Background

Suicide in children is a pressing public health concern. The increasing number of deaths by suicide and emergency visits for suicidal ideation and self-harm in children might not be fully representative; it is likely that many more children are in distress but do not seek out help. We conducted a systematic review and meta-analysis of existing studies to quantify the prevalence of suicidal ideation and self-harm behaviours among children in the community aged 12 years and younger.

Methods

In this systematic review and meta-analysis, we searched PsycINFO, MEDLINE, and Web of Science via OVID from database inception to Feb 28, 2022, for articles published in French or English that reported estimates of prevalence of suicidal ideation (including suicide planning) and self-harm behaviours (namely, self-harm, suicide attempts, and non-suicidal self-injury) in children aged 12 years and younger. Reference lists were also searched; case studies, qualitative studies, and health-care visit studies were excluded. The outcomes were suicidal ideation, suicide plan or attempts, and self-harm. We used a random-effects model to calculate the overall pooled prevalence of suicidal ideation and self-harm behaviours for all timeframes combined and for ever versus the past 12 months for suicidal ideation. We used the Joanna Briggs Institute Critical Appraisal tool to evaluate the risk of bias in each study. This study is registered with PROSPERO, CRD42020179041.

Findings

28 articles, encompassing 30 studies overall, met the inclusion criteria, aggregating findings from 98 044 children (of whom 46 980 [50·5%] were girls and 46 136 [49·5%] were boys; six articles did not report sex or gender) aged 6–12 years. The pooled prevalence estimate was 7·5% (95% CI 5·9–9·6) for suicidal ideation from 28 studies and 2·2% (2·0–2·5) for suicide planning from three studies. The pooled prevalence was 1·4% (0·4–4·7) for self-harm from four studies, 1·3% (1·0–1·9) for suicide attempt from six studies, and 21·9% (6·2–54·5) for non-suicidal self-injury from two studies. The prevalence of suicidal ideation was higher in studies that included child-reported outcomes (10·9% [95% CI 8·1–14·5] for child only and 10·4% [6·8–15·5] for child and parent combined) than for parent-only reported outcomes (4·7% [3·4–6·6]; p=0·0004). The prevalence of suicidal ideation and self-harm behaviours was similar in boys and girls (suicidal ideation, 7·9% [95% CI 5·2–12·0] for boys vs 6·4% [3·7–10·7] for girls; self-harm behaviours, 3·5% [1·6–7·2] for boys vs 3·0% [1·4–6·4%] for girls). Detailed ethnicity data were not available. High heterogeneity was identified across estimates (I²>90%), which was not well explained by the characteristics of the studies.

Interpretation

A high number of children in the general population can experience suicidal ideation and self-harm behaviours, thus underlining the need for more research on childhood suicide, including developmentally appropriate preventive strategies, such as youth-nominated support teams or dialectical behavioural therapy.

Funding

Canada Research Chair in Youth Mental Health and Suicide Prevention.

中文翻译：

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12 岁及以下儿童自杀意念和自残行为的患病率：系统评价和荟萃分析

背景

儿童自杀是一个紧迫的公共卫生问题。越来越多的儿童因自杀和因自杀意念和自残而紧急就诊而死亡的人数可能并不完全具有代表性；很可能有更多的儿童处于困境中但不寻求帮助。我们对现有研究进行了系统回顾和荟萃分析，以量化社区 12 岁及以下儿童的自杀意念和自残行为的流行率。

方法

在这项系统评价和荟萃分析中，我们通过 OVID 搜索了从数据库开始到 2022 年 2 月 28 日的 PsycINFO、MEDLINE 和 Web of Science，以查找以法语或英语发表的报告估计自杀意念（包括自杀计划）流行率的文章和 12 岁及以下儿童的自伤行为（即自伤、自杀未遂和非自杀性自伤）。还搜索了参考列表；案例研究、定性研究和医疗保健访问研究被排除在外。结果是自杀意念、自杀计划或企图，以及自残。我们使用随机效应模型来计算所有时间范围内的自杀意念和自残行为的总体汇总流行率，以及过去 12 个月的自杀意念。我们使用乔安娜布里格斯研究所批判性评估工具来评估每项研究的偏倚风险。本研究已在 PROSPERO 注册，CRD42020179041。

发现

总共包含 30 项研究的 28 篇文章符合纳入标准，汇总了 98 044 名儿童的研究结果（其中 46 980 [50·5%] 为女孩，46 136 [49·5%] 为男孩；6 篇文章未报告性别或性别）6-12 岁。28 项研究的自杀意念汇总流行率估计为 7·5% (95% CI 5·9-9·6)，三项研究的自杀计划为 2·2% (2·0-2·5)。四项研究的自伤率汇总为 1·4% (0·4-4·7)，六项研究的自杀未遂率为 1·3% (1·0-1·9)， 21·9% (6·2–54·5) 来自两项研究的非自杀性自伤。在包括儿童报告结果的研究中，自杀意念的发生率较高（仅儿童为 10·9% [95% CI 8·1-14·5]，儿童为 10·4% [6·8-15·5]孩子和父母的总和）比仅由父母报告的结果（4·7% [3·4-6·6]；p=0·0004）。而女孩则为6·4% [3·7–10·7]；自伤行为，男孩为 3·5% [1·6-7·2]，女孩为3·0% [1·4-6·4%]。没有详细的种族数据。在估计中发现了高异质性（I ² >90%），研究的特征不能很好地解释这一点。

解释

一般人群中的大量儿童可能会出现自杀意念和自残行为，因此强调需要对儿童自杀进行更多研究，包括适合发育的预防策略，例如青年提名的支持团队或辩证行为疗法。

资金

加拿大青年心理健康和自杀预防研究主席。