Prevalence of suicidal ideation and self-harm behaviours in children aged 12 years and younger: a systematic review and meta-analysis.

BACKGROUND: Suicide in children is a pressing public health concern. The increasing number of deaths by suicide and emergency visits for suicidal ideation and self-harm in children might not be fully representative; it is likely that many more children are in distress but do not seek out help. We conducted a systematic review and meta-analysis of existing studies to quantify the prevalence of suicidal ideation and self-harm behaviours among children in the community aged 12 years and younger. METHODS: In this systematic review and meta-analysis, we searched PsycINFO, MEDLINE, and Web of Science via OVID from database inception to Feb 28, 2022, for articles published in French or English that reported estimates of prevalence of suicidal ideation (including suicide planning) and self-harm behaviours (namely, self-harm, suicide attempts, and non-suicidal self-injury) in children aged 12 years and younger. Reference lists were also searched; case studies, qualitative studies, and health-care visit studies were excluded. The outcomes were suicidal ideation, suicide plan or attempts, and self-harm. We used a random-effects model to calculate the overall pooled prevalence of suicidal ideation and self-harm behaviours for all timeframes combined and for ever versus the past 12 months for suicidal ideation. We used the Joanna Briggs Institute Critical Appraisal tool to evaluate the risk of bias in each study. This study is registered with PROSPERO, CRD42020179041. FINDINGS: 28 articles, encompassing 30 studies overall, met the inclusion criteria, aggregating findings from 98 044 children (of whom 46 980 [50·5%] were girls and 46 136 [49·5%] were boys; six articles did not report sex or gender) aged 6-12 years. The pooled prevalence estimate was 7·5% (95% CI 5·9-9·6) for suicidal ideation from 28 studies and 2·2% (2·0-2·5) for suicide planning from three studies. The pooled prevalence was 1·4% (0·4-4·7) for self-harm from four studies, 1·3% (1·0-1·9) for suicide attempt from six studies, and 21·9% (6·2-54·5) for non-suicidal self-injury from two studies. The prevalence of suicidal ideation was higher in studies that included child-reported outcomes (10·9% [95% CI 8·1-14·5] for child only and 10·4% [6·8-15·5] for child and parent combined) than for parent-only reported outcomes (4·7% [3·4-6·6]; p=0·0004). The prevalence of suicidal ideation and self-harm behaviours was similar in boys and girls (suicidal ideation, 7·9% [95% CI 5·2-12·0] for boys vs 6·4% [3·7-10·7] for girls; self-harm behaviours, 3·5% [1·6-7·2] for boys vs 3·0% [1·4-6·4%] for girls). Detailed ethnicity data were not available. High heterogeneity was identified across estimates (I2>90%), which was not well explained by the characteristics of the studies. INTERPRETATION: A high number of children in the general population can experience suicidal ideation and self-harm behaviours, thus underlining the need for more research on childhood suicide, including developmentally appropriate preventive strategies, such as youth-nominated support teams or dialectical behavioural therapy. FUNDING: Canada Research Chair in Youth Mental Health and Suicide Prevention.

Examining the Relationship Between Mindfulness, Self-Compassion, and Emotion Regulation in Self-Injury.

OBJECTIVE: The objective of the current study was to investigate whether mindfulness and self-compassion are negatively associated with engagement in non-suicidal self-injury (NSSI) and whether emotion dysregulation would mediate this relation. METHOD: 343 participants (82.2% female; Mage = 23.98; SD = 7.47) were recruited from university and community settings, and completed online questionnaires. Two groups of participants were created: those with lifetime engagement in NSSI (n = 153) and a comparison group with no prior engagement in NSSI (n = 190). RESULTS: First, two one-way MANOVAs revealed significant mean differences (NSSI/comparison) across the self-compassion dimensions and specific mindfulness facets. Second, logistic regressions revealed that the self-coldness dimension of self-compassion significantly predicted engagement in NSSI, and specific mindfulness facets (nonjudging and acting with awareness) were found to negatively predict NSSI engagement. Lastly, mediation analyses revealed that emotion dysregulation fully mediated the relationships between both mindfulness total and self-coldness, and NSSI group status. CONCLUSION: The present study demonstrates preliminary support for the protective role of key mindfulness facets and potential risk of the self-coldness aspect of self-compassion in NSSI engagement. Implications for potential use of treatment protocols may include teaching key aspects of mindfulness and self-compassion as healthier and kinder alternatives to coping with dysregulated emotions.HighlightsMindfulness and self-compassion significantly differ between NSSI/comparison groupsKey mindfulness facets and self-compassion dimensions negatively predict engagement in NSSIEmotion dysregulation fully mediates self-coldness and mindfulness with NSSI group status.

Evaluating the Use of Mindfulness and Yoga Training on Forensic Inpatients: A Pilot Study.

Forensic inpatients (i. e., individuals found not responsible for a criminal offense on account of mental illness) represent an often marginalized and difficult-to-treat population. This has led to the need for research exploring the effectiveness of novel interventions. A Canadian forensic hospital has developed an 8-weeks mindfulness and yoga training program (MTP). This pilot study examined the potential effects of this program on patients' mindfulness, stress, and use of cognitive and emotion regulation strategies. A sample of 13 forensic inpatients (male = 92%) participating in the MTP program completed self-report measures assessing dispositional mindfulness, perceived stress, and use of cognitive emotion regulation strategies at baseline, post-intervention, and a 3-months follow-up. Repeated measure ANOVAs found a significant increase in the describe facet of mindfulness (p = 0.03) with a large effect size (ηp 2 = 0.26) and a significant decrease in stress (p = 0.003) with a large effect size (ηp 2 = 0.39). Pairwise comparisons revealed medium to large significant changes between baseline and post-intervention for both the describe facet (p = 0.03, Hedge's g = 0.55) and stress (p = 0.003, Hedge's g = 0.70). However, comparisons were insignificant between baseline and follow-up. No significant main effects were found on the use of cognitive emotion regulation strategies. This pilot study offers preliminary support for the use of the MTP as an adjunctive therapy in forensic inpatient treatment. Further investigation is needed into the long-term impacts of this training.