Preteen children who have more trouble expressing their feelings and who perceive themselves as a greater burden to others may be on the cusp of having suicidal thoughts and behaviors (STB), according to a report in the Journal of the American Academy of Child and Adolescent Psychiatry.

Increases in caregiver criticism and conflict are also risk factors for impending STBs, according to the study. Preteen girls with these traits are at especially high risk.

“Preadolescent STBs are dramatically increasing, and it is critical to identify risk factors that can be clinically assessed and modified with treatment,” wrote Renee Thompson, Ph.D., of Washington University, St. Louis, and colleagues.

The researchers analyzed the association between a host of psychosocial factors and suicidal thoughts and behaviors in 192 children aged 7 to 12; most of the children had participated in a clinical study of preadolescent depression, though some children who did not have depression were added as controls.

The participants completed a series of surveys that assessed suicidality and the following psychosocial risk factors:

• Depressive symptoms
• Positive and negative affect
• The ability to understand what one is feeling
• The sense of being disconnected from people and not belonging anywhere
• The perception that one is burdensome to others
• Criticism from and conflict with caregivers
• The ability or willingness to manage and/or express one’s feelings

The surveys were conducted weekly with children whose caregivers reported any incidents of suicidal thoughts or self-harm at baseline, or monthly otherwise, for 12 months. Participants were on average 10.13 years old and 63% male. Thirty percent met criteria for major depression, and 37.7% met criteria for another internalizing disorder. During the one-year time frame, 70 children screened positive for STBs.

Overall, girls were four times more likely than boys to report STBs, and boys and girls with severe depressive symptoms were 10 times more likely to have STBs than children with mild or moderate symptoms.

Thompson and colleagues then looked closer at the week-to-week responses of high-risk children—those with a history of STBs when entering the study. They found that at any given week, children who reported expressive suppression, perceived burdensomeness, and caregiver criticism and conflict above their historical average levels were more likely to have a positive STB report in the following week.

“The risks identified in the present study … may be useful to clinicians and important for future research to consider as potential targets for prevention and treatment aimed at decreasing STB risk,” the authors concluded.

For related information see the Psychiatric News article “Suicidal Thoughts Begin Early for Some Youth.”