Suicidal and Self-Harming Preschoolers

Research on suicidal ideation (SI) and suicidal behavior (SB) in very young children is scarce. However, in clinical settings, child psychiatrists encounter these constellations repeatedly. Although death by suicide before 10 years of age is rare, suicidal thoughts, and sometimes behaviors, do occur. Indeed, the prevalence of suicidal thoughts and behaviors, considered together, in preschoolers is reported to be 4% to 13%.^1-3 Along the more severe end of the suicidal spectrum, a frequency of SB and/or attempts of 1.6% (5 of 306 children)² and of suicidal plans or attempts of 2% to 3%³ were reported for children 3 to 7 years old. Although the variability in reported prevalence rates might be influenced by factors such as the specific definition of SI/SB used¹ and reporting bias (assessment of SI/SB by parent/primary caregiver report), expressions of SI/SB in preschool age are strongly associated with distress, psychopathology (eg, depression, attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, posttraumatic stress disorder, impulsivity, nonsuicidal self-directed aggression, abuse/neglect, runaway behavior), parental psychopathology, and family instability.^2-6 Notably, the presence of SI/SB in preschool age was a predictor of school-age SI/SB in a prospective longitudinal study.² Indeed, almost three-fourths of preschoolers with SI/SB reported these behaviors as school-aged children (7-12 years), too,² which underlines the importance of proper assessment and timely intervention.