Methods: This is a population based, prospective, cohort study of suicide deaths. Study includes all children born January 1, 1999 to December 31, 2000. Vital birth, death, and child protection service (CPS) records were linked to identify the children born in 1999 or 2000, these children were then followed prospectively through both CPS and death records to identify those who died by suicide and/or had a history of CPS involvement by 2017. Each suicide death (case) was matched to 4 living controls based on sex, year of birth, maternal race/ethnicity, maternal age at birth, insurance type at birth (public/private), maternal education, and presence of second parent on birth certificate. A conditional logistic regression model was used to determine differences in suicide rates among children and youth with no CPS history and those who (1) had a history of report to CPS for alleged child maltreatment, (2) were substantiated as a victim of child maltreatment, and (3) had a history of foster care placement. Adjusted rate ratios and 95% confidence intervals are reported.
Results: Overall, 170 California children and youth born in 1999 or 2000 died by suicide. Of these youth approximately 57% had a history of child protective service involvement. Significantly different suicide rates were found between children and youth with and without CPS history. Children and youth who had received a formal allegation of child maltreatment had a suicide rate 3.1 times that of children and youth who had no CPS history. Children and youth who had been substantiated as a victim of child maltreatment had a suicide rate 5.2 that of children and youth with no CPS history and or children and youth who had spent time in foster care had a suicide rate 4.9 times that of children and youth with no CPS history. No discernable differences were found between those with a substantiation or foster care history and children with an allegation only.
CPS contact is a common experience among children and youth who died by suicide, and children and youth with prior CPS involvement of any kind, have significantly higher odds of suicide. Together these findings highlight the need for providing mental health screenings to all kids who are alleged to have experienced child maltreatment. It also underscores the importance of primary child maltreatment prevention efforts both in the community at large and at the first point of contact, the child protection hotline.