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Cited by 27Suicide and Self-Harm StudiesChild and Adolescent Psychosocial and Emotional DevelopmentTreatment of Major Depression

Preschool-onset major depressive disorder as a strong predictor of suicidal ideation and behaviors into preadolescence

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Hennefield, Laura, Whalen, Diana J., Tillman, Rebecca, Barch, Deanna M., Luby, Joan L.·2024·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2023.11.008PMC PMC11156793
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Abstract

Objective Suicidal thoughts and behaviors (STBs) in children are an escalating public health concern. This study focused on 1 understudied candidate risk factor, namely, preschool-onset major depressive disorder (PO-MDD), as a predictor of persistent and emerging STBs from early childhood into preadolescence.Method Participants were 137 children 8 to 12 years of age who met criteria for PO-MDD when they were 3 to 6 years of age, and a nondepressed sample of 53 age-, income-, and sex-matched peers. STBs were reported by caregivers (preschool, preadolescence) and children (preadolescence) using age-appropriate diagnostic interviews.Results By preadolescence, children who had PO-MDD were 7.38 times more likely than their peers to have endorsed STBs after early childhood (p < .001; 67.9% vs 22.6%), including 6.71 times more likely to have engaged in suicide behaviors/attempts (p = .012; 21.9% vs 3.8%); they were also 8.98 times more likely to have endorsed STBs over the prior month (p = .005; 26.3% vs 3.8%). Similar findings emerged when limiting the PO-MDD group to children without preschool STBs, and when controlling for externalizing comorbidities, implicating PO-MDD as a unique diagnostic predictive risk factor. However, children who had PO-MDD with STBs were 3.46 times more likely than children who had PO-MDD without STBs to endorse later STBs (p = .018; 83.1% vs 54.2%), indicating substantial continuity of preschool STBs alongside strikingly high rates of emerging STBs into preadolescence.Plain language summary This longitudinal study explores preschool onset major depressive disorder (PO-MDD) as a predictor of having suicidal thoughts or attempting suicide by age 12. 137 children aged 8 to 12 years who met criteria for PO-MDD when they were 3 to 6 years of age and 53 non-depressed peers were included in the study. The study found that preadolescents who had experienced preschool-onset depression were 6.14 times more likely to experience active suicidal thoughts and 8.03 times more likely to have made a suicide attempt by age 12 when compared to preadolescents who did not experience preschool depression. Results suggest that children with preschool-onset depression would likely benefit from increased suicide screening, proactive safety planning and early interventions.Conclusion PO-MDD is a strong risk factor for the emergence and persistence of STBs into preadolescence. Children with PO-MDD would likely benefit from increased suicide screening, proactive safety planning, and early interventions.

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Authors
Hennefield, L., Whalen, D. J., Tillman, R., Barch, D. M., & Luby, J. L.
Affiliations
Washington University in St. Louis (US)
Corresponding author
Hennefield, Laura
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2024-09
Volume
63
Issue
9
Pages
919-930
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2023.11.008
PMC
PMC11156793
OpenAlex
W4389405995
Cited by
27
References
44
Citations by year
2026: 8 · 2025: 14 · 2024: 4 · 2023: 1
FWCI
7.84
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health Neuroscience Center (R01 MH117436, K01 MH127412, K23 MH118426)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
suicidal ideation, suicide attempts, childhood depression, late childhood, suicide risk factors, child mental health
MeSH terms
Child, Child, Preschool, Major Depressive Disorder, Female, Humans, Male, Risk Factors, Suicide, Attempted, Age of Onset, Suicidal Ideation

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