Les tentatives de suicide des enfants de moins de 13ans sont très peu décrites dans la littérature. L’objectif de notre étude était de mieux décrire cette population.

Cette étude est descriptive, rétrospective et monocentrique. Elle s’est déroulée dans le service de psychopathologie du développement de l’hôpital Femme-Mère-Enfant des hospices civils de Lyon. Tous les enfants de moins de 13ans hospitalisés pour tentative de suicide entre 2008 et 2011 ont été inclus. L’analyse des dossiers s’est faite à l’aide d’une grille de lecture permettant de décrire le geste, l’environnement, les antécédents et la prise en charge.

Les filles étaient majoritaires (sex-ratio : 0,85). En moyenne, les garçons étaient plus jeunes (p=0,047) et ils utilisaient des moyens plus violents (p=0,048) que les filles. Les enfants utilisant des moyens violents étaient plus jeunes que ceux utilisant des moyens non violents (p=0,01). Les deux diagnostics principaux d’hospitalisation étaient les troubles de l’adaptation (37,5 %) et la dépression (27 %).

Le sex-ratio des enfants de cette étude était différent de celui des populations d’adolescents suicidant (0,09 à 0,32 selon les études). Les moyens violents sont également très présents dans la tranche d’âge concernée.

Cette population est particulièrement à risque sachant qu’à l’âge adulte, le risque de décès par suicide est plus fort lorsqu’il existe un antécédent de tentative de suicide par méthode violente. Ces enfants doivent être pris en charge au cours et au décours d’une hospitalisation systématique, permettant une évaluation psychologique et socio-environnementale.

Research is limited on suicide attempts in children under 13 years of age. The objective of this study was to provide an in-depth description of this population.

The present study is both retrospective and descriptive. Data were collected retrospectively from a file containing the causes for hospitalization of each child admitted into the Department of Child Psychiatry at the hôpital Femme-Mère-Enfant (hospices civils de Lyon). We included all patients under 13 years of age who were hospitalized for a suicide attempt between 2008 and 2011. The methods used to collect the medical records consisted in using a form made up of four major parts: suicide attempts, social environment, medical history, and therapy.

The 26 girls and 22 boys included had a mean age of 11.52 years. The boys were younger than the girls (P=0.047) and their parents were usually separated (P=0.034). The boys used more violent means to commit suicide in comparison to the girls (P=0.048). On average, children using violent means were younger (P=0.013). Boys underwent more psychotherapy (P=0.027) and were prescribed more psychotropic medication in comparison to girls (P=0.051). Adjustment disorders (37.5%) and depression (27%) were the two main diagnoses for hospitalization. They were hospitalized on average (±standard deviation) 9.6 days (±10 days). Psychotherapy was organized when leaving the hospital (98%) with legal measures (8.3%), change of residence (12.5%), and prescription of psychotropic drugs (37.5%). None had physical complications.

In children under 13 years of age, attempted suicide was more frequent in girls than boys. However, the sample included 18 girls and nine boys who were 12 years old (sex ratio of 12-year-olds, 0.5). There were more boys (16 boys/eight girls) in the children under 12 (sex ratio of 8- to 11-year-olds, 1.6). Children under 11 used more violent means (P=0.01). The literature also reports that more violent means lead to a greater risk of death by suicide. Consequently, suicidal behavior in children under 11 years of age is closer to a behavior of a person who has committed suicide than an adolescent attempting suicide. As a result of the sex ratio and non-violent means, 12-year-old children's behavior can be considered like that of adolescents. One factor that could explain children's attempted suicide is family cohesion. The children in this study were most often from broken families and had a difficult relationship with their parents. From 1981 to 1985, more than 50% of children who consulted for their first suicide attempt were not hospitalized. Now hospitalization is recommended for all children who consult for attempted suicide. They are hospitalized on average 8.9–9 days. Individual psychotherapy is systematic. The main difference between the treatments for adolescents and children is the importance of the social worker who will require legal measures or changing residences when necessary.

The sex ratio in 6- to 12-year-olds attempting suicide is higher than the sex ratio in adolescents attempting suicides. Insecure attachment was found in all families in this sample. This population is particularly at risk knowing that in adulthood, the risk of death by suicide is higher when there is a background of attempted suicide by violent methods. These children should always be hospitalized for a psychological and socioenvironmental evaluation.