Suicidal ideation and self-harming behaviors in treatment-seeking young children

• Two patterns of suicidal thoughts and self-harming behaviors (STB) were identified. • Children with active STB were more verbally aggressive. • Children with passive STB were more likely diagnosed with anxiety disorder. • STB should be assessed throughout treatment. • Interventions to reduce aggression and anxiety may alter the trajectory of STB. Preschool age suicidal thoughts and self-harming behaviors (STB) is the strongest predictor of school age STB, but very little research has been conducted. The present clinical record review study of 51 children ages 2–6, mostly male and White, explored 1) the ways in which early childhood STB manifests; and 2) whether the demographic, contextual, and clinical correlates may differ by the nature and identified timing of STB. About one-third of the sample ( n = 17) exhibited suicidal behaviors; 35 children (69 %) expressed either active ( n = 11) or passive ( n = 24) suicide ideation; 19 (37 %) demonstrated non-suicidal self-injury; and 7 (14 %) exhibited a preoccupation with death. Children with suicidal self-harming behaviors and/or active suicide ideation ( n = 23, 45 %), compared to those without such suicidal manifestation ( n = 28, 55 %), were more verbally aggressive (83 % vs. 61 %, p = 0.08), yet less likely diagnosed with an anxiety disorder (52 % vs. 82 %, p = 0.02). Children identified as suicidal at the initial mental health assessment ( n = 25, 49 %), compared to those identified during treatment ( n = 26, 51 %), were older (5.75 years vs. 4.5 years), tended to be more physically aggressive (96 % vs. 73 %, p < 0.05), endorse sadness (56 % vs. 31 %, p = 0.07), exhibit negative self-talk (24 % vs. 4 %, p < 0.05), and be affected by trauma (88 % vs. 69 %, p = 0.10). Clinical interventions focusing on the reduction of aggression and anxiety may alter the trajectory of STB across childhood, adolescence, and adulthood.