Experts Think Suicide Prevention Should Begin in Elementary School

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Researchers say programs that focus on how to deal with emotions can help suicide attempts in young children. Getty Images
  • An increase in suicides and suicide attempts in young children has convinced some experts that prevention programs should begin in elementary school.
  • The prevention programs for this age group focus on recognizing and dealing with emotions, not on suicide itself.
  • For teens, experts say some warning signs of suicidal behavior are withdrawing from family, risk-taking actions, and a change in eating and sleeping patterns.

Suicide prevention works, even as early as elementary school.

That’s the conclusion from a new study from Nationwide Children’s Hospital in Ohio.

In the study, published in the journal Child Psychiatry & Human Development, researchers examined 21 children, ages 6 to 9 years old, with and without a maternal history of suicidal behavior.

During the study, the mothers and children were asked to report on lifetime and past-month suicidal ideation and attempts as well as significant events that took place in the child’s life in the past year and the child’s emotion regulation skills.

“Unfortunately, suicide and suicidal behaviors are increasing among youth, but youth suicide and suicidal behaviors are preventable,” said Arielle Sheftall, PhD, the study’s lead author and a principal investigator with the Center for Suicide Prevention and Research at Nationwide Children’s Hospital.

“[This study is] giving us a little peek of what could potentially be beneficial for suicide prevention in younger children, but in order to know if emotional regulation is the target for prevention, we should examine these factors in a larger sample of kids, but we are working on that, so that’s the good news,” she told Healthline.

Sheftall says experts aren’t sure why suicide rates are rising.

“That’s the problem. We just don’t know,” Sheftall said.

She said the research on suicide and suicidal behaviors in young children is currently lacking, and it is difficult to pinpoint one cause for the increased rates.

She noted that from 2012 to 2017 the annual percentage increase in suicide was almost 15 percent for children 5 to 12 years old.

“And when you look at suicidal behavior, one study found a 92 percent increase in hospitalizations for suicide attempts and ideation for youth 5 to 18 years old between 2007 and 2015,” said Sheftall.

“Unfortunately, we have noticed there are changes not only in age, but in sex also with the gap between male and female youth closing when examining the rate of suicide,” she added. “There have also been some racial disparities that we have been noticing in the field as well.”

Sheftall said the factors related to the racial disparities are still unknown. However, economic downturns, housing market crashes, racial discrimination, and mental health service access may all play a role.

“For example, you have parents who are suffering and losing their jobs. They are not able to pay the bills and are getting kicked out of their homes. Little people understand when you are down. I have little people myself. They see when we’re upset and when we’re mad and when we’re happy and they internalize these emotions. This all affects them. As much as we don’t think it does, it really does,” she said.

Sheftall added that the COVID-19 pandemic has exacerbated these issues.

“Millions of people are struggling to put food on the table and, again, we are in this very uncertain time,” she said. “I think all of what we are experiencing is going to unfortunately lead to some detrimental health concerns. With the COVID-19 pandemic, Black and brown families are being affected more than other racial groups, and I believe this will lead to many other concerns physically, mentally, and emotionally.”

Suicide is the second leading cause of death for people between the ages of 10 and 24.

But interventions for suicide and suicidal behavior can begin as young as 4 years old with curriculum-based programs such as PATHS (Promoting Alternative Thinking Strategies), says Sheftall.

The programs are available for pre-kindergarten, elementary school, and middle school classrooms.

Supporters say the programs can help both students and teachers cultivate a safer and more positive learning environment.

The study researchers mentioned PATHS as a potential intervention strategy to reduce suicide rates and suicidal behavior in youth.

“Providing emotion regulation strategies early in childhood may decrease the likelihood of the development of risk factors (e.g., emotion dysregulation) associated with suicidal behavior,” the researchers wrote in the study.

“Teaching kids to understand the emotions they’re facing so they can regulate them effectively could be extremely helpful,” Sheftall said.

For example, what’s positive and what’s negative? What can you do with the information you’re receiving or feeling on the inside?

If such programs and curriculum inclusions aren’t available in your school district, Sheftall suggests PBS Kids’ Mister Rogers’ spin-off, Daniel Tiger’s Neighborhood. In the series, Daniel experiences a range of emotions and models for children how to regulate them and have a healthy response.

Educators can also employ Daniel Tiger to teach children about emotions by way of fun and interactive online games such as “Guess the Feeling.”

“Being
able to recognize and name feelings is the very first step in helping children manage their feelings,” PBS Kids says.

Their desktop games and mobile-friendly apps give children a chance to play while learning about what different feelings look like.

“And it can give you the chance to talk with your child about all kinds of different feelings,” says PBS Kids.

The Feelings Friends educator and parent kits from The Feelings Company are additional ways to incorporate emotion regulation learning in-school settings and at-home. Their kits help adults teach children how to identify, express, and manage emotions. Each comes with associated hand puppet feeling friends and tools for success.

Across all options, the goal is to teach children about their emotions rather than have any discussion directly about suicide.

“Having a discussion about suicide can be a scary conversation to have with a little person,” said Sheftall.

Experts say suicide prevention can take place at any life stage, including after an attempt.

A recent analysis of 14 studies published by JAMA Psychiatry shows that participants who received follow-up calls or text messages after their discharge, as well as coordinated care with professionals, were 30 percent less likely to experience repeat attempts.

In these cases, participants were helped with developing coping skills and strategies for suicidal behaviors and ideation. Mental health professionals and clinicians worked to raise awareness about the warning signs of suicide and suicidal behavior.

“Suicide is preventable and we could play a role in the prevention, it’s just knowing what those signs and symptoms are so we can act when necessary,” Sheftall said.

Experts familiar with the study of youth suicide say it’s crucial that parents take all threats of harm seriously and seek immediate help for your child or teen.

The Mayo Clinic lists these common warning signs for youth suicide:

  • making suicidal statements
  • giving away belongings
  • withdrawing from friends and family
  • having extreme mood swings

Other warning signs may include:

  • risk-taking behavior, such as alcohol use, reckless driving, or sex without using birth control or a barrier method
  • a change in normal routine, such as eating or sleeping patterns
  • a change in personality or becoming severely anxious, agitated, or hostile (in addition to some of the other warning signs above)

Sheftall says, “It’s OK to ask kids, ‘Hey, have you had thoughts about hurting yourself?’ Some people don’t feel they have the ability to do so, but it really could save someone’s life.”

“Just that one question… but also knowing what to do if they answer ‘yes,’” she added. “There are so many barriers for parents who are struggling. There are some folks who find it very hard to seek out services or who can’t afford services.”

For assistance, you can call the National Suicide Prevention Lifeline (800-273-8255) or text HOME to the Crisis Text Line (741741). These resources are available 24 hours, 7 days a week, 365 days a year. (See also this suicide prevention resource guide.)

“It can be hard knowing what resources are available but remember, the hotline is always there,” Sheftall said. “Don’t feel bad calling the hotline, that’s what they’re there for.”

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