Research report Suicidal ideation and mental health disorders in young school children across Europe Viviane Kovess-Masfety a,n , Daniel J. Pilowsky i , Dietmar Goelitz e , Rowella Kuijpers f , Roy Otten f , Maria Francesca Moro a , Adina Bitfoi c , Ceren Koç d , Sigita Lesinskiene g , Zlatka Mihova h , Greg Hanson a , Christophe Fermanian a , Ondine Pez a , Mauro Giovanni Carta b a EHESP Rennes, Sorbonne Paris Cite, EA 4057 Paris Descartes University, Paris, France b Centro di Psichiatria di Consulenza e Psicosomatica Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy c The Romanian League for Mental Health, Bucharest, Romania d Yeniden Health and Education Society, Istanbul, Turkey e Institute of Psychology, University of Koblenz-Landau (Campus Koblenz), Koblenz, Germany f Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands g Clinic of Psychiatry, Faculty of Medicine, University of Vilnius, Vilnius, Lithuania h New Bulgarian University, Sofia, Bulgaria i Mailman School of Public Health, Department of Epidemiology at Columbia University, New York State Psychiatric Institute, New York, USA article info Article history: Received 30 September 2014 Received in revised form 10 February 2015 Accepted 11 February 2015 Available online 19 February 2015 Keywords: Suicide Children Suicidal ideation ADHD Mental health abstract Introduction: The aim of this study is to measure the prevalence of suicidal ideation and thoughts of death in elementary school children in a European survey and to determine the associated socio- demographic and clinical factors. Methods: Data refer to children aged 6–12 (N¼7062) from Italy, Turkey, Romania, Bulgaria, Lithuania, Germany, and the Netherlands randomly selected in primary schools. Suicidal thoughts and death ideation were measured using a computerized pictorial diagnostic tool from the Dominic Interactive (DI) completed by the children. The Strengths and Difficulties Questionnaire (SDQ) was administrated to teachers and parents along with a socio-demographic questionnaire. Results: Suicidal ideation was present in 16.96% of the sample (from 9.9 in Italy to 26.84 in Germany), death thoughts by 21.93% (from 7.71% in Italy to 32.78 in Germany). SI and DT were more frequent in single-parent families and large families. Externalizing disorders were strongly correlated with SI and DT after controlling for other factors and this was true for internalizing disorders only when reported by the children. Conclusion: Recognizing suicidal ideation in young children may be recommended as part of preventive strategies such as screening in the context of the presence of any mental health problems whether externalizing or internalizing. & 2015 Elsevier B.V. All rights reserved. 1. Introduction Completed suicide is fortunately much less common in children and young adolescents than in adults. In the U.S. the one-year 2010 incidence rates for suicide ranged from 0.03/100,000 (for children 5–9 years old), which corresponds to 7 cases, to 1.29/100,000 (for youths 10–14 years old), which corresponds to 267 cases, and 7.53/100,000 (for youths 15–19 years old), corresponding to 1659 cases; as compared to a higher prevalence in U.S. adults, i.e. 13.92/100,000 (20–29 years old), and 16.69/100,000 (40–49 years old) in adults 1 . Because most statistics on suicide rates report on 0–14 year olds, estimates do not adequately reflect the prevalence of suicide in children as most cases occur in preadolescents aged 11 and older. For example, in France in the same year (2010) 40 children below 15 years committed suicide (44 if overseas French territories are included), which corresponds to 0.5/100,000. However, it is not possible to separate those under 11 using these French estimates. The same limitation is applicable to WHO Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jad Journal of Affective Disorders http://dx.doi.org/10.1016/j.jad.2015.02.008 0165-0327/& 2015 Elsevier B.V. All rights reserved. n Corresponding author. E-mail address: viviane.kovess-masfety@ext.parisdescartes.fr (V. Kovess-Masfety). 1 Centers for Disease Control and Prevention, National Center for Injury Preven- tion and Control. Web-based Injury Statistics Journal of Affective Disorders 177 (2015) 28–35