Children diagnosed with major depressive disorder between the ages of 3 and 6—known as preschool-onset MDD—are more likely than their peers to express suicidal thoughts and behaviors before the age of 13, a report in the Journal of the American Academy of Child and Adolescent Psychiatry suggests.
“While general [suicidal thoughts and behaviors] screening is not indicated for children under age 8, suicide assessment should be conducted if warning signs such as mood disturbances are present,” wrote Laura Hennefield, Ph.D., of the Washington University School of Medicine and colleagues. “Children with [preschool-onset] MDD would likely benefit from increased suicide screening, proactive safety planning, and early interventions.”
The study included 137 children aged 8 to 12 years who met the criteria for preschool-onset MDD and 53 children aged 8 to 12 with no history of depression.
The children with preschool-onset MDD and their caregivers had initially participated in a study testing the effectiveness of a parent-child psychotherapy for early childhood depression. As part of that study, caregivers completed multiple assessments about their children, such as the Kiddie Schedule for Affective Disorders and Schizophrenia-Early Childhood (K-SADS-EC). When the children were between 8 and 12 years, the researchers asked the caregivers to complete the K-SADS-Present and Lifetime (K-SADS-PL), which included questions on lifetime and current symptoms of depression as well as suicidal thoughts, behaviors, and attempts. The children also reported on their own lifetime and current symptoms. A child was considered to have suicidal thoughts and behaviors if such behaviors were reported by the caregiver or the child.
The researchers found that 67.9% of 8-to 12-year-old children who had preschool-onset MDD expressed suicidal thoughts and behaviors by preadolescence, including 26.3% over the prior month. In contrast, 22.6% of children without a history of depression endorsed suicidal thoughts and behaviors by preadolescence, including 3.8% over the prior month. The children with preschool-onset MDD were also significantly more likely to have made a suicide attempt by age 12 compared with peers without depression history.
Further analysis revealed that children with preschool-onset MDD who achieved remission following parent-child psychotherapy (defined as at least 50% reduction in symptom severity and loss of preschool-onset MDD diagnosis) were less likely to experience suicidal thoughts and behaviors after preschool.
“Studying those with or at risk for [suicidal thoughts and behaviors] early in development holds promise for identifying at-risk children for targeted preventative intervention to alter risk trajectories away from persistent or escalating [suicidal thoughts and behaviors],” the researchers said.
For related information, see the Psychiatric News article “Suicidal Thoughts Begin Early for Some Youth.”
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