Associated Psychiatric Disorders in Children Hospitalized for a Serious Suicide Attempt

Several studies agree on the increase in suicide attempts in children over the past 15 years. This trend has been aggravated by the COVID 19 pandemic.

It is recognized that suicide attempts are mostly encountered in individuals with a psychiatric disorder. Serious suicide attempts, which probably better reflect the risk of completed suicide, are very poorly known and have been very little explored. They could be related to more specific and earlier psychiatric disorders or even concern children with developmental particularities that are insufficiently defined to fall under a categorical diagnosis, but which could be better understood with dimensional measurements. Better characterizing them would seem quite important given their high lethality. Indeed, a high lethality is found for half of the suicide attempts in children fewer than 12, contrasting with a moderate or low intentionality ; in children, the means used are often more violent and more lethal than in adolescents (over 12 years old): hanging, firearm, etc.

The Necker-Enfants Malades hospital has a pediatric neurosurgery department as well as a specialized multidisciplinary team to care for polytraumatized children in a regional "Trauma Center" type structure. As a result, most children and adolescents in Ile-de-France who have made a violent suicide attempt are sent to the Necker hospital. Once medico-surgically stabilized, these children and adolescents are assessed by the hospital's child psychiatry team. This regional recruitment makes it possible to have an epidemiological representativeness. From this population, the investigative team proposes to better characterize the developmental profile and psychiatric disorders of children who have made a serious suicide attempt.

The study also proposes to examine in detail the psycho-emotional development as well as the psychopathological characteristics of these children in order to shed light on these early and lethal acting out. The investigative team proposes in particular to use dimensional evaluations to analyze behavioral traits in more detail. To the knowledge of the child psychiatry department of the Necker Enfants Malades hospital, there is no such study to date.

In addition to the question of neurodevelopmental disorders, an ancillary study will make it possible to question attachment disorders in children who have made a serious suicide attempt.

In fact, a link between attachment disorders and suicidal ideation or attempted suicide has been shown in the literature.

Attachment disorders correspond to an early imbalance in the bond between a child and the primary caregiver, particularly before the age of 3. Attachment relationships that do not allow a solid bond between the young child and the person occupying the maternal function may not be pathological in themselves but would be risk factors for pathologies in adolescence and adulthood, and in particular a category of so-called disorganized attachment disorders in the occurrence of dissociative symptoms.

In 2016, the French national institute of statistics and economic studies (INSEE) indicates about the death of children aged 5 to 14 in France, that 4.2% of deaths at this age (n=26) are due to suicide, with a possible sub- assessment of suicide in this age group because a certain number of deaths are attributed to accidents.

Several studies agree on the increase in suicide attempts in children over the past 15 years. This trend has been aggravated by the COVID 19 pandemic. Indeed, several recent studies have reported deterioration in the mental health of children and adolescents since the start of the pandemic and an increase in the rate of suicidal ideation and suicide attempts in 2020. Among the factors that could explain this increase, we can cite the phenomena of social distancing and isolation.

It is recognized that suicide attempts are mostly encountered in individuals with a psychiatric disorder. Indeed, psychological autopsies indicate a prevalence of psychiatric disorders of more than 90% among people who died by suicide.

Nevertheless, serious suicide attempts, which probably better reflect the risk of completed suicide, are very poorly known and have been very little explored. They could be related to more specific and earlier psychiatric disorders or even concern children with developmental particularities that are insufficiently defined to fall under a categorical diagnosis, but which could be better understood with dimensional measurements. Better characterizing them would seem quite important given their high lethality. Indeed, a high lethality is found for half of the suicide attempts in children fewer than 12, contrasting with a moderate or low intentionality ; in children, the means used are often more violent and more lethal than in adolescents (over 12 years old): hanging, firearm, etc.

The Necker-Enfants Malades hospital has a pediatric neurosurgery department as well as a specialized multidisciplinary team to care for polytraumatized children in a regional "Trauma Center" type structure. As a result, most children and adolescents in Ile-de-France who have made a violent suicide attempt are sent to the Necker hospital. Once medico-surgically stabilized, these children and adolescents are assessed by the hospital's child psychiatry team. This regional recruitment makes it possible to have an epidemiological representativeness. From this population, the investigative team proposes to better characterize the developmental profile and psychiatric disorders of children who have made a serious suicide attempt.

The study also proposes to examine in detail the psycho-emotional development as well as the psychopathological characteristics of these children in order to shed light on these early and lethal acting out. The investigative team proposes in particular to use dimensional evaluations to analyze behavioral traits in more detail. To the knowledge of the child psychiatry department of the Necker Enfants Malades hospital, there is no such study to date.

In addition to the question of neurodevelopmental disorders, an ancillary study will make it possible to question attachment disorders in children who have made a serious suicide attempt.

In fact, a link between attachment disorders and suicidal ideation or attempted suicide has been shown in the literature.

Attachment disorders correspond to an early imbalance in the bond between a child and the primary caregiver, particularly before the age of 3. Attachment relationships that do not allow a solid bond between the young child and the person occupying the maternal function may not be pathological in themselves but would be risk factors for pathologies in adolescence and adulthood, and in particular a category of so-called disorganized attachment disorders in the occurrence of dissociative symptoms.

The adolescent relationship scale questionnaire (ARSQ), to determine attachment style, will be offered to children and adolescents who have made serious suicide attempts who will participate in the study as well as to a control group of children and adolescents.

Eligibility Criteria:
Inclusion Criteria:

* Patients:

  * Between the ages of 9 and 15 inclusive at the time of hospitalization at the Necker Enfants Malades Hospital following a serious suicide attempt that took place after January 1, 2016.
  * Serious suicide attempt whose criteria are: hospitalization for more than 24 hours and one of the following criteria: care in a specialized service, surgery under general anesthesia, hospitalization in intensive care or continuous care or resuscitation unit, attempted suicide by methods involving a high risk of mortality: precipitation, hanging, firearm...
  * Control patients aged 9 to 15 years old hospitalized at the Necker-Enfants Malades hospital at time of the study for a non-serious suicide attempt.
  * Without intellectual disability (IQ\>70).
* Parents:

  - At least one of the parents of a patient meeting the inclusion criteria.
* All subjects (parent(s) and minor or adult children) informed and not objecting to participation in the study. Holders of parental authority of minor patients informed and not opposing the participation of their child in the study.

Exclusion Criteria:

* Insufficient command of French to answer the questionnaires.
* Incomplete file of patients whose hospitalization is no longer in progress.
* Medical impossibility to pass the questionnaires.