Skip to main content

Advertisement

SpringerLink
Log in

Suicidality risk in children and adolescents with externalizing disorders: symptoms profiles at high risk and the moderating role of dysregulated family relationships

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Children and adolescents with externalizing disorders are at risk for suicidal ideation or behavior. Factors that put them at risk could be symptoms related or facilitated by their environment. We evaluated the links of symptoms profiles with suicidality, and the effects of family relationship characteristics on these links. Latent profile analysis was used to subgroup participants referred for ADHD assessment (n = 1249, aged 6–17) based on their externalizing and internalizing symptoms. Self- and parent-reported child suicidal ideation (S–SI, P-SI), and parent-reported self-harm behavior (P-SHB) were compared across profiles. The moderating effects of parent-reported marital conflict and parenting practices were examined. A four-profile model showed optimal fit. Participants of the Low Symptoms profile followed by the Inattentive-Hyperactive/Impulsive profile showed lower P-SI compared to those of the Irritable-Defiant and the Conduct Problems profiles. Low Symptoms participants also reported lower S–SI compared to those of the Inattentive-Hyperactive/Impulsive and the Irritable-Defiant profiles. Participants of the Irritable-Defiant and the Conduct Problems profiles had higher P-SHB compared to the Low Symptoms and the Inattentive-Hyperactive/Impulsive participants. Dysregulated marital conflict practices were associated with greater increase in P-SI in all profiles compared to the Low Symptoms profile. Aggressive marital conflict practices were associated with increased P-SHB in the Conduct Problems profile compared to the Inattentive-Hyperactive/Impulsive profile. Children and adolescents with irritability and defiance symptoms with or without conduct problems show higher risk for suicidal ideation and behavior compared to those with ADHD symptoms alone. Dysregulated and aggressive marital conflict practices might pose additional suicidality risk in children and adolescents with disruptive behavior.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Janiri D, Doucet GE, Pompili M et al (2020) Risk and protective factors for childhood suicidality: a US population-based study. Lancet Psychiatry 7:317–326. https://doi.org/10.1016/S2215-0366(20)30049-3

    Article  PubMed  PubMed Central  Google Scholar 

  2. Copeland WE, Goldston DB, Costello EJ (2017) Adult associations of childhood suicidal thoughts and behaviors: a prospective, longitudinal analysis. J Am Acad Child Adolesc Psychiatry 56:958-965.e4. https://doi.org/10.1016/j.jaac.2017.08.015

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bridge JA, Goldstein TR, Brent DA (2006) Adolescent suicide and suicidal behavior. J Child Psychol Psychiatry 47:372–394. https://doi.org/10.1111/J.1469-7610.2006.01615.X

    Article  PubMed  Google Scholar 

  4. Mayes SD, Calhoun SL, Baweja R et al (2015) Suicide ideation and attempts are associated with co-occurring oppositional defiant disorder and sadness in children and adolescents with ADHD. J Psychopathol Behav Assess 37:274–282. https://doi.org/10.1007/s10862-014-9451-0

    Article  Google Scholar 

  5. Nock MK, Green JG, Hwang I et al (2013) Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the national comorbidity survey replication adolescent supplement. JAMA Psychiat 70:300–310. https://doi.org/10.1001/2013.jamapsychiatry.55

    Article  Google Scholar 

  6. Strandheim A, Bjerkeset O, Gunnell D et al (2014) Risk factors for suicidal thoughts in adolescence-a prospective cohort study: the Young-HUNT study. BMJ Open 4:e005867. https://doi.org/10.1136/bmjopen-2014-005867

    Article  PubMed  PubMed Central  Google Scholar 

  7. Balazs J, Kereszteny A (2017) Attention-deficit/hyperactivity disorder and suicide: a systematic review. World J Psychiatry 7:44. https://doi.org/10.5498/wjp.v7.i1.44

    Article  PubMed  PubMed Central  Google Scholar 

  8. Erskine HE, Norman RE, Ferrari AJ et al (2016) Long-term outcomes of attention-deficit/hyperactivity disorder and conduct disorder: a systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry 55:841–850. https://doi.org/10.1016/j.jaac.2016.06.016

    Article  PubMed  Google Scholar 

  9. Shoval G, Visoki E, Moore TM et al (2021) Evaluation of attention-deficit/hyperactivity disorder medications, externalizing symptoms, and suicidality in children. JAMA Netw Open 4:e2111342–e2111342. https://doi.org/10.1001/jamanetworkopen.2021.11342

    Article  PubMed  PubMed Central  Google Scholar 

  10. Oquendo MA, Mann JJ (2000) The biology of impulsivity and suicidality. Psychiatr Clin North Am 23:11–25. https://doi.org/10.1016/S0193-953X(05)70140-4

    Article  CAS  PubMed  Google Scholar 

  11. Balazs J, Miklósi M, Keresztény Á et al (2014) Attention-deficit hyperactivity disorder and suicidality in a treatment naïve sample of children and adolescents. J Affect Disord 152–154:282–287. https://doi.org/10.1016/j.jad.2013.09.026

    Article  PubMed  Google Scholar 

  12. Chen YY, Chen YL, Gau SSF (2019) Attention-deficit hyperactivity disorder and suicidality: the mediating effects of psychiatric comorbidities and family function. J Affect Disord 242:96–104. https://doi.org/10.1016/j.jad.2018.08.023

    Article  PubMed  Google Scholar 

  13. Levy T, Kronenberg S, Crosbie J, Schachar RJRJ (2020) Attention-deficit/hyperactivity disorder (ADHD) symptoms and suicidality in children: the mediating role of depression, irritability and anxiety symptoms. J Affect Disord 265:200–206. https://doi.org/10.1016/j.jad.2020.01.022

    Article  PubMed  Google Scholar 

  14. Aebi M, Barra S, Bessler C et al (2016) Oppositional defiant disorder dimensions and subtypes among detained male adolescent offenders. J Child Psychol Psychiatry 57:729–736. https://doi.org/10.1111/jcpp.12473

    Article  PubMed  Google Scholar 

  15. Althoff RR, Kuny-Slock AV, Verhulst FC et al (2014) Classes of oppositional-defiant behavior: Concurrent and predictive validity. J Child Psychol Psychiatry 55:1162–1171. https://doi.org/10.1111/jcpp.12233

    Article  PubMed  PubMed Central  Google Scholar 

  16. Krieger FV, Polanczyk GV, Goodman R et al (2013) Dimensions of oppositionality in a brazilian community sample: Testingthe DSM-5 proposal and etiological links. J Am Acad Child Adolesc Psychiatry 52:389-400.e1. https://doi.org/10.1016/j.jaac.2013.01.004

    Article  PubMed  PubMed Central  Google Scholar 

  17. Benarous X, Consoli A, Cohen D et al (2019) Suicidal behaviors and irritability in children and adolescents: a systematic review of the nature and mechanisms of the association. Eur Child Adolesc Psychiatry 28:667–683. https://doi.org/10.1007/s00787-018-1234-9

    Article  PubMed  Google Scholar 

  18. Orri M, Galera C, Turecki G et al (2019) Pathways of association between childhood irritability and adolescent suicidality. J Am Acad Child Adolesc Psychiatry 58:99-107.e3. https://doi.org/10.1016/j.jaac.2018.06.034

    Article  PubMed  Google Scholar 

  19. Wei HT, Lan WH, Hsu JW et al (2016) Risk of suicide attempt among adolescents with conduct disorder: a longitudinal follow-up study. J Pediatr 177:292–296. https://doi.org/10.1016/j.jpeds.2016.06.057

    Article  PubMed  Google Scholar 

  20. Wertz J, Agnew-Blais J, Caspi A et al (2018) From childhood conduct problems to poor functioning at age 18 years: examining explanations in a longitudinal cohort study. J Am Acad Child Adolesc Psychiatry 57:54-60.e4. https://doi.org/10.1016/j.jaac.2017.09.437

    Article  PubMed  PubMed Central  Google Scholar 

  21. Gvion Y, Apter A (2011) Aggression, impulsivity, and suicide behavior: a review of the literature. Arch Suicide Res 15:93–112. https://doi.org/10.1080/13811118.2011.565265

    Article  PubMed  Google Scholar 

  22. Sourander A, Klomek AB, Niemelä S et al (2009) Childhood predictors of completed and severe suicide attempts findings from the finnish 1981 birth cohort study. Arch Gen Psychiatry 66:398–406. https://doi.org/10.1001/archgenpsychiatry.2009.21

    Article  PubMed  Google Scholar 

  23. Vander Stoep A, Adrian M, McCauley E et al (2011) Risk for suicidal ideation and suicide attempts associated with co-occurring depression and conduct problems in early adolescence. Suicide Life Threat Behav 41:316–329

    Article  PubMed  Google Scholar 

  24. Wesselhoeft R, Stringaris A, Sibbersen C et al (2019) Dimensions and subtypes of oppositionality and their relation to comorbidity and psychosocial characteristics. Eur Child Adolesc Psychiatry 28:351–365. https://doi.org/10.1007/s00787-018-1199-8

    Article  PubMed  Google Scholar 

  25. Besemer S, Loeber R, Hinshaw SP, Pardini DA (2016) Bidirectional associations between externalizing behavior problems and maladaptive parenting within parent-son dyads across childhood. J Abnorm Child Psychol 44:1387–1398. https://doi.org/10.1007/s10802-015-0124-6

    Article  PubMed  PubMed Central  Google Scholar 

  26. Derella OJ, Burke JD, Stepp SD, Hipwell AE (2020) Reciprocity in undesirable parent-child behavior? Verbal aggression, corporal punishment, and girls’ oppositional defiant symptoms. J Clin Child Adolesc Psychol 49:420–433. https://doi.org/10.1080/15374416.2019.1603109

    Article  PubMed  Google Scholar 

  27. Kazdin AE, Siegel TC, Bass D (1992) Cognitive problem-solving skills training and parent management training in the treatment of antisocial behavior in children. J Consult Clin Psychol 60:733–747. https://doi.org/10.1037/0022-006x.60.5.733

    Article  CAS  PubMed  Google Scholar 

  28. Taylor CA, Manganello JA, Lee SJ, Rice JC (2010) Mothers’ spanking of 3-year-old children and subsequent risk of children’s aggressive behavior. Pediatrics 125(5):e1057–e1065. https://doi.org/10.1542/peds.2009-2678

    Article  PubMed  Google Scholar 

  29. Logan J, Hall J, Karch D (2011) Suicide categories by patterns of known risk factors: a latent class analysis. Arch Gen Psychiatry 68:935–941. https://doi.org/10.1001/archgenpsychiatry.2011.85

    Article  PubMed  Google Scholar 

  30. Ickowicz A, Schachar RJ, Sugarman R et al (2006) The parent interview for child symptoms: a situation-specific clinical research interview for attention-deficit hyperactivity and related disorders. Can J Psychiat 51:325–328. https://doi.org/10.1177/070674370605100508

    Article  Google Scholar 

  31. Lenhard A, Daseking M (2022) Accounting for intraindividual profiles in the wechsler intelligence scales improves the prediction of school performance. Children 9(11):1635. https://doi.org/10.3390/CHILDREN9111635

    Article  PubMed  PubMed Central  Google Scholar 

  32. Boyle MH, Offord DR, Racine Y et al (1996) Identifying thresholds for classifying childhood psychiatric disorder: issues and prospects. J Am Acad Child Adolesc Psychiatry 35:1440–1448. https://doi.org/10.1097/00004583-199611000-00012

    Article  CAS  PubMed  Google Scholar 

  33. Boyle MH, Offord DR, Racine Y et al (1993) Evaluation of the revised ontario child health study scales. J Child Psychol Psychiatry 34:189–213. https://doi.org/10.1111/j.1469-7610.1993.tb00979.x

    Article  CAS  PubMed  Google Scholar 

  34. Eley TC, Lichtenstein P, Moffitt TE (2003) A longitudinal behavioral genetic analysis of the etiology of aggressive and nonaggressive antisocial behavior. Dev Psychopathol 15:383–402. https://doi.org/10.1017/S095457940300021X

    Article  PubMed  Google Scholar 

  35. Rowe R, Maughan B, Eley TC (2006) Links between antisocial behavior and depressed mood: the role of life events and attributional style. J Abnorm Child Psychol 34:283–292. https://doi.org/10.1007/s10802-006-9032-0

    Article  Google Scholar 

  36. Kovacs M (2015) Children’s depression inventory (CDI and CDI 2). the encyclopedia of clinical psychology. John Wiley & Sons Inc, pp 1–5

    Google Scholar 

  37. Haltigan JD, Aitken M, Skilling T et al (2018) “P” and “DP:” examining symptom-level bifactor models of psychopathology and dysregulation in clinically referred children and adolescents. J Am Acad Child Adolesc Psychiatry 57:384–396. https://doi.org/10.1016/j.jaac.2018.03.010

    Article  PubMed  Google Scholar 

  38. Joffe BI, van Lieshout RJ, Duncan L, Boyle MH (2014) Suicidal ideation and behavior in adolescents aged 12–16 years: A 17-year follow-up. Suicide Life Threat Behav 44:497–509. https://doi.org/10.1111/sltb.12077

    Article  PubMed  Google Scholar 

  39. Franklin JC, Ribeiro JD, Fox KR et al (2017) Risk factors for suicidal thoughts and behaviors: a meta-analysis of 50 years of research. Psychol Bull 143:187–232. https://doi.org/10.1037/BUL0000084

    Article  PubMed  Google Scholar 

  40. Pinquart M (2017) Associations of parenting dimensions and styles with externalizing problems of children and adolescents: an updated meta-analysis. Dev Psychol 53:873–932. https://doi.org/10.1037/dev0000295

    Article  PubMed  Google Scholar 

  41. Renaud J, Brent DA, Birmaher B et al (1999) Suicide in adolescents with disruptive disorders. J Am Acad Child Adolesc Psychiatry 38:846–851. https://doi.org/10.1097/00004583-199907000-00014

    Article  CAS  PubMed  Google Scholar 

  42. Zalsman G, Shoval G, Mansbach-Kleinfeld I et al (2016) Maternal versus adolescent reports of suicidal behaviors: a nationwide survey in Israel. Eur Child Adolesc Psychiatry 25:1349–1359. https://doi.org/10.1007/s00787-016-0862-1

    Article  PubMed  Google Scholar 

  43. Silver J, Mackin DM, Bufferd SJ et al (2023) Tonic and phasic irritability in 6-year-old children: differential correlates and outcomes. J Child Psychol Psychiatry 64:234–243. https://doi.org/10.1111/JCPP.13688

    Article  PubMed  Google Scholar 

  44. Koriakin TA, Mccurdy MD, Papazoglou A et al (2013) Classification of intellectual disability using the wechsler intelligence scale for children: full scale IQ or general abilities index? Dev Med Child Neurol 5(9):840–845. https://doi.org/10.1111/dmcn.12201

    Article  Google Scholar 

  45. Fuller-Thomson E, Carroll SZ, Yang W (2018) Suicide attempts among individuals with specific learning disorders: an underrecognized issue. J Learn Disabil 51:283–292. https://doi.org/10.1177/0022219417714776

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Behavior Regulation Service, Geha Mental Health Center, 1 Helsinki St., 49100, Petah-Tikva, Israel

    Tomer Levy

  2. Sacker Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel

    Tomer Levy

  3. Department of Psychology, Simon Fraser University, Burnaby, BC, Canada

    Hali Kil

  4. McCain Centre for Child Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada

    Hali Kil & Brendan F. Andrade

  5. Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada

    Russell James Schachar

  6. Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Russell James Schachar & Brendan F. Andrade

  7. Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA

    Liat Itzhaky

Authors
  1. Tomer Levy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hali Kil
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Russell James Schachar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Liat Itzhaky
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Brendan F. Andrade
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

T.L., B.A and H.K formulated the hypotheses. H.K. conducted the data analysis and prepared the figures. B.A. supervised the data analysis T.L. wrote the main manuscript text. B.A., R.J.S. and L.I. supervised the manuscript writing. All authors reviewed the manuscript.

Corresponding author

Correspondence to Tomer Levy.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 78 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Levy, T., Kil, H., Schachar, R.J. et al. Suicidality risk in children and adolescents with externalizing disorders: symptoms profiles at high risk and the moderating role of dysregulated family relationships. Eur Child Adolesc Psychiatry 33, 811–820 (2024). https://doi.org/10.1007/s00787-023-02190-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-023-02190-z

Keywords

Search

Navigation