Changing residences associated with increased risk of suicidal behavior among children

Danish children who move frequently appear to have an increased risk of attempted or completed suicide between ages 11 and 17, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Changes of residence occur frequently in modern society, and about half of children move at least once before their 10th birthday, according to background information in the article. Moving frequently is a burden to most people, including children, who typically move passively because of a parent's decision. "Whatever inspires the move, such experiences during childhood may be traumatic or psychologically distressing and, therefore, may affect a child's physical, mental, social and emotional well-being," the authors write. "Some children have difficulties coping with the change and may exhibit their distress as suicidal behavior, the last-resort response to the hardship and stress."

Ping Qin, Ph.D., M.D., and colleagues at the University of Aarhus, Denmark, use data from Danish national registries to identify all children born between 1978 and 1995. Between 11 and 17 years of age, 4,160 of these children attempted suicide based on hospital records, and 79 completed suicide. For each suicide attempt or completion, the researchers selected 30 control children who were the same sex and age.

Compared with the control children, those who attempted suicide were more likely to have changed residences frequently -- 55.2 percent of suicidal children and 32 percent of controls had moved more than three times, and 7.4 percent had moved more than 10 times (compared with 1.9 percent of controls). Frequent moves were also more common among children who completed suicide.

A dose-response relationship was observed for both attempted and completed suicide, meaning that the more often a child changed addresses, the more likely he or she was to have attempted or completed suicide. The associations remained significant after the researchers controlled for other factors, such as birthplace and parents' mental health.

"The breakdown of connections with peers, discontinuation of group activities, distress and worries related to the new environment are potentially psychologically distressing events for young children. Frequent exposures to these events can be stressful and confusing and may affect their psychosocial well-being, thus increasing their intention toward ending their life if they are unable to cope," the authors write. In addition, moving is stressful for parents and may result in their inability to attend to their children's emotional needs. "Children may feel ignored and have no one to communicate with. A suicide attempt may, to some extent, express the need for more attention from their parents."

"Although we could not distinguish whether frequent change of residence was a causal risk factor or merely an intermediate variable of other risk factors for suicidal behavior, the findings from this study suggest the importance of stability on children's psychosocial well-being," they conclude. The results raise questions for parents who move frequently, such as whether they have to move, how to minimize the effects of necessary moves on children and how to further involve children in the moving process. "Last, but not least, parents, caretakers and schools should be aware of the psychosocial needs of children who have recently moved and be ready to help them resolve their distress together or through professional assistance."

(Arch Gen Psychiatry. 2009;66[6]:628-632. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was funded by the Danish Health Insurance Foundation, the Danish Ministry of Social Affairs and the Stanley Medical Research Institute. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

June 1, 2009