Did You Know?

A better understanding of the role of adverse childhood experiences in suicide deaths comes from an analysis of data relating to nearly 550,000 youth. In this study, researchers followed all individuals born in Sweden between 1987 and 1991 from birth to age 24, assessing eight adverse experiences between birth and age 14. While all eight forms of adversity increased the likelihood of dying by suicide, risk was doubled or more for young people when they had experienced these adversities:

• a family member had died by suicide
• a parent had a criminal history, or
• a parent had a mental disorder.

Other adversities that significantly increased the risk for suicide death by between 40% and 90% included:

• having a parent with problematic substance use
• experiencing a death in the family
• receiving public assistance
• experiencing residential instability, and
• living in a single-parent household.

Notably, suicide risk increased as the number of adversities increased — increasing 90% with two and 160% with three or more. For more information, see Vol. 17, No. 1 of the Children’s Mental Health Research Quarterly.

To understand the relationships between mental disorders and suicide, a recent systematic review examined 24 longitudinal studies involving 12- to 26-year-olds from eight mostly high-income countries, including Canada. Data on more than 25,000 individuals were combined and analyzed. Young people with mental disorders had more than 10 times greater odds of dying by suicide and more than three times greater odds of attempting suicide than those without these disorders. This systematic review also examined how having more than one mental disorder can increase the risk for suicide attempts. Young people with any concurrent mental disorders had nearly nine times greater odds of attempting suicide than those with no disorder. Among the specific diagnoses, young people with mood disorders, including depression, had 54% higher odds for suicide attempts than those with other disorders.

More information on mental health and suicidality comes from a Canadian study that followed a representative sample of more than 6,700 children from ages 10 to 17. The researchers found that when these young people reached adolescence, those with severe conduct disorder symptoms had more than four times greater odds of attempting suicide than those without these problems. Youth who developed severe depressive symptoms had 61% greater odds of experiencing suicidal ideation, and those who used cannabis at least once or twice a month had 74% higher odds. For more information, see Vol. 17, No. 1 of the Children’s Mental Health Research Quarterly.

Findings from a recent review by the Children’s Health Policy Centre offer hope for preventing childhood suicide. These findings suggest five implications for practice and policy:

• Support more research on promising school-based suicide prevention programs. Of the programs we reviewed, Youth Aware of Mental Health (YAM) showed the most promise — reducing suicide attempts as well as reducing serious suicidal ideation by one-year follow-up in a large study spanning 10 countries. However, before considering implementation of this program, replication evaluations are needed, ideally in BC student populations. Policy-makers and practitioners can support researchers in these efforts.

• Recognize that effective programs can be brief, using limited resources. YAM was delivered in one month, with facilitators delivering two lectures and supporting three role-play sessions. Given the demands on schools, the brevity of this program makes it compelling and worth further evaluation.

• Build on the collaborative relationships between practitioners and school personnel. BC has invested in bringing more mental health practitioners into schools. Forging these collaborations can help facilitate suicide prevention programs in BC schools.

• Consider delivery in settings beyond schools. Effective suicide prevention programs could be delivered outside of schools, for example, in after-school programs, which often reach large numbers of children. New evaluations in these settings would also improve the knowledge base, informing new options to help young people.

• Understand the importance of directly teaching suicide prevention skills. Efforts to reduce suicide should ideally involve reaching as many young people as possible using effective universal interventions. Yet the high-quality research evidence on these interventions is still limited. More research is therefore needed. Nevertheless, programs such as YAM can be a helpful starting point. For example, policy-makers and practitioners could collaborate with researchers to conduct new evaluations of this promising program. Doing so can add to the evidence that would benefit young people in BC.

Investing in new research with BC children is an important step toward reducing the impact of suicide in this province.

For more information, see Vol. 16, No. 4 of the Children’s Mental Health Research Quarterly.

The Fort Apache community in Arizona set out to teach youth business development and life skills while promoting a positive Apache identify. They did so by developing an eight-month community-based program for 13- to 16-year-olds. The program did not make a significant difference for suicide attempts or involvement in physical fights. However, at two-year follow-up, youth who participated in the program had significantly lower rates of past month cannabis use. The rate was 24.1% for youth who received the intervention compared to 31.4% for youth in the control group.

For more information, see Vol. 16, No. 4 of the Children’s Mental Health Research Quarterly.

Suicide prevention programs may be either universal (delivered to all children in a given population) or targeted (delivered to those most at risk). Both approaches have a role in preventing youth suicide. Universal programs have the benefits of reaching large numbers of young people without stigmatizing them and without requiring extensive screening efforts.

Of the programs examined by the Children’s Health Policy Centre, Youth Aware of Mental Health (YAM) showed the most promise. Self-reported suicide-related outcomes were assessed three and 12 months after students completed the program. At three-month follow-up, there was no significant difference between youth who received YAM and those in the control group regarding suicide attempts (0.9% vs. 1.1%) or severe suicidal ideation in the prior two weeks (1.5% for both groups). However, statistically significant differences did emerge later. By one-year follow-up, 0.7% of youth who participated in YAM had made a suicide attempt compared with 1.5% of youth in the control group. As well, 0.8% of youth who received YAM had experienced severe suicidal ideation in the two weeks prior to the one-year assessment, compared with 1.4% of youth in the control group. These findings suggest that YAM may be especially helpful in reducing suicidality.

For more information, see Vol. 16, No. 4 of the Children’s Mental Health Research Quarterly.

Established by the United Nations in 1954, World Children’s Day, Nov 20, promotes and celebrates children’s rights.

Each year, UNICEF, the United Nations Children’s Fund, helps organize kids’ takeovers in which children “take over” high-visibility roles in politics, sports and media. This allows kids to raise their voices on issues that matter to them, including climate change, mental health and education.

World Children’s Day also shines a light on international agreements made to protect the rights of children, including the Declaration of the Rights of the Child and the Convention on the Rights of the Child — adopted on Nov. 20 in 1959 and 1989, respectively. The day calls on world leaders to honour and uphold the rights enshrined in those agreements.

Access to high-quality health care — including mental health care — is one of those rights. But many children in Canada do not have easy access to effective programs for preventing mental disorders. Effective treatments that involve self-delivery may be one way to improve capacity. To learn more, see Vol. 14, No. 2 of the Children’s Mental Health Research Quarterly.

A significant number of young Canadians struggle with thoughts of suicide. Data from the National Longitudinal Survey of Children and Youth revealed that 13% of 14- and 15-year-olds reported having seriously considered attempting suicide in the past year. Similar findings emerged from the most recent BC Adolescent Health Survey which found 17% of respondents reported seriously considering killing themselves in the past year.

Identifying and responding to youth who have thoughts of suicide is critical since about one-third will make a suicide attempt within a year. Services immediately available to children and youth in BC who are struggling with thoughts of suicide include the following:

• YouthInBC.com provides assistance from a crisis responder 24 hours a day by phone (1-800-784-2433 or 604-872-3311 for youth in Greater Vancouver) and online chatting from noon to 1 a.m. through their website: youthinbc.com.

• Kids Help Phone provides support from a professional counsellor 24 hours a day by phone (1-800-668-6868) or from a crisis responder by text (686868) or via Facebook Messenger through their website: kidshelpphone.ca. Young people can be connected with First Nations, Inuit or Métis crisis responders.

• Youth Space provides support from trained volunteers from 6 p.m. to midnight by chat through their website (youthspace.ca) or by text (778-783-0177).

For more information, see Vol. 16, No. 4 of the Children’s Mental Health Research Quarterly.

The National Longitudinal Survey of Children and Youth provides important information on suicide attempts among Canadian youth. After tracking a representative sample of young people for more than a decade, researchers found most young people (96.0%) had never attempted suicide. But among the 4.0% who did make an attempt, researchers found clear patterns. For half of these young people, attempts occurred only during adolescence, while for the other half, they continued into adulthood. Where attempts were limited to the teen years, risk peaked at ages 14 to 15 and then declined. In contrast, where attempts continued into adulthood, risk increased steadily throughout adolescence.

BC data on youth suicide attempts also exist. Among the 38,000 students in Grades 7 to 12 participating in the McCreary Centre Society’s most recent BC Adolescent Health Survey, 5% acknowledged attempting suicide in the past year  — a figure in keeping with the Canadian data noted above. Overall, suicide attempts warrant serious attention because they are an important risk factor for subsequent attempts, including fatal ones.

For more information, see Vol. 16, No. 4 of the Children’s Mental Health Research Quarterly.

Suicide affects far too many young Canadians and their families. In fact, suicide is the second leading cause of death in this country, behind only unintentional injuries, for 15- to 19-year-olds, and the third leading cause for 10- to 14-year-olds. To help meet the goal of reducing youth suicide, the World Health Organization (WHO) has been a leader in collecting vital information. A recent meta-analysis of WHO data compared suicide rates for 10- to 19-year-olds across 35 countries, including Canada. From 2010 to 2018, the suicide rate for Canadian youth was 5.01 per 100,000 — putting Canada above the average global rate of 3.77 per 100,000. Still, WHO data revealed declining Canadian youth suicide rates in recent years, with the comparable figure for 2000 to 2011 being 5.36 per 100,000.

Suicides by Canadian youth differ based on age, gender and the interaction of the two. Regarding age, suicides are more frequent for 15- to 19-year-olds. Regarding gender, and as typical of other countries, boys account for the most suicides among older teens, at 70%. But among those between 10 and 14 years, girls account for 59% of suicides — making Canada the only country among the 35 included in the meta-analysis of WHO data with higher suicide rates for girls than for boys in this younger age group.

Researchers have also documented differing patterns in Canadian youth suicide rates over time, by gender. Between 2000 and 2018, the suicide rate for boys between 10 and 19 years declined slightly. The comparable suicide rate for girls showed a statistically significant increase of 0.09 deaths per 100,000.

For more information, see Vol. 16, No. 4 of the Children’s Mental Health Research Quarterly.

ADHD Awareness Month is part of a global effort to share information to help people with ADHD thrive. Attention Deficit/Hyperactivity Disorder (ADHD) affects children and adults all around the world, and this month offers an opportunity to fight misconceptions about ADHD and highlight helpful strategies for managing it. The ADHD Awareness Month Coalition provides numerous online resources, including expert Q & As, videos and podcasts, personal stories, and daily tips for life with ADHD.

ADHD is the second most common mental health disorder in children, exceeded only by anxiety. Positive and engaged caregiving can help children develop the self-regulation skills they need, and there is evidence that interventions such as child Cognitive Behavioural Therapy (CBT), behavioural therapy and neurofeedback can also be effective in helping children with ADHD. To learn more, see Vol. 10, No. 4 and Vol. 11, No. 1 of the Children’s Mental Health Research Quarterly.