BYLINE: Brittany Phillips

Newswise — The idea of a child dying by suicide is unimaginable. Yet, according to recent data, a significant number of children will seriously consider or attempt suicide, even at ages as young as 5. For Adam Bryant Miller, PhD, a UNC School of Medicine researcher and father of two, this statistic is deeply alarming. He believes it’s critical to identify warning signs early, and he’s made it the focus of his current research.

“In clinical psychology, we’ve learned that waiting until mental health problems – like depression or anxiety – show up in the teenage years can make them harder to treat,” said Miller, associate professor in the Department of Psychiatry at the UNC School of Medicine. “But when we look earlier in a child’s development, before symptoms fully emerge, we will likely have a better chance of helping to prevent suicide.”

Miller and his team are now trying to understand how early suicidal thoughts and behaviors emerge in kids. Their findings, published in the Journal of American Academy of Child & Adolescent Psychiatry, show that 34% of children reported passive suicidal ideation (thoughts of dying), and 33% reported active suicidal ideation (specific plan to take one’s life).

“I think this points to the need for caregivers and clinicians to be alert to the possibility that children may experience suicidal thoughts,” said Miller, first author, associate director of the Child and Adolescent Mood and Anxiety Disorders Program (CHAAMP). “The good news is that many studies show early intervention for mental health problems is more effective than waiting until later. We’re hopeful that these findings, along with our ongoing research, will help us develop even more effective ways to assess suicidal thoughts and behaviors in children and preteens.”

The study involved 98 children ages 5 to 10 years old, along with their caregivers. Researchers assessed the feasibility, acceptability, and safety of measuring suicidal thoughts and behaviors (STBs). Children were recruited based on potential exposure to adversity, such as violence exposure and child maltreatment, and completed assessments on suicidal thoughts and behaviors during an in-home visit. The research team wanted to see if children could understand and answer questions about these serious topics, how caregivers felt about the process, and whether such questions might have any harmful effects.

Pilot Study: Suicide Risk in Children Under 10

Key Findings

Passive Suicidal Ideation: Reported by 31% of caregivers and 34% of children.

Active Suicidal Ideation: Reported by 14% of caregivers and 33% of children.

Suicide Planning and Attempts: 5% of children reported having made a suicide plan, with one child reporting a suicide attempt.

Safety: One-week follow-up indicated no concerning harmful effects from participating in the study.

Through age-appropriate questionnaires and guided interviews researchers asked children and caregivers about the child’s thoughts and behaviors related to self-harm. The questionnaire included simple statements like “Have you thought about death?” or “Have you thought about killing yourself?” Although this tool is usually used with older children, Miller and his team wanted to see if younger children could also understand and complete it. Researchers also asked children and caregivers separately about the child’s lifetime experiences with suicidal thoughts, plans, attempts, and other self-harming behaviors.

Miller notes that this line of questioning did not lead to harmful effects. While a few children showed brief curiosity or mild behavior changes after the assessment, there was no evidence of lasting distress or increased risk. In fact, some caregivers noted slight improvements in their child’s mood. Overall, the findings suggest that questions about death and suicide are generally acceptable to most caregivers, though some may experience discomfort when addressing these topics.

“We’re still in the early stages of this work, but I would encourage parents who may have concerns to ask their kids if they’ve ever had scary thoughts like this,” said Miller. “It’s important because it shows the caregiver is open to taking those thoughts seriously. If we ignore or pretend they don’t exist, kids are left to deal with them alone. We need to approach these conversations nonjudgmentally and reassure children that the adults in their lives can help.”

Findings suggest that early assessment of thoughts related to self-injury and behaviors can be done safely and may help identify children who need support. It also highlights the importance of more research to understand these behaviors early in development, particularly in children exposed to adversity. For Dr. Miller and his team, future research will continue to explore how these early experiences relate to long-term mental health, and how best to support families through sensitive conversations.

“We are currently conducting two National Institutes of Mental Health (NIMH) funded, larger studies on suicidal thoughts and behaviors in children,” said Miller. “One involves kids between the ages of 5-7, and the other is for kids between the ages 8-12. We hope that these two studies will help us get even better information to help parents, caregivers, and clinicians take care of kids who struggle with these thoughts and behaviors.”

If a parent has concerns about their child’s mood or behavior, Miller recommends speaking with a medical or mental health professional. A pediatrician is a good place to start and can help connect families with appropriate care.

If you or someone you know is struggling with thoughts of suicide or self-harm, it’s important to seek help immediately. Call or text 988 to reach the Suicide & Crisis Lifeline. Trained counselors are available 24/7 to listen, support, and connect you with resources.

Media Contact: Brittany Phillips, Communications Specialist, UNC Health | UNC School of Medicine