Editorial: Progress and Challenges in Characterizing Psychiatric Symptoms and Behaviors in Suicidal Preadolescent Children

Historically, little clinical and research attention has been focused on suicide in preadolescent children because of the commonly held view that children at this age do not possess the cognitive capacity fully to comprehend death (eg, its finality) and therefore are incapable of experiencing suicidal thoughts and behaviors.1 This view may result in expressions of suicidal thoughts by preadolescent children being interpreted and treated as momentary expressions of distress, but not of actual desire or intent to engage in suicidal behavior. There is accumulating evidence, however, to urge caution against such an interpretation. Although preadolescent suicide occurs at a low base rate, it has been increasing, rising from the 10th leading cause of death in this age group in 2008 to the 5th leading cause of death by 2019 in the United States according to data from the US Centers for Disease Control and Prevention.2 Furthermore, in the general community, suicidal thoughts and behaviors have been found to occur at concerningly high rates among preadolescent children in a recent systematic review, with lifetime prevalence of 2.6% for suicide attempts and 15.1% for suicidal thoughts.3 In this age group, another form of self-injurious thoughts and behaviors (SITBs), nonsuicidal self-injury (ie, deliberate self-harm in the absence of suicidal intent), is also poorly understood and a significant concern, with a lifetime prevalence of 6.3% among preadolescent children in the general community. Accurate characterization of the psychiatric symptom and behavioral profiles of preadolescents with SITBs is an important step toward identifying children in need of intervention or preventive efforts to avoid these outcomes.