Importance Considerably less is known about self-injurious thoughts and behaviors (SITBs) in preadolescence than older age groups, owing partly to the common view that young children are incapable of suicidal thoughts. Yet, preadolescent suicide has increased in recent years and is now the fifth leading cause of death in this age group, leading the National Institute of Mental Health to identify it as a priority for research and intervention. Objective To assess prevalence estimates of preadolescent SITBs, identify correlates of these outcomes, and conduct head-to-head comparisons of preadolescent and adolescent SITBs in terms of associated characteristics. Data Sources MEDLINE, PsycINFO, and Embase were systematically searched from inception through December 23, 2021, for studies on the prevalence and correlates of preadolescent SITBs. The search was restricted to English language publications and peer-reviewed journals. Study Selection Two reviewers independently identified studies providing data on prevalence and correlates of preadolescent SITBs. Data Extraction and Synthesis Two reviewers independently extracted data from each study, and the Joanna Briggs Institute Checklist for Prevalence Studies was used to assess study quality. Pooled prevalence and Cohen d were derived from random-effects meta-analyses. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. Main Outcomes and Measures Prevalence and correlates of suicidal ideation, suicide attempts, suicide deaths, and nonsuicidal self-injury among preadolescents. Results Fifty-eight studies with 626 486 590 individuals were included. Lifetime prevalence of suicide in the general population was 0.79 per 1 million children. Prevalence for lifetime suicidal thoughts, suicide attempts, and nonsuicidal self-injury among preadolescents were 15.1%, 2.6%, and 6.2%, respectively, in community samples. These data suggest that approximately 17.0% of preadolescents with suicidal ideation transition to attempting suicide. Across several analyses, male individuals appear more likely to have SITBs in preadolescence than adolescence. Correlate data were modest for SITBs other than suicidal ideation, but among specific disorders, attention-deficit/hyperactivity disorder (suicidal ideation: d = 0.54 [95% CI, 0.34-0.75]) and depression (suicidal ideation: d = 0.90 [95% CI, 0.71-1.09]; suicide attempts: d = 0.47 [95% CI, 0.26-0.68]) emerged as the strongest correlates. Among interpersonal factors, child maltreatment (suicidal ideation: d = 2.62 [95% CI, 1.56-3.67]) and parental support (suicidal ideation: d = -0.34 [95% CI, -0.46 to -0.22]) yielded the largest effect sizes. Conclusions and Relevance In this systematic review anda meta-analysis, although preadolescent suicide deaths were rare, other SITB types occur with concerning frequency. Male individuals were at greater risk for SITBs in preadolescence relative to adolescence. Attention-deficit/hyperactivity disorder, child maltreatment, and parental support were especially relevant to suicidal ideation, as well as depression for suicidal thoughts and behaviors, in this age group. Further study, especially of SITBs other than suicidal ideation, is needed.

中文翻译：

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儿童自杀和非自杀性自伤的发生率和相关性：系统评价和荟萃分析。

重要性 与年龄较大的年龄组相比，对青春期前的自我伤害思想和行为 (SITB) 的了解要少得多，部分原因是人们普遍认为幼儿不会产生自杀念头。然而，近年来青春期前的自杀有所增加，现在是这个年龄组的第五大死亡原因，导致国家心理健康研究所将其确定为研究和干预的优先事项。目的 评估青春期前 SITB 的患病率估计，确定这些结果的相关性，并根据相关特征对青春期前和青春期 SITB 进行面对面比较。数据来源 MEDLINE、PsycINFO 和 Embase 从一开始到 2021 年 12 月 23 日进行了系统搜索，以研究青春期前 SITB 的流行率和相关性。搜索仅限于英文出版物和同行评审期刊。研究选择 两位评论员独立确定了提供有关青春期前 SITB 患病率和相关性数据的研究。数据提取和综合 两名评价员独立地从每项研究中提取数据，并使用 Joanna Briggs Institute 的患病率研究清单来评估研究质量。合并流行率和 Cohen d 源自随机效应荟萃分析。遵循系统评价和元分析 (PRISMA) 报告指南的首选报告项目。主要结果和措施 青春期前自杀意念、自杀未遂、自杀死亡和非自杀性自伤的发生率及其相关因素。结果 58 项研究共纳入 626 486 590 人。一般人群的终生自杀率为每 100 万儿童中有 0.79 人自杀。在社区样本中，青春期前的终生自杀念头、自杀企图和非自杀性自伤的发生率分别为 15.1%、2.6% 和 6.2%。这些数据表明，大约 17.0% 的有自杀意念的青春期前儿童转变为企图自杀。在几项分析中，男性个体似乎在青春期前比青春期更容易患 SITB。除自杀意念外，SITB 的相关数据不大，但在特定障碍、注意力缺陷/多动障碍（自杀意念：d = 0.54 [95% CI，0.34-0.75]）和抑郁症（自杀意念：d = 0.90 [95] % CI, 0.71-1.09]；自杀未遂：d = 0.47 [95% CI, 0.26-0.68]) 成为最强的相关因素。在人际因素中，虐待儿童（自杀意念：d = 2.62 [95% CI，1.56-3.67]）和父母支持（自杀意念：d = -0.34 [95% CI，-0.46 至 -0.22]）产生的影响最大尺寸。结论和相关性 在这项系统回顾和荟萃分析中，虽然青春期前自杀死亡很少见，但其他 SITB 类型的发生频率很高。相对于青春期，男性个体在青春期前患 SITB 的风险更大。在这个年龄组中，注意力缺陷/多动障碍、儿童虐待和父母支持与自杀意念以及自杀念头和行为的抑郁特别相关。需要进一步研究，尤其是自杀意念以外的 SITB。67]）和父母支持（自杀意念：d = -0.34 [95% CI，-0.46 至 -0.22]）产生的影响最大。结论和相关性 在这项系统回顾和荟萃分析中，虽然青春期前自杀死亡很少见，但其他 SITB 类型的发生频率很高。相对于青春期，男性个体在青春期前患 SITB 的风险更大。在这个年龄组中，注意力缺陷/多动障碍、儿童虐待和父母支持与自杀意念以及自杀念头和行为的抑郁特别相关。需要进一步研究，尤其是自杀意念以外的 SITB。67]）和父母支持（自杀意念：d = -0.34 [95% CI，-0.46 至 -0.22]）产生的影响最大。结论和相关性 在这项系统回顾和荟萃分析中，虽然青春期前自杀死亡很少见，但其他 SITB 类型的发生频率很高。相对于青春期，男性个体在青春期前患 SITB 的风险更大。在这个年龄组中，注意力缺陷/多动障碍、儿童虐待和父母支持与自杀意念以及自杀念头和行为的抑郁特别相关。需要进一步研究，尤其是自杀意念以外的 SITB。尽管青春期前的自杀死亡很少见，但其他类型的 SITB 发生的频率很高。相对于青春期，男性个体在青春期前患 SITB 的风险更大。在这个年龄组中，注意力缺陷/多动障碍、儿童虐待和父母支持与自杀意念以及自杀念头和行为的抑郁特别相关。需要进一步研究，尤其是自杀意念以外的 SITB。尽管青春期前的自杀死亡很少见，但其他类型的 SITB 发生的频率很高。相对于青春期，男性个体在青春期前患 SITB 的风险更大。在这个年龄组中，注意力缺陷/多动障碍、儿童虐待和父母支持与自杀意念以及自杀念头和行为的抑郁特别相关。需要进一步研究，尤其是自杀意念以外的 SITB。