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Randomized Controlled Trial
. 2019 Mar;58(3):339-349.
doi: 10.1016/j.jaac.2018.07.909. Epub 2019 Jan 8.

Changing Conceptions of Death as a Function of Depression Status, Suicidal Ideation, and Media Exposure in Early Childhood

Laura Hennefield  1 , Diana J Whalen  2 , Grace Wood  2 , Mary C Chavarria  2 , Joan L Luby  2
Affiliations
Randomized Controlled Trial

Changing Conceptions of Death as a Function of Depression Status, Suicidal Ideation, and Media Exposure in Early Childhood

Laura Hennefield et al. J Am Acad Child Adolesc Psychiatry. 2019 Mar.

Abstract

Objective: This study characterized 3- to 6-year-old children's understanding of death as a function of depression status, suicidal ideation (SI), and media consumption.

Method: Participants were 79 children with depression (3.0-6.11 years old) who completed a comprehensive psychiatric assessment and experimenter-led death interview and a comparison group of 60 healthy children (4.0-7.12 years old). The interview assessed children's understanding of 5 concepts of death: universality, applicability, irreversibility, cessation, and causality. Children's mastery of each concept and overall understanding of death was examined as a function of depression and SI status: depressed with SI (n = 22), depressed without SI (n = 57), and healthy (n = 60). Children's observed emotional reactions to hearing about natural death, accidental death, and suicide were assessed by death-themed stories. Parent reports of children's television and videogames/internet consumption assessed links between media exposure and understanding of death.

Results: Children with depression and SI scored higher on overall understanding of death than those with depression without SI and healthy children. They also exhibited more sad and anxious affect listening to death-themed stories and were more likely to describe death as caused by violence. Across this sample, older children also were more likely to depict death as violent. More television use was associated with less understanding of death, including the concept of irreversibility.

Conclusion: Children with depression and SI have a more advanced understanding of death than their peers, dispelling the myth that these ideations arise in the context of a poor understanding of death. The increase in violence attributions across early childhood could indicate increasing normalization of violence in children's perceptions of death.

Clinical trial registration information: A Randomized Controlled Trial of PCIT-ED for Preschool Depression; http://clinicaltrials.gov; NCT00595283.

Keywords: death understanding; depression; early childhood; media; suicidality.

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Conflict of interest statement

Conflicts of Interest / Financial Disclosures

Dr. Hennefield, Dr. Whalen, Grace Wood, and Mary Chavarria declare no conflicts of interest. Dr. Luby has received royalties from Guilford Press.

Figures

Figure 1.
Figure 1.. Children’s Understanding of Death Concepts by Group and Age
Note: All previously significant findings remain significant when 3-year-olds are removed from the analyses. Group comparisons were not performed for causality because MDD+SI did not vary on this measure. MDD+SI: depressed with suicidal ideation, MDD-SI: depressed without suicidal ideation, HC: healthy comparison. a indicates significant findings for age b indicates significant findings for MDD+SI vs HC c indicates significant findings for MDD+SI vs MDD-SI
Figure 2.
Figure 2.. Children’s Emotional Reactions to the Death-Themed Narratives as a Function of Group
Note: MDD+SI: depressed with suicidal ideation, MDD-SI: depressed without suicidal ideation, HC: healthy comparison. a indicates significant group differences between HC vs MDD+SI b indicates significant group differences between MDD-SI vs MDD+SI
See this image and copyright information in PMC

Comment in

References

    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 5 Washington, DC;2013:1–970.
    1. Luby JL, Belden AC, Pautsch J, Si X, Spitznagel E. The clinical significance of preschool depression: Impairment in functioning and clinical markers of the disorder. J Affect Disord 2009;112(1–1):111–119. - PMC - PubMed
    1. Slaughter V Young children’s understanding of death. Aust Psychol 2005;40(3):179–186.
    1. Jay SM, Green V, Johnson S, Caldwell S, Nitschke R. Differences in death concepts between children with cancer and physically healthy children. J Clin Child Psychol 1987;16(4):301–306.
    1. Reilly TP, Hasazi JE, Bond LA. Children’s conceptions of death and personal mortality. J Pediatr Psychol 1983;8(1):21–31. - PubMed

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