Suicide: Specific Childhood Risk Factors

Biological Risk Factors

It appears that suicidal behavior can be attributed to impulsivity in children more than in any other age group. Therefore, the suicidal acts of children tend to be more impulse-based (e.g., running in front of a car, jumping from a building) than acts that require planning (e.g., hoarding and taking medication). Children who are at high suicide risk are those who are angry and impulsive and who use an assaultive approach to problem solving. These children are often labeled ADHD, antisocial, behaviorally disordered, or brain damaged. Children in this high-risk group are seen as impulsive, hyperactive, destructive, and hostile. These children may come from homes with parents who display similar behavioral patterns. Thus, it is difficult to determine whether these behaviors are biologically based or simply learned coping patterns.

Emotional Risk Factors

Suicidal children often evidence a variety of mental health issues, depression being by far the most common. Depression is more common among suicidal children than among nonsuicidal children. Severely depressed children "think about suicide and ... they think about it more often than nondepressed children or those who are suffering only mild depression" (Stillion & McDowell, 1996, p. 83). As is true for all age groups, the depressive symptom of hopelessness is a stronger predictor of suicide than is general depression alone. Thus, children who are unhappy, have low self-esteem, and are generally depressed may be at risk for suicide, but when hopelessness about the future is added to the clinical picture, the severity of the risk becomes much higher.

Another psychological risk factor for children is the expendable child syndrome, in which adults communicate to the child that he or she is expendable. In these instances, adults respond to the children with low personal regard and hostility, withdrawing love and affection. Children come to believe that their death will not matter to anyone, and committing suicide is a way to relieve others of the burden of their existence. This phenomenon was first identified by Sabbath in 1969, and since that time, case studies of childhood suicides have supported its existence, although no systematic research has been conducted to determine the prevalence of this syndrome, and it is difficult to determine the magnitude of this occurrence. Nevertheless, mental health practitioners should be aware of the possibility of increased suicide risk if a child feels that she or he is expendable.

Cognitive Risk Factors

As we discussed earlier, an immature view of death may be partially responsible for suicidal behaviors in the very young or in the cognitively disabled. Children who view death as not permanent might believe that suicide is a satisfactory option for a temporary problem. Orbach and Glaubman (1979) believed that even if children have a mature view of death, they may regress to a more immature view once they begin to contemplate suicide. Children who understand the abstract nature of the finality of death might succumb to more concrete thinking when they are suicidal that allows them to view their own death as pleasant and transient. Work with suicidal children has supported this regression to concrete thinking.

Concrete operational thinking, even outside of the context of beliefs about death and suicide, also has been linked to suicidal risk in children. Children who have a rigid cognitive structure in general are at higher risk for suicide and other destructive behaviors. These children cannot generate multiple solutions to problems and tend to think dichotomously (black/white, right/wrong, life/death). Support for this risk factor comes from research such as a 1984 study that found that suicidal children were more rigid in their thinking than were either nonpsychiatrically involved children or children with terminal illnesses (Orbach, 1984). In this study, suicidal children were significantly more likely to be rigid in their problem solving, and cognitive rigidity was found to be highly correlated with a measure of attraction to death among suicidal children. Orbach concluded that cognitive rigidity is an important intervening variable for childhood suicide risk. These children handle life stressors poorly, tend to overestimate the seriousness of their problems, consider very few solutions to their problems, and are overly attracted to suicide as a solution.

Another cognitive risk factor is what Stillion and McDowell labeled "attraction to and repulsion from life and death" (1996, p. 86). On the basis of the work of Orbach and others, they noted that positive and healthy children should be attracted to life and repulsed by death. Suicidal children hold the opposite views. Studies have shown that suicidal children showed more "repulsion from life, less attraction to life, more attraction to death, and less repulsion from death than nonsuicidal children" (Stillion and McDowell, 1996, p. 86). Children who are attracted to death talk about death, draw death-related pictures, and fantasize about death. Although not every child who draws skulls or wears black (popular in the Goth culture) is at risk for suicide, it is important that such children be approached in a nonconfrontational manner to ascertain whether they are at risk for suicide.

Environmental Risk Factors

The most common environmental risk factor is early loss. Suicidal children, as a group, have experienced more frequent and earlier loss than their nonsuicidal peers. Parental death, separation, and divorce rates for suicidal children are higher than the national averages. Parental absence is identified as a major risk factor for suicidal thoughts and behaviors.

Family dysfunction is a second important environmental risk factor. Suicidal children are more likely to live in homes with significant dysfunction, including parental conflict, physical violence, parental substance abuse, family inflexibility, resistance to change, and unclear parent/child boundaries and role definitions. The families are often rigid in their belief systems and unwilling to consider new ways of handling problems.

Child abuse and neglect also are important risk factors in childhood suicide. Children who are abused have higher rates of depression and hopelessness than do nonabused children. A seminal study by Green in 1978 found that 50% of physically abused children and 17% of neglected children demonstrated suicidal behavior, compared with 7% of their peers. In 2001, Finzi and colleagues found that in their sample of physically abused children, more than half demonstrated suicidal thoughts and/or behaviors, compared with 6% of the nonabused control group. Risk-taking behaviors (e.g., running into the road without caution, climbing without thoughts of safety, ingesting nonedible substances) also was higher in children who had been physically abused (75%) compared with the nonabused control group (9%). These studies and others point to the increased risk of children of abuse and neglect.

Environmental factors outside of the family also can contribute to suicidal behaviors. In a 1999 study of bully-victim problems in schools, Rigby and Slee found that children who are more frequently victimized by their peers at school and feel generally unsupported by others when they have a problem are, in general, more likely to experience suicidal ideation. They also found that among boys, children who engage in bullying may be more likely to experience suicidal ideation than their peers.

Now that you have read about risk factors in children, you can see how many risk factors Bryan had that contributed to his death: impulsivity, hyperactivity, aggression, depression, and many more. Reread the case, and try to identify these specific risk factors.