department personnel. , 2007, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[11]  S. Freedenthal.  Racial disparities in mental health service use by adolescents who thought about or attempted suicide. , 2007, Suicide & life-threatening behavior.

[12]  I. Rockett,et al.  The black-white suicide paradox: possible effects of misclassification. , 2006, Social science & medicine.

[13]  D. Brent,et al.  Adolescent suicide and suicidal behavior. , 2006, Journal of child psychology and psychiatry, and allied disciplines.

[14]  Jon S Vernick,et al.  Association between youth-focused firearm laws and youth suicides. , 2004, JAMA.

[15]  R. Aseltine,et al.  An outcome evaluation of the SOS Suicide Prevention Program. , 2004, American journal of public health.

[16]  W. L. Robinson,et al.  Psychological Distress for African-American Adolescent Males: Exposure to Community Violence and Social Support as Factors , 2003, Child psychiatry and human development.

[17]  Lang Wu,et al.  BEREAVED PARENTS' OUTCOMES 4 TO 60 MONTHS AFTER THEIR CHILDREN'S DEATHS BY ACCIDENT, SUICIDE, OR HOMICIDE: A COMPARATIVE STUDY DEMONSTRATING DIFFERENCES , 2003, Death studies.

[18]  Arthur Kleinman,et al.  Reducing Suicide: A National Imperative , 2002 .

[19]  W. Cockerham,et al.  Ready to die: a postmodern interpretation of the increase of African-American adolescent male suicide. , 2002, Social science & medicine.

[20]  J. Jordan.  The American Association of Suicidology Is Suicide Bereavement Different ? A Reassessment of the Literature , 2012 .

[21]  D. Phillips,et al.  Adequacy of official suicide statistics for scientific research and public policy. , 1993, Suicide & life-threatening behavior.

[22]  J. T. Gibbs.  Conceptual, methodological, and sociocultural issues in black youth suicide: implications for assessment and early intervention. , 1988, Suicide & life-threatening behavior.

[23]  J. Bachman,et al.  Racial, Ethnic, and Gender Differences in School Discipline among U.S. High School Students: 1991-2005. , 2008, The Negro educational review.

[24]  Suicide trends among youths and young adults aged 10-24 years--United States, 1990-2004. , 2007, MMWR. Morbidity and mortality weekly report.

[25]  J. Talbott.  Association Between Youth-Focused Firearm Laws and Youth SuicidesWebster DW, Vernick JS, Zeoli AM, et al (Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; Univ of Pennsylvania, Philadelphia) JAMA 292:594–601, 2004§ , 2006 .

[26]  F. Earls,et al.  Trends in adolescent suicide: misclassification bias? , 2001, American journal of public health.

[27]  Peter K. Smith,et al.  Understanding Children's Development , 1982 .