Improving Suicide Prevention by Examining Characteristics and Precipitating Circumstances Among Children Aged 5 to 11 Years

Improving Suicide Prevention by Examining Characteristics and Precipitating Circumstances Among Children Aged 5 to 11 Years 150 150 Natalie Wilson

Suicides among children aged 11 or younger are on the rise. In response to this trend and a call to action by the National Institute of Mental Health task force on child suicide research, researchers have identified common themes across coroner’s and police reports on suicide deaths in this age group to identify warning signs and improve prevention strategies.

Suicide is the eighth leading cause of death among youth aged 5 to 11 in the United States, and suicide rates in this age group increased nearly 15% annually between 2012 and 2017, according to recent mortality statistics from the Centers for Disease Control and Prevention.

An enhanced understanding of the potentially unique circumstances surrounding these deaths is critical to improving suicide prevention among at-risk children. Yet research on suicide deaths among youth aged 5 to 11 has been limited.

To address this gap, a team of researchers led by Donna Ruch, PhD, a research scientist in the Center for Suicide Prevention and Research at Nationwide Children’s Hospital, and Jeff Bridge, PhD, director of the center, examined common characteristics and precipitating circumstances of youth suicide deaths using the National Violent Death Reporting System (NVDRS), a system that collects data on suicide and violent deaths from coroner’s and police reports.

Their study, published in JAMA Network Open, found that although the circumstances around any suicide death are complex, there are often shared characteristics and experiences among young children who die by suicide.

Results showed that suicide in children is most often associated with mental health concerns, prior suicidal behavior, trauma — including abuse or neglect, exposure to domestic violence, suicide or the death of a family member — or peer, school or family-related problems. Suicide deaths were commonly preceded by a negative or “triggering” event on the day of death such as an argument between the child and a family member or a disciplinary action.

“Identifying these common themes associated with childhood suicide can inform prevention strategies,” says Dr. Ruch.

A total of 134 suicide deaths of children aged 5-11 years between 2013 and 2017 were identified from the database. Most were among children aged 10-11, and 75% of the children in the study were male.

Among children who died by suicide, 31% experienced a mental health concern or diagnosis, with attention deficit hyperactivity disorder (ADHD) and mood disorders such as depression and co-occurring disorders being most common. A prior psychiatric hospitalization was documented in 24% of children in the study, and 78% were receiving mental health treatment before their deaths.

More than 25% of children in the study who died by suicide experienced one or more traumatic events, and many children in the study experienced one or more family-related circumstances including divorce or custody issues, parental substance abuse, or a family history of psychological problems or suicide. Findings suggest family-based interventions and a trauma-informed approach towards youth suicide prevention may play an important role in preventing suicidal thoughts and behaviors in childhood.

Researchers also found children in the study were disciplined on the day of suicide in 32% of cases. Disciplinary actions often followed a school-related issue or an argument between children and their parent or guardian and involved sending children to their bedrooms in half of cases or taking away a technological device in 29% of cases.

“We found these major themes were often co-occurring,” says Dr. Ruch. “Children with mental health concerns or a history of suicidal behavior often had traumatic histories related to adverse family situations. School problems frequently resulted in parent-child conflicts and were more likely to occur in children with mental health concerns.”

The study also found common patterns in how the suicide deaths occurred. While most suicides in this age group occurred by hanging/suffocation in the child’s bedroom, 19% occurred by firearm. In all cases where detailed information on these deaths was available, children had obtained unsecured guns from within their homes, where they were stored loaded, unlocked, with ammunition or otherwise unsafely. Educational programs, youth-focused firearm laws and safe firearm storage public awareness campaigns could improve safe storage practices, and evidence suggests this would protect against unintentional firearm shootings and suicide attempts in all age groups, including young children.

A prior history of suicide attempts was reported in 12% of children in the study, and a history of suicidal ideation or suicidal statements was reported in about 25% of cases. More than 10% of children expressed these comments to parents, teachers or school employees on the day of their deaths, suggesting suicidal statements should be taken seriously in younger children.

“These findings underscore the importance of early suicide prevention efforts that include improvements in suicide risk assessment, family relations and lethal means safety, particularly safe firearm storage,” says Dr. Bridge.

Although reports in the NVDRS database offer detailed information, their quality varies by state and incident. The content for these retrospective reports is also provided by parents, family members and others who have relationships with the children whose deaths are recorded in this system. These individuals may not be aware of all circumstances associated with these children’s suicide deaths.

“We also want to emphasize that families and clinicians should not be overly alarmed by our findings. The themes and precipitating circumstances we identified are also experienced by children who will never engage in suicidal behavior. But identifying these can help inform prevention efforts,” says Dr. Ruch.

“Future research further examining the myriad aspects of childhood suicide, including racial/ethnic and sex differences, is needed,” adds Dr. Ruch, “But these findings are an important starting point.”

If you or your child are feeling suicidal, talk to someone. Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the Youth Psychiatric Crisis Line for Franklin County residents at (614) 722-1800; connect to the Lifeline Crisis Chat at; or reach the Crisis Text Line by texting “START” to 741-741.

If you ever have immediate/urgent concerns about your safety or the safety of anyone else, call 911.

If you believe an overdose has occurred, call the national Poison Help hotline at 1-800-222-1222.

Among children and young adults ages 5-21, warning signs of suicide can vary; however, research is very clear that talking about suicide does not give your child ideas about trying it or increase the risk of a suicide attempt in the future. Talking about suicide is safe and shows your child that you are concerned and want to help. Even if your child is not depressed, it is important to have direct conversations about mental health and how friends may be dealing with these issues. Information about suicide warning signs, resources for suicide prevention and resources for families, including those who have lost a loved one to suicide, are available at

Recommendations for reporting on suicide can be found at


Ruch DA, Heck KM, Sheftall AH, Fontanella CA, Stevens J, Zhu M, Horowitz LM, Campo JV, Bridge JA. Characteristics and precipitating circumstances of suicide among children aged 5-11 years in the United States: 2013–2017. JAMA Network Open. 2021 Jul 27.

About the author

Marketing Strategist, Research Communications

Natalie is a passionate and enthusiastic writer working to highlight the groundbreaking research of the incredible faculty and staff across Nationwide Children's Hospital and the Abigail Wexner Research Institute. Her work at Nationwide Children's marries her past interests and experiences with her passion for helping children thrive and a long-held scientific curiosity that dates back to competing in the Jefferson Lab Science Bowl in middle school. Natalie holds a bachelor’s degree in sociology from Wake Forest University, as well as minors in women's, gender & sexuality studies and interdisciplinary writing. As an undergraduate student, Natalie studied writing and journalism, engaged with anthropological and sociological research with a focus on race and ethnic relations, served as executive editor for the student newspaper, the Old Gold & Black, and gained marketing experience as an intern for a nonprofit entrepreneurial incubator, Winston Starts, as well as by working for Wake Forest University School of Law Office of Communication and Public Relations and its Innocence and Justice Clinic.