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From 1999 through 2015, 1,309 children ages five to 12 took their own lives in the United States according to the CDC. That’s one child under 13 dying of suicide nearly every five days over those 17 years.

A study published in Pediatrics from researchers at Nationwide Children’s Hospital focused on precipitating circumstances of suicide in children and early adolescents, defined as ages five to 14.

“Although suicide is extremely rare in elementary school-aged children, parents should be aware that children can and sometimes do think about suicide,” says Jeff Bridge, PhD, director of the Center for Suicide Prevention and Research at Nationwide Children’s and co-author of the study.

“Children who died by suicide were more likely to have relationship problems with family members or friends whereas early adolescents were more likely to have boyfriend or girlfriend relationship problems,” says Arielle Sheftall, PhD, a postdoctoral research fellow in the Center for Suicide Prevention and Research and first author of the study.

The study team used the National Violent Death Reporting System (NVDRS) to analyze suicide deaths from 2003 to 2012 in 17 states, segregating them by age group. The NVDRS database includes information from multiple sources including medical examiners and law enforcement reports, allowing more in-depth information to be gathered concerning personal, familial and social factors surrounding a child’s death.

A current mental health problem was present in about 33 percent of children in the study sample, with a diagnosis of ADD or ADHD being more common in children who died by suicide compared to early adolescents, who were more likely to be affected by depression or dysthymia.

That might mean the younger kids are more susceptible to responding impulsively to problems, noted Dr. Sheftall. “I think having information that we are seeing ADD/ADHD in kids (5-11) dying by suicide may help us to intervene differently in that age group.”

“We also found that 29 percent of children and early adolescents disclosed their intention for suicide to someone prior to their death,” says Dr. Sheftall. “Our study highlights the importance of educating primary health care providers, school personnel and families on how to recognize the warning signs of suicide and what steps to take. These warning signs include a child making suicidal statements, being unhappy for an extended period, withdrawing from friends or school activities or being increasingly aggressive or irritable.”

Research indicates that the use of suicide risk screening tools by pediatricians increases the detection of suicide risk in youth 400 percent without overburdening clinical care. Not only do pediatricians potentially see at-risk children on a regular basis, early detection allows the health care providers an opportunity to alert parents of potential risks and increases the likelihood of a child receiving mental health services.

“It’s important to ask children directly about suicide if there is a safety concern. Research has refuted the notion that asking children directly about suicide will trigger suicidal thinking or behavior,” says Dr. Bridge. “It does not hurt to ask. In fact, asking about suicide leads to hope for at-risk youth.”

Read more here.