It is the first study to exclusively focus on precipitating circumstances of suicide in children and early adolescents, defined as ages 5 to 14.
"Children who died by suicide were more likely to have relationship problems with family members or friends whereas early adolescents were more likely to have boyfriend or girlfriend relationship problems," said Arielle Sheftall, postdoctoral research fellow at the Nationwide Children's Hospital in the US.
"These differences tended to fall along developmental lines given elementary school-aged children are more likely to spend time with family and friends and less likely to engage in romantic relationships, which become more common during adolescence," said Sheftall.
"We also found that 29 per cent of children and early adolescents disclosed their intention for suicide to someone prior to their death," added Sheftall.
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The study highlights the importance of educating pediatricians, primary health care providers, school personnel and families on how to recognise the warning signs of suicide and what steps to take when suicidal intent is disclosed.
"These warning signs include a child making suicidal statements, being unhappy for an extended period, withdrawing from friends or school activities or being increasingly aggressive or irritable," said Sheftall.
Not only do pediatricians potentially see at-risk children on a regular basis, early detection allows the healthcare providers an opportunity to alert parents of potential risks and increases the likelihood of a child receiving mental health services in a timely fashion.
"Although suicide is extremely rare in elementary school-aged children, parents should be aware that children can and sometimes do think about suicide," said Jeff Bridge, from Nationwide Children's Hospital in the US.