A mixed-methods, multi-informant study of childhood suicide ideation to improve risk assessment - Abstract Despite increases in suicides among children, we have no available developmentally and culturally informed measures of childhood suicide ideation (SI) to inform risk assessment. In addition, there is little information about how to integrate caregiver reports into assessment of child SI subtypes (based on frequency) and pathways of suicide risk (based on thematic analysis) among adolescents. A recent study on the severity of SI, revealed that the most common form of SI among children who had attempted suicide was nonspecific active SI (without plan, method, or intent). In the absence of a plan, a method, or intent as markers of risk, assessments may need an approach that focuses on expressions of distress preceding the SI or attempt, which may be more easily reported by children and detected by caregivers. Body mapping is a “ground-zero” assessment of expressions of distress that is low in cultural bias and can complement data from verbal reports. The overall goal of this R01 is to characterize childhood SI and expressions of distress – as assessed by child and caregiver report – to improve prediction of SI severity and suicide attempts among ethnoracially diverse children. In consultation with a Community Advisory Board of youth, caregivers, and health workers, we will conduct a mixed methods study of a diverse sample of 150 children, ages 8-12, with recent SI or SA, and their caregivers, recruited from emergency departments in New York City and Austin, Texas. Dyads will be interviewed within two weeks of the child’s SI or attempt, and three and six months later. This project aims: 1) To identify profiles of SI among ethnoracially diverse children using mixed methods; 2) to test how child SI profiles predict SI severity trajectories over time; and 3) To test whether child SI profiles show differences in expressions of distress, as reported by children and caregivers. This project aligns with the NIMH mission of designing culturally and developmentally informed suicide risk assessments for children. Our findings will reveal profiles of SI and expressions of distress that children display when they are thinking about suicide or just before they attempt suicide. The combination of verbal and nonverbal methods, quantitative and qualitative approaches, and caregiver and child reports overcome limitations of traditional assessments that are mostly based on verbal responses to a few questions about the presence or absence of suicide ideation or attempts.
