Child suicide, family environment, and economic crisis.

Suicide among children is considered to be a rare event, although it is still one of the leading causes of death in children younger than 15 years of age worldwide (Pelkonen & Marttunen, 2003; Vajani, Annest, Crosby, Alexander, & Mille, 2007). Compared to other age groups, the prevalence of suicide in children is more likely to be underestimated (Beautrais, 2001; Crepeau-Hobson, 2010; Fortune & Hawton, 2007; McClure, 2001). Possible reasons for this underestimation may be the social stigma and shame surrounding suicide in general, the reluctance by officials or coroners to determine a verdict of suicide in a child, disparities in death classification systems, and/or the misconception that children are precluded from engaging in suicidal acts due to cognitive immaturity (Crepeau-Hobson, 2010; Schmidt, Muller, Dettmeyer, & Madea, 2002; Shaw, Fernandes, & Rao, 2005; Pritchard & Hansen, 2005). However, research has indicated that, from the age of 8 on, children understand the concept of suicide (Mishara, 1998; Fortune & Hawton, 2007) and are capable of carrying it out. Research in adolescent and youth suicide is growing. While previous studies provided a broad overview of the phenomenon, few focused specifically on suicide in children. There appears to be some empirical support for the notion that children may be less exposed to common suicide risk factors, such as mental illness and substance abuse, and less likely to display predictive factors, such as prior suicidal behavior (Beautrais, 2001; Groholt, Ekeberg, Wichstrom, & Haldorsen, 1998; Pelkonen & Marttunen, 2003; Schmidt et al., 2002). Groholt et al. (1998) suggested that the low suicide incidence in children might be related to fewer risk factors rather than to their resilience to these risk factors. Interpersonal family conflicts, especially parent-child conflicts, are important suicide risk factors in children and younger adults and appear more frequently compared to older adults. Beautrais (2001) reported that 70.5% of child suicides aged 9–14 years had a family conflict as a triggering factor. Furthermore, it has been reported that parental divorce or a stepparent in the family increases the risk of suicidal behaviors in children and adolescents (Pelkonen & Marttunen, 2003; Samm et al., 2010). A growing body of research indicates that the risk of child and adolescent suicide and attempted suicides increases when family psychopathology is involved, such as parental mental health problems or a history of suicidal behavior (King, 2009). However, the existence and impact of shared genetic risk factors, the level of influence of an adverse family environment, and whether these influences can be mediated remain unknown in the context of child suicide (Brent & Mann, 2006; King, 2009). It also appears that the family environment – parenting style, physical abuse, and parental mental health problems – can be greatly influenced by economic pressure (Yoder & Hoyt, 2005). Since the beginning of the global financial crisis, several editorials and papers have indicated the possible impact the economic recession may have on morbidity (Catalano, 2009; Uutela, 2010), mortality (Simms, 2009), and, more specifically, suicide (Gunnell, Platt, & Hawton, 2009). Indeed, based on past experiences and from a public health perspective, it is very important to notify professionals and politicians about the possible consequences (Stuckler, Basu, Suhrcke, Coutts, &McKee, 2009). Meanwhile, speculations continue about eventual scenarios, as it is too early to see the impact the global financial crisis might have on overall suicide mortality and morbidity rates. The effects of an economic recession on children, general child mortality and morbidity, violence against children, schooling, quality of care, and emotional well-being also need to be considered (Harper, Jones, McKay, & Espey, 2009). Yet, how much do we know about the possible fallouts of an economic crisis on children, their suicidal behaviors, and child suicides? The impact of an economic recession can be measured both on an aggregated and an individual level. In a recent paper, Apter, Bursztein, Bertolote, Fleischmann, and Wassermann (2009) considered that turmoil following rapid changes in the economy has been