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Stable overall suicide rate among young children obscures racial differences

The JAMA Network Journals

The overall suicide rate among children ages 5 to 11 was stable during the 20 years from 1993 to 2012 but that obscures racial differences that show an increase in suicide among black children and a decrease among white children, according to an article published online by JAMA Pediatrics.

Youth suicide is a major public health concern. However not much is known about childhood suicide because prior studies have typically excluded children younger than 10 years old and only investigated trends among older children, according to the study background.

Jeffrey A. Bridge, Ph.D., of the Research Institute at Nationwide Children's Hospital, Columbus, Ohio, and coauthors examined suicide in U.S. children ages 5 to 11 by analyzing 20 years of nationwide mortality data.

The authors found that 657 children ages 5 to 11 died by suicide between 1993 and 2012 - an average of nearly 33 children per year - and 553 (84 percent) of the children were boys and 104 (16 percent) were girls. The overall suicide rate remained stable during the period going from 1.18 per 1 million to 1.09 per million. Hanging/suffocation was the predominant method of suicide, accounting for 78.2 percent (514 of 657) of the total suicide deaths, followed by firearms (17.7 percent; 116 of 657) and other methods (4.1 percent; 27 of 657), according to the results.

However, the authors observed that the stable overall rate resulted from divergent trends in suicide for black and white children during those 20 years. The suicide rate increased in black children from 1.36 per 1 million to 2.54 per 1 million, while the suicide rate decreased in white children from 1.14 per 1 million to 0.77 per 1 million.

The statistically significant racial differences were confined to both black and white boys, with an increase in the suicide rate among black boys (1.78 to 3.47 per 1 million) and a decrease in the suicide rate among white boys (from 1.96 to 1.31 per 1 million). Although the changes were not statistically significant among girls, the suicide rate among black girls increased from 0.68 to 1.23 per 1 million during the 20-year period, while the suicide rate among white girls remained stable from 0.25 to 0.24 per 1 million.

The authors suggest the racial differences prompt questions about what factors might influence increasing suicide rates among young black children, such as disproportionate exposure to violence and traumatic stress, aggressive school discipline, and an early onset of puberty. However, the authors note it remains unclear if any of these factors are related to increasing suicide rates.

"The stable overall suicide rate among U.S. children aged 5 to 11 years during 20 years of study masked a significant increase in the suicide rate among black children and a significant decline in the suicide rate among white children. From a public health perspective, future steps should include ongoing surveillance to monitor these emerging trends and research to identify risk, protective and precipitating factors associated with suicide in elementary school-aged children to frame targets for early detection and culturally informed interventions," the study concludes.

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(JAMA Pediatrics Published online May 18, 2015. doi:10.1001/jamapediatrics.2015.0465. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: An author made a funding/support disclosure. Please see article for additional information, including other authors, author contributions and affiliations, etc.

Media Advisory: To contact corresponding author Jeffrey A. Bridge, Ph.D., call Gina Bericchia at 614-355-0495 or email MediaRelations@NationwideChildrens.org.

To place an electronic embedded link to this study in your story Links will be live at the embargo time: http://archpedi.jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2015.0465

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