Objective

Suicidal thoughts and behaviors (STBs) in children are an escalating public health concern. This study focused on one understudied candidate risk factor, preschool-onset major depressive disorder (PO-MDD), as a predictor of persistent and emerging STBs from early childhood into preadolescence.

Method

Participants were 137 8-to 12-year-old children who met criteria for PO-MDD when they were aged 3-6 years, and a non-depressed sample of 53 age, income, and gender-matched peers. STBs were reported by caregivers (preschool, preadolescence) and children (preadolescence) using age-appropriate diagnostic interviews.

Results

By preadolescence, children who had PO-MDD were 7.38 times more likely than their peers to have endorsed STBs after early childhood (p<.001; 67.9% versus 22.6%), including 6.71 times more likely to have engaged in suicide behaviors/attempts (p=.012; 21.9% versus 3.8%); they were also 8.98 times more likely to have endorsed STBs over the prior month (p=.005; 26.3% versus 3.8%). Similar findings emerged when limiting the PO-MDD group to children without preschool STBs, and when controlling for externalizing comorbidities, implicating PO-MDD as a unique diagnostic predictive risk factor. However, children who had PO-MDD with STBs were 3.46 times more likely than children who had PO-MDD without STBs to endorse later STBs (p=.018; 83.1% versus 54.2%), indicating substantial continuity of preschool STBs alongside strikingly high rates of emerging STBs into preadolescence.

Conclusion

PO-MDD is a strong risk-factor for the emergence and persistence of STBs into preadolescence. Children with PO-MDD would likely benefit from increased suicide screening, proactive safety planning, and early interventions.

中文翻译：

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学龄前发病的重度抑郁症是青春期前自杀意念和行为的有力预测因素

客观的

儿童的自杀想法和行为 (STB) 是一个日益严重的公共卫生问题。这项研究的重点是一个尚未得到充分研究的候选危险因素，即学前发病的重度抑郁症 (PO-MDD)，它是从幼儿期到青春期前持续存在和新出现的 STB 的预测因素。

方法

参与者是 137 名 8 至 12 岁的儿童，他们在 3 至 6 岁时符合 PO-MDD 标准，以及 53 名年龄、收入和性别匹配的同龄人中的非抑郁样本。STB 由看护者（学龄前、青春期前）和儿童（青春期前）通过适合年龄的诊断访谈报告。

结果

到青春期前，患有 PO-MDD 的儿童在幼儿期后认可 STB 的可能性是同龄人的 7.38 倍（p <.001；67.9% 对比 22.6%），其中发生自杀行为/企图自杀的可能性是同龄人的 6.71 倍( p = 0.012；21.9% 对比 3.8%)；他们认可机顶盒的可能性也是上个月的 8.98 倍（p = 0.005；26.3% 与 3.8%）。当将 PO-MDD 组限制为没有学前 STB 的儿童时，以及在控制外化合并症时，出现了类似的发现，表明 PO-MDD 是一种独特的诊断预测风险因素。然而，患有 PO-MDD 且带有 STB 的儿童比患有 PO-MDD 且无 STB 的儿童认可后来的 STB 的可能性高 3.46 倍（p = 0.018；83.1% 对比 54.2%），这表明学龄前 STB 具有显着的连续性，同时也非常高。进入青春期前的新出现 STB 的比率。

结论

PO-MDD 是青春期前 STB 出现和持续存在的一个重要危险因素。患有 PO-MDD 的儿童可能会受益于加强自杀筛查、主动安全规划和早期干预。