Clinical Description of Suicide in Children

Suicidal ideation and acts are episodic events that have discrete onsets and durations. Incidence rate of suicide more enlarge the epidemiology of suicidal behavior in children in the last decade. Intent to harm oneself is an essential defining characteristic of suicidal behavior. Suicidal intent may be explicit and strong or it may be ambiguous. Evaluating intentionality often is a difficult clinical task, especially among preadolescents. For example, a 9 year old boy who was seriously despondent after his dog died threatened to stab himself with a knife during an argument with his mother.

He denied that he had thoughts of wanting to kill him, but stated that he wanted to upset his mother. In this case, the intent was not clear, but the overt behavior was potentially life threatening. In contrast, a 15-year-old girl ingested 127 aspirin tablets after she broke up with her boyfriend. She wanted to kill herself because she felt she had nothing to live for. In this case, suicidal intent was clearly stated.

Because intentionality often is difficult to identify suicidal thought in children and adolescents, it is helpful for clinicians to consider that self-injurious acts in children and adolescents are potentially suicidal and make efforts to protect such youths from self-harm. In this way, clinicians can be more focused on administering life-sparing interventions rather than to limit their intervention strategies.

It is essential to appreciate that young children will not know that death is final and that it is not until adolescence that comprehension of the finality of death is fully realized. Therefore, in evaluating suicidal behavior in children and adolescents the understanding that death is final is not an essential ingredient in determining whether children or adolescents are suicidal. Concepts about death develop in parallel with children's advancing development. Although appreciation of the finality of death may not occur until adolescence, some suicidal adolescents do not have mature concepts of death.

Additionally, children's concepts of death may vary. For example, a 7-year-old may understand that because his pet bird has died, it will no longer be alive. However, this child may not understand that if he dies he will never be alive again. Children's understanding of death also may fluctuate. Children may realize that death is final at one time but when severely stressed for example, by the divorce and arguments of their parents children may believe that death is reversible. Therefore, it is quite evident that young children, such as preschoolers who do not appreciate the finality of death, can be considered to be suicidal if they wish to carry out a self-destructive act with the goal of causing death.

Children and adolescents, like adults, can plan and carry out suicidal acts using a variety of potentially lethal methods that include shooting, hanging, ingestion, and other suicidal methods involving suffocation, stabbing, running into traffic, burning, and drowning. Females attempt suicide more frequently and use less violent methods than males. Gender differences for suicide methods may account for why suicide rates are higher among males. Suicide prevention should be done early. Namely by identifying and performing treatment since the child showed suicidal thoughts that most of the impact of mood disorders. Treatment of mood disorders should be able to eliminate thoughts of suicide in order not to be realized.