OBJECTIVE This study characterized 3- to 6-year-old children's understanding of death as a function of depression status, suicidal ideation (SI), and media consumption. METHOD Participants were 79 children with depression (3.0-6.11 years old) who completed a comprehensive psychiatric assessment and experimenter-led death interview and a comparison group of 60 healthy children (4.0-7.12 years old). The interview assessed children's understanding of 5 concepts of death: universality, applicability, irreversibility, cessation, and causality. Children's mastery of each concept and overall understanding of death was examined as a function of depression and SI status: depressed with SI (n = 22), depressed without SI (n = 57), and healthy (n = 60). Children's observed emotional reactions to hearing about natural death, accidental death, and suicide were assessed by death-themed stories. Parent reports of children's television and videogames/internet consumption assessed links between media exposure and understanding of death. RESULTS Children with depression and SI scored higher on overall understanding of death than those with depression without SI and healthy children. They also exhibited more sad and anxious affect listening to death-themed stories and were more likely to describe death as caused by violence. Across this sample, older children also were more likely to depict death as violent. More television use was associated with less understanding of death, including the concept of irreversibility. CONCLUSION Children with depression and SI have a more advanced understanding of death than their peers, dispelling the myth that these ideations arise in the context of a poor understanding of death. The increase in violence attributions across early childhood could indicate increasing normalization of violence in children's perceptions of death. CLINICAL TRIAL REGISTRATION INFORMATION A Randomized Controlled Trial of PCIT-ED for Preschool Depression; http://clinicaltrials.gov; NCT00595283.

中文翻译：

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死亡观念的改变与抑郁状况、自杀意念和童年早期媒体接触有关。


目的 这项研究将 3 至 6 岁儿童对死亡的理解作为抑郁状态、自杀意念 (SI) 和媒体消费的函数。方法 参与者包括 79 名完成全面精神病学评估和实验者主导的死亡访谈的抑郁症儿童（3.0-6.11 岁），对照组包括 60 名健康儿童（4.0-7.12 岁）。访谈评估了孩子们对死亡的5个概念的理解：普遍性、适用性、不可逆转性、终止性和因果性。儿童对每个概念的掌握和对死亡的整体理解作为抑郁和 SI 状态的函数进行了检查：有 SI 的抑郁 (n = 22)、无 SI 的抑郁 (n = 57) 和健康 (n = 60)。通过死亡主题的故事来评估儿童听到自然死亡、意外死亡和自杀时观察到的情绪反应。家长关于儿童电视和视频游戏/互联网消费的报告评估了媒体曝光与对死亡的理解之间的联系。结果 患有抑郁症和 SI 的儿童在对死亡的总体理解上得分高于那些没有 SI 的抑郁症儿童和健康儿童。他们在听到以死亡为主题的故事时也表现出更多的悲伤和焦虑情绪，并且更有可能将死亡描述为由暴力造成的。在这个样本中，年龄较大的孩子也更有可能将死亡描述为暴力。使用电视的次数越多，人们对死亡的了解就越少，包括不可逆转的概念。结论 患有抑郁症和 SI 的儿童比同龄人对死亡有更深入的理解，消除了这些想法是在对死亡了解不足的情况下产生的神话。 幼儿期暴力归因的增加可能表明儿童对死亡的看法中的暴力日益正常化。临床试验注册信息 PCIT-ED 治疗学前抑郁症的随机对照试验； http://clinicaltrials.gov； NCT00595283。