Thoughts about killing oneself and engaging in suicidal behavior may begin much younger than previously thought. While about one of nine youths attempt suicide by the time they graduate from high school, new findings reveal that a significant proportion make their first suicide attempt in elementary or middle school.

In a study published in the November issue of the Journal of Adolescent Health, nearly 40 percent of young adults who said they had tried suicide said that they made their first attempt before entering high school.

The researchers also found that suicide attempts during childhood and adolescence were linked to higher scores of depression at the time of the attempts, validating for the first time that young adults can reliably recall when they first attempted suicide.

"Young adults who end up having chronic mental health problems show their struggles early," said James Mazza, lead author and professor of educational psychology at the University of Washington. "This study suggests that implementation of mental health programs may need to start in elementary and middle schools, and that youth in these grades are fairly good reporters of their own mental health."

Adolescence can often be a struggle for some youth with ongoing pressures of drugs, alcohol, sexual relationships and sexual orientation. At the same time, they're becoming more autonomous.

"Adolescence is a time when kids are preparing to be more independent from their parents or guardians, but lack the experience of how to do this," said Mazza, a school psychologist. "And their support network  their friends  doesn't have the experience either, especially in crisis situations."

As part of an ongoing survey, Mazza and his collaborators asked 883 young adults aged 18 or 19 about their history of suicide attempts. Seventy-eight respondents, nearly 9 percent, said that they had tried suicide at some point.

Suicide attempt rates showed a sharp increase around sixth grade, about age 12, with rates peaking around eighth or ninth grade. For the 39 respondents reporting multiple suicide attempts, their first attempt was significantly earlier  as young as 9  than those making a single attempt.

Mazza compared the young adults' recollection of their suicide attempts with their past depression scores, which were collected yearly as part of their participation in the Raising Healthy Children project led by researchers at UW's Social Developmental Research Group at the School of Social Work.

Depression levels were higher at the time of the youths' reported first suicide attempts compared with their peers who had not attempted suicide. And Mazza found an increase in depression scores at the time of the attempt compared with depression scores the year before and after the attempt for the same child.

"This suggests that kids are able to tell us, by their depression scores, that things aren't going well for them," Mazza said. "We're likely not giving kids enough credence in assessing their own mental health, and this study shows that we can rely on self-report measures to help identify youth who may be at risk for current mental health concerns, including possible suicidal behavior."

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More information: Study online: Study online: jahonline.org/article/S1054-139X %2811%2900127-3/abstract