Cynthia R. Pfeffer

Suicidal behavior in latency-age children: an empirical study.

Abstract Fifty-eight children, ages 6 to 12 years, consecutively admitted to a psychiatric hospital unit were evaluated for suicide potential. A battery of specially constructed scales was utilized to assess variables that might be correlated with suicide potential. Some degree of suicidal risk was found in 72% of the children. Factors significantly correlating with suicidal behavior were depression, feelings of hopelessness and worthlessness, the wish to die, preoccupations with death, the concept that death is temporary and pleasant, and severe depression and suicidal behavior in the parents.

Suicidal Behavior in Adolescent Psychiatric Inpatients

Abstract Factors associated with suicidal behavior were evaluated during an analysis of the records of 200 consecutively admitted adolescent psychiatric inpatients. Interrater reliability was established for the rated categories of analysis, and a uniform format was used for the standardization and recording of data. Suicidal attempts occurred in 34% of inpatients. DSM-III diagnoses positively associated with suicidal behavior were major depressive and alcohol abuse disorders. Significant predictors of suicidal behavior were alcohol abuse, past suicidal behavior, depression, and aggressive behavior. Some differences between male and female patients were found.

Suicidal Behavior in Latency-Age Children: An Outpatient Population

Abstract Thirty-nine children, ages 6 to 12 years, were evaluated for suicidal behavior in a municipal hospital psychiatric outpatient clinic. Thirty-three percent of the children displayed suicidal ideas, threats, or attempts. Variables that significantly differentiated suicidal from nonsuicidal children were increased psychomotor activity, intense preoccupations with death, and parental suicidal ideation. A comparison between this outpatient population and a previously studied inpatient population revealed that the inpatients had a higher incidence of ego deficits and more serious suicidal behavior. This study demonstrated a higher incidence of childhood suicidal behavior in psychiatric outpatient care than reported previously.

Child survivors of suicide: psychosocial characteristics.

OBJECTIVEnTo describe psychosocial characteristics of children and young adolescents who experienced the recent suicidal death of a parent or sibling.nnnMETHODnSixteen families with children aged 5 years to 14 years and who experienced the suicidal death of a relative on average within the year of research assessment were recruited from the community and evaluated with standard research instruments for levels of childrens psychiatric symptoms and social adjustment.nnnRESULTSnChild survivors of suicide had a higher rate of internalizing symptoms and poorer school adjustments than a standard community sample. Twenty-five percent of the families had children who reported clinically significant symptoms of depression. Approximately 40% of the families included children who reported at least moderate symptoms of posttraumatic stress. Approximately 31% of families had at least one child who reported suicidal ideation, but no child reported a suicide attempt. Significant associations were identified between psychosocial features of the children and parental psychiatric symptoms and stressful life events.nnnCONCLUSIONnChild survivors of suicide are at risk for psychiatric symptoms and social maladjustment which require early identification and preventive intervention to minimize risk for more extensive psychosocial morbidity.

Suicidal behavior in latency-age psychiatric inpatients: a replication and cross validation

A study of 65 psychiatric inpatients, 6-12 years old, revealed 78.5% with suicidal ideas, threats, or attempts. The high number of children from middle social status differed from a previous inpatient population of children predominantly from low social status. Findings that replicated a previous empirical study of child inpatients were high frequency of suicidal tendencies and jumping from heights; significant correlations of death preoccupations and depression with severity of suicidal behavior; and lack of significant correlations of sex, and race/ethnicity with severity of suicidal behavior. Neurophysiological variables did not significantly correlate with severity of suicidal behavior.

Normal Children at Risk for Suicidal Behavior: A Two-Year Follow-up Study

ABSTRACT Seventy-five preadolescents, mean age 12.1 ± 0.25 years, with no prior history of psychiatric care, and their mothers were extensively interviewed in this 2-year follow-up study. Among 67 children who reported on suicidal tendencies at follow-up, there were: 80.6% nonsuicidal, 17.9% with suicidal ideas, and 1.5% with suicidal threats. One hundred and one children studied initially included 88.1% nonsuicidal, 8.9% with suicidal ideas, 2.0% with suicidal threats, and 1.0% with mild suicidal attempts. Fifty percent reported suicidal ideas or acts initially and at follow-up. Of the children who were not initially suicidal, 15.3% were suicidal at follow-up. Suicidal tendencies at follow-up were associated with depression, death preoccupation, aggression, general psychopathology, and ego defenses of denial, reaction formation, and projection. Associations between suicidal tendencies and depression, death preoccupations, and general psychopathology were reported also in the initial study. At follow-up, some factors not associated with suicidal tendencies were: social status, age, sex, race/ethnicity, impulse control, hopelessness, and parental depression. Implications of these findings are discussed.

Suicidal Children Grow Up: Suicidal Episodes and Effects of Treatment during Follow-up

OBJECTIVESnThis paper describes risk for first recurrent suicidal episodes in follow-up of suicidal child psychiatric inpatients. It identifies relations between suicide attempts in follow-up and psychosocial and psychopharmacological treatments.nnnMETHODSnFirst suicidal episodes involving either suicidal ideation or a suicide attempt in a 6 to 8 year follow-up period were rated for 69 child psychiatric inpatients and 64 children selected from the community. Psychiatric treatments were determined from reports from multiple sources.nnnRESULTSnForty-five percent of 133 subjects reported a suicidal episode during follow-up. Children who reported suicidal ideation or a suicide attempt were greater than twice as likely to report a suicidal episode in follow-up than were children from the community. Children treated with antidepressants in follow-up were more likely to attempt suicide than were those not treated with antidepressants.nnnCONCLUSIONSnClose follow-up of suicidal children is warranted to identity risk and to intervene to prevent suicidal episodes. Lack of efficacy of naturalistic treatments implies that controlled treatment studies are needed to determine effective intervention for suicidal children.

Suicidal children grow up: relations between family psychopathology and adolescents' lifetime suicidal behavior.

Standard family history and family study methods were used with 650 first- and 1174 second-degree biological relatives of 133 adolescents who were studied initially 6 to 8 years ago. They included 69 prepubertal children considered at risk for suicidal behavior and 64 prepubertal children selected from the community. This study aimed to identify relationships between family psychopathology and adolescents lifetime history of suicidal states. Family discord, suicide attempts of mother, and substance abuse of mothers and fathers were significantly more prevalent among adolescents with lifetime history of a suicide attempt. Mothers and fathers substance abuse was associated with adolescents lifetime history of suicidal ideation. Results highlight importance of evaluating and treating family psychopathology to reduce risk for youth suicidal states.

Interviewing Prepubertal Children about Suicidal Ideation and Behavior

OBJECTIVEnMuch of the literature on assessment of suicidal children has focused on identifying risk factors associated with suicidal ideation and behavior in this population. Unique problems encountered in interviewing prepubertal children about suicidal ideation and behavior are examined in this paper.nnnMETHODnObservations of problems encountered in interviewing prepubertal children about suicidal ideation and behavior were gleaned in the context of interviews of children admitted to a child psychiatry inpatient unit and interviews of the parents of these children.nnnRESULTSnUnique problems include difficulties in assessment of suicidal intent, impact of cognitive development, particularly of the concept of death, interaction between current emotional state and memory of previous suicidal episodes, characteristics of play associated with suicidal states, effects of parents attitudes toward assessment on information gathering, and the impact of certain risk factors on cognition and behavior during the interview.nnnCONCLUSIONnInterviewing children about suicidal ideation and behavior necessitates that the clinician attend to multiple elements of the interview simultaneously. These interviews are further complicated by the stressful thoughts and feelings that can be raised in both clinician and child in reaction to exploring the childs suicidal ideation and behavior. Additional research is needed to refine the process of reliable interviewing of children about suicidal ideation and behavior and to develop instruments both to quantitate the different elements of these interviews and to guide the clinicians conducting them.

Suicidal children grow up: ego functions associated with suicide attempts.

OBJECTIVEnTo evaluate the relations between suicidal behavior in children and ego functions including impulse control, reality testing, and ego mechanisms of defense.nnnMETHODnOne hundred thirty-three children were assessed initially and at a 6- to 8-year follow-up for levels of reality testing and impulse control and frequency of use of several ego mechanisms of defense. Associations between suicidal ideation and suicide attempts at the initial assessment and at follow-up were analyzed with regard to ego functions.nnnRESULTSnSpecific ego functions, such as impulsivity, poor reality testing, and ego mechanisms of defense such as projection, regression, compensation, and reaction formation were positively associated with suicide attempts. Repression was a protective factor to prevent suicide attempts in the follow-up period.nnnCONCLUSIONSnThe results suggest that ego functions are related to behavior of consequence and are useful in the identification of children at risk for suicidal behavior.