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The Association Between Teen Suicidal Ideation and Childhood Depression and Irritability

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT
Meet The Team >

If My Child Is Depressed and Irritable, Does That Increase Their Risk of Suicide as a Teen?

[seriesbox]A Parent’s Guide to Self-Harm and Suicide Risk in Teens
Insomnia and Sleep Disturbances in Teens Linked to Higher Risk of Suicide
Bullying and Cyberbullying Associated with Higher Risk of Suicide in Teens
Are Brooding, Impulsive Teens at Higher Risk for Suicidality?
Risk of Escalation from Self-Harm to Suicide Attempts in Adolescents
Teen Suicide Contagion: Is Suicide Contagious?[/seriesbox]During the early years of child-raising, parents spend half their time trying to figure out what’s going on with their youngsters. And by that, we mean trying to interpret their moods or current emotional state based on their behavior.

We learn early on that in most cases, when picking them up and showering them with love and attention doesn’t work, irritability or sadness in infants and toddlers means they’re one of three things: tired, hungry, or in need of a diaper change.

When kids grow out of their diapers, it may take a little while to realize they really haven’t changed much. If attention, listening, and affection don’t work, the child is probably hungry or tired. A snack does the trick, a nap does wonders, and then the child is back with their special brand of buoyancy and zest for life.

However, some school age kids, which we’ll define loosely as kids age 6-12, experience low moods and demonstrate irritability or anger despite our best efforts to provide the basics of love, attention, food, and rest.

What parents may not realize is that some of these young kids have mental health issues. They may have internalizing disorders, also called mood disorders, such as anxiety and/or depression. Or they may have externalizing disorders, such as attention-deficit hyperactivity disorder (ADHD), conduct disorder (CD), or oppositional/defiant disorder (ODD).

Another thing parents may not realize is something that may surprise them: the presence of these mental health issues in the early years may increase the risk of suicidal ideation or suicide attempts during adolescence.

New Research Offers New Insight

Two studies published recently – Association of Childhood Irritability and Depressive/Anxious Mood Profiles With Adolescent Suicidal Ideation and Attempts and Mental Health Problems and Risk of Suicidal Ideation and Attempts in Adolescents – examined data on school age children (age 6-12) who display low mood associated with internalizing disorders, and anger/irritability associated with externalizing disorders to determine whether the presence of those disorders during childhood or pre-adolescence increased risk of suicidal ideation or suicide attempts during adolescence.

This article will discuss the results of these studies and offer advice on how parents can support teens with a history of mental health issues to manage the symptoms that may increase their risk of suicidal ideation or suicide attempts.

First, let’s talk about the studies – and some background as to why these researchers choose to focus their time and energy on these topics.

The background is easy to understand. In 2014, suicide became the second leading cause of death for teens (12-18) and young adults (19-24). This fact is disturbing, to say the least. Our young people are killing themselves at rates higher than ever before.

To learn more about this – and to see the latest statistic on teen suicide, please read this article we published recently:

September is National Suicide Prevention Month: #BeThe1To

Now, about these studies. They caught our attention first because they include a large number of youth and teens, which allows scientists to extrapolate broad, population-level insights from their results. Second, they examined data collected from youth and teens over several years, rather than at one point in time. One examined data collected between ages 6-12 and 13-17, while the other examined data collected at ages 13, 15, 17, and 20. Comparative studies like these are difficult to design and follow through on, for various reasons. Dropout rates, changes in the circumstances of the youth and teens involved, and the challenges inherent in reaching reliable, verifiable statistical conclusions on large amounts of raw data all add complexity to the research.

But when scientists have the time, resources, and skills, we benefit. And by benefit, we mean that the data they share can help us help our teens. Which, in this case, is incredibly important, because suicidal ideation and suicide attempts are both things everyone – especially parents – want to prevent.

Now let’s get to the data.

Early Depression and Irritability and Adolescent Suicidal Ideation

The lead researchers of the first study identified this primary goal:

“To examine the joint association of irritability and depressive/anxious mood assessed repeatedly across childhood with suicidality* during adolescence.”

*[Suicidality includes suicidal ideation (thinking or talking about suicide), planning suicide, and/or attempting suicide]

In a group of 1,430 young people, with data collected at the time points described above, this is how they divided up the data:

  • Group 1. No irritability and low depressive/anxious mood (at age 6-12)
  • Group 2. Low irritability and low depressive/anxious mood (at age 6-12)
  • Group 3. Moderate irritability and low depressive/anxious mood (at age 6-12)
  • Group 4. Moderate declining irritability and high depressive/anxious mood (at age 6-12)
    • This group is referred to below as “high depressive mood/anxious mood only”
  • Group 5. High irritability and depressive/anxious mood (at age 6-12)

To analyze the data, researchers combined groups (1) and (2) to form a reference group, which they called the “Low irritability/low anxious mood group.” They then compared the results from that group with the other three groups.

Here’s what they found when they collected data from the groups above, when the subjects were age 13-17:

Group One (combined group, low irritability, and low depressive/anxious mood):

  • Suicidality: 11%
  • Suicidal Ideation: 13%
  • Suicide Attempts: 5.3%

Group Two (moderate irritability and low depressive/anxious mood):

  • Suicidality: 13%
  • Suicidal Ideation: 6.8%
  • Suicide Attempts: 6.2%

Group Three (high depressive mood/anxious mood only):

  • Suicidality: 10.6%
  • Suicidal Ideation: 6.4%
  • Suicide Attempts: 4.3%

Group Four (high irritability and high depressive/anxious mood):

  • Suicidality: 16.4%
  • Suicidal Ideation: 8.6%
  • Suicide Attempts: 7.9%

Let’s take a moment to unpack that data. Here are the three things we want you to take away:

  1. The group most at-risk for all three metrics – suicidality, suicidal ideation, and suicide attempts) – is the group of 13–17-year-olds who, between ages 6-12, showed the highest levels of irritability, depression, and anxiety.
  2. The group that showed high depressive mood and high anxious mood only at ages 6-12 showed lower rates of suicidality, suicidal ideation, and suicide attempts between ages 13-17, as compared to all other groups.
  3. Risk of suicidality, suicidal ideation, and suicidality were higher across all metrics for the group that showed any clinically significant irritability between ages 6-12.

Now let’s move on to the second study.

Internalizing Disorders, Externalizing Disorders, and Suicidality

The second study included data collected by the same research group, but from a different group of adolescents. They collected data at ages 13, 15, 17, and 20. In this study, researchers did not collect data between ages 6-12.

In this group – including over 1600 adolescents – the data largely supported the findings of the first study. What they found was that teens with externalizing disorders, such as attention-deficit hyperactivity disorder and conduct disorder, had higher rates of suicidality, suicidal ideation, and suicide attempts than the group with internalizing disorders, such as depression and anxiety.

This supports the data from the first study in that characteristics of externalizing disorders include irritability or anger as primary symptoms, whereas the characteristics of internalizing disorders such as anxiety and depression include irritability and anger, but those symptoms are less common than low mood, withdrawal from friends and family, hopelessness, and loss of interest in favorite activities.

We’ll let the study authors sum up the research:

“Early manifestation of chronic irritability during childhood, especially when combined with depressive/anxious mood, may be associated with an elevated risk for adolescent suicidality.”

Now, as a parent, you may ask yourself this question:

How can I help my child (age 6-12) or my teen (age 13-17) manage their symptoms, and reduce risk of suicidality?

The answer: professional treatment and support.

Treatment for Mental Health Disorders Works for Children and Teens

If your child or teen has a combination of low mood, anxiety, and chronic irritability/anger, evidence shows that the following types of treatment are effective:

To learn more about treatment for teen in general, please read this article:

Mental Health Treatment for Adolescents: An Overview

To learn more about the specific types of treatment on this bulleted list above please navigate to our page:

Our Therapies

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness (NAMI) also provide and high-quality online resources, ready and waiting for you right now.

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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