Suicide and Life-Threatening Behavior 1

2017 The American Association of Suicidology

DOI: 10.1111/sltb.12340

Suicidal Ideation, Depressive Symptomatology,

and Self-Concept: A Comparison Between
Mexican Institutionalized and Noninstitutio-
nalized Children
ANA-MARIA CHAVEZ-HERNANDEZ, PHD , FREDI-EVERARDO CORREA-ROMERO, PHD,
IRMA-BEATRIZ ACOSTA-ROJAS, MA, KAREN-VIVIANA CARDOSO-ESPINDOLA, BA,
GUSTAVO M. PADILLA-GALLEGOS, MA, AND ISABEL VALADEZ-FIGUEROA, PHD

Previous research reports a significant prevalence of child depression

worldwide and self-concept as a predictor of depression and suicide behavior.
Although suicide in children is an increasing problem in Mexico, there are
scarce studies reporting risk factors and none of children in foster care institu-
tions. This was a comparative, ex post facto study whose aim was to analyze
associations between suicidal ideation, depression, and self-concept in two
paired samples of Mexican children (83 institutionalized and 83 noninstitution-
alized). Results show 16% of the children reported suicidal ideation and statisti-
cally significant differences among variables in both samples. Suggestions are
made to address this problem from early ages.

DEPRESSION IN CHILDREN similar to those observed in adults, notable

Depression is a condition characterized by
extended periods of sadness in which suffer-
ers lose interest and pleasure in otherwise
enjoyable activities, experience sleeping and
eating disorders, and have a deterioration of
social relations (American Psychiatric Asso-
ciation, 2013). Major depression in children
is an increasing worldwide issue, sometimes
associated with psychological, physical, or
sexual abuse (Hankin, 2015). Even though
symptoms of depression in children are
differences include difficulties in socializing
with peers and a diminished self-concept. It
has been reported that depression in child-
hood is a high predictor of depression dur-
ing adulthood (McCabe, Ricciardelli, &
Banfield, 2011), with the most severe conse-
quence being suicide (Van Orden, Witte,
Selby, Bender, & Joiner, 2008).
Child depression has been reported in
12% of the population, with depression in
adolescents increasing to 48% (Vogel, 2012);
however, some studies have estimated

ANA-MARIA CHAVEZ-HERNANDEZ, Psychol- Universidad de Guanajuato, Le on, Guanajuato,

ogy, Universidad de Guanajuato, Le on,
Guanajuato, Mexico; FREDI-EVERARDO CORREA-
ROMERO, Psychology, Universidad de Guanaju-
ato Campus Le on, Le
on de los Aldama,
Guanajuato, Mexico; IRMA-BEATRIZ ACOSTA-
ROJAS and KAREN-VIVIANA CARDOSO-ESPINDOLA,
Crculo de Estudios de Psicologa Profunda,
Leon, Mexico; GUSTAVO M. PADILLA-GALLEGOS,
Mexico; ISABEL VALADEZ-FIGUEROA, Universidad
de Guadalajara, Guadalajara, Jalisco, Mexico.
*Address correspondence to Ana-Maria
Chavez-Hernandez, Psychology, Universidad de
Guanajuato, Rossini #101, Le
on Moderno,
Le
on, Guanajuato, Mexico 37480; E-mail:
anamachavez@hotmail.com
2 SUICIDAL IDEATION
symptoms of depression in children in more
than 30% of the population (Gallegos, Linan-
Thompson, Stark, & Ruvalcaba, 2013). Cogni-
tive mechanisms such as stress vulnerability and
self-evaluation have been studied in association
with child depression. Self-concept refers to the
internal organization of attitudes, feelings,
expectations, and meaning about oneself (Har-
ter, 2006). A positive self-concept in children
leads to adequate psychological development, as
it helps them understand their environment and
react properly in different contexts; it also pro-
motes general well-being and influences positive
social relations.
Cohen, Young, and Abela (2012) aimed
to identify specific cognitive traits related to
the appearance of depressive symptoms in
children, finding that differences in self-con-
cept and self-evaluation after negative events
predicted the appearance of depressive symp-
toms and a proneness to major depression.
McCabe et al. (2011) reported a 23% preva-
lence of clinical depression in a sample of 510
children; when comparing their sample of
depressed children to their control group,
they found that self-concept accounted for
the strongest negative association. Garaigor-
dobil, Perez, and Mozaz (2008) found that
negative self-concept was not only associated
with symptoms of depression, but also with
psychosomatic problems, obsessivecompul-
sive behavior, and hostility.
Depression in Institutionalized Children
Around 8 million children worldwide
live in foster care institutions; reasons
include orphanage, family violence, and pov-
erty (United Nations Childrens Emergency
Fund [UNICEF], 2006). Previous research
has shown that children in foster institutions
present increased proneness to a number of
psychosocial difficulties, including self-harm
behavior. Institutionalized children have
been reported to have remarkably poor
mental health (in comparison with children
living with their biological families) in the
form of low self-esteem, low confidence,
aggressive behavior, and worse social com-
petence (Tarren-Sweeney & Hazell, 2006).
IN MEXICAN CHILDREN
Suicidal Behavior and Depression in
Mexican Children
Prevalence of suicidal ideation in Mex-
ican children has been reported in up to
29.2% of the population and has been associ-
ated with lower self-esteem and symptoms of
depression (De la Torre, Cubillas Rodrguez,
Roman Perez, & Valdez, 2009). According
to the World Health Organization (2001),
out of their evaluated nations, Mexico
showed the highest increase (61.9%) in sui-
cide rates in children and adolescents in the
period ranging from 1982 to 1995.
The Mexican Health Department
[SSA] (2006) estimated that 2.5% of children
and 8.3% of adolescents could suffer from
depression, while the National Institute of
Statistics and Geography [INEGI] (2014)
reported that more than 100,000 children
(aged 714 years) reported to have felt
depressed on a daily basis and that 42.5% of
them had symptoms of severe depression,
out of which 34.1% took prescribed antide-
pressants at the time of the survey.
Since 1990, the age group at highest
risk in Mexico comprises those aged 1524,
while those aged 1014 have shown an
alarming increase in those at risk; in 2014,
a total of 246 suicides were registered in
children below age 14 (INEGI, 2016).
Although suicide rates are higher among
youth aged 1524 in Mexico, it is neverthe-
less disturbing to find such high levels of
suicidal ideation and suicide attempts in
earlier ages (Borges, Orozco, Benjet, &
Medina-Mora, 2010; Paramo-Castillo &
Chavez-Hernandez, 2007).
Although there are around 29,000
children fostered in 703 Mexican institu-
tions (Latin American Foster Care Net-
work, 2011), few studies have targeted this
population for suicidal behavior and depres-
sion research. Early diagnosis and treatment
of depression in children may lead to a
decrease in depression and suicidal behavior
in both childhood and adulthood. The aims
of this study were to analyze the presence
of suicidal ideation and depressive symp-
toms and to estimate their statistical
CHAVEZ-HERNANDEZ ET AL.
association with self-concept in comparative
samples of institutionalized (IC) and nonin-
stitutionalized children (NIC) in the state
of Guanajuato, Mexico.
METHODS
Sample
An intentional, nonprobabilistic sam-
ple of 166 children from Guanajuato, Mex-
ico, fell into two groups (IC and NIC)
paired to age and sex, with 83 children per
group. IC refer to children living in resi-
dential foster institutions with a 24-hour
staff. NIC were sampled in three private
primary schools. Both groups consisted of
68.7% males and 31.3% females aged 612
(mean age = 9.33, SD = 1.78). Only chil-
dren without diagnoses of psychiatric
disorders or intellectual disabilities were
considered. Participation was voluntary and
approved by parents or tutors, with the
proper institutional authorizations.
Instruments
The Child Depression Inventory
(CDI), adapted to the Spanish language
(Kovacs, 2004), is a self-report scale that
measures symptoms of depression in chil-
dren, grouped into the following subscales:
negative mood, ineffectiveness, negative self-
esteem, pessimism, and social withdrawal.
The scale also provides the following indica-
tors for the depression factor: dysphoria,
negative self-esteem, and suicidal ideation.
The General Self-Concept Question-
naire [GSCQ; Garca-Torres, 2001] consists
of 48 indicators grouped into six categories:
physical self-concept, social acceptance, fam-
ily self-concept, intellectual self-concept,
sense of control, and personal self-evaluation.
Procedure and Ethical Considerations
Informed consent was obtained from
the authorities of both foster institutions and
3
schools, and also from parents and tutors.
Trained psychologists administered the
instruments to groups of 510 children who
voluntarily agreed to participate, and who
were reassured that they were able to suspend
their participation without any explanations
given. A final report of the investigation was
provided for every institution. Talks regard-
ing risk behavior assessment and addressing
were offered to parents and school staff.
Statistical Analysis
Frequencies were obtained for each
indicator to further analyze variable associa-
tions. Variables with absolute scores, from
both scales, were measured in intervals. To
compare both groups, statistical chi-square
and Students t tests were used; to deter-
mine the importance of the GSCQ factors
on the overall score of depressive symp-
tomatology, a linear regression analysis was
performed.
RESULTS
Child Depression
Suicidal ideation was found in 36%
of the sampled children: 28% positively
responded to the item I think about killing
myself, although I wouldnt do it and 8%
who positively responded to I think about
killing myself (Table 1).
Symptoms of depression were found
in 22.6% of the sample, including 12.7%
with severe symptoms. Within the NIC
group, 6% had symptoms of severe depres-
sion and 4% had symptoms of minor
depression. In comparison, the IC group
showed three times more symptoms of
severe depression (19%) and minor depres-
sion (13.8); the differences between the
two groups were statistically significant
(v2 = 11.82, df = 2, p = <.05). Raw scores
of depression were 10.84 for NIC versus
15.42 for IC. This was also a significant dif-
ference (t = 3.81, df = 164, p = <.001).
4 SUICIDAL IDEATION IN MEXICAN CHILDREN

TABLE 1
Percentages of Suicidal Ideation Items for Both Groups
I think about killing myself I think about
although I would not do it (%) killing myself (%) Total (%)

Noninstitutionalized children 9.2 1.8 11

Institutionalized children 18.3 6.7 25
Total 27.5 8.5 36

Self-Concept TABLE 2
Self-Concept Scores by Category
Diminished self-concept was found in a
significant amount of children, as 46.4% of Below average Above
them expressed difficulty accepting their Self-concept (Deficient average
physical appearance, in contrast with 18.1% category self-concept) (Overvaluation)
children who expressed a high level of physi- Physical 46.4 18.1
cal self-concept. Regarding social acceptance, self-concept
36.7% expressed difficulty with establishing Social 36.7 12.0
social relations, more than double the 12.1% acceptance
who perceived themselves with high social Family 30.7 21.1
skills and peer acceptance. Similarly, 30.7% self-concept
scored low in family self-concept, compared Intellectual 30.7 21.0
with the 21.1% who scored high. Regarding self-concept
Personal 50.6 19.3
intellectual self-concept and school perfor-
self-evaluation
mance, 30.7% scored below average, describ-
Sense of control 34.9 12.2
ing themselves with intellectual difficulties,
while 21% scored above average; that is, only
2 of 10 children expressed confidence in their To support those results and to lower
intellectual abilities. variation in group comparison, statistically
Concerning personal self-evaluation, significant differences were obtained with a
50.6% scored below average, suggesting low Students t-distribution, finding that IC
self-esteem in half of the children. In contrast, scored lower for family self-concept
only 19.3% scored above average. About (t = 2.89, df = 2, p = <.05), personal self-
12.2% expressed that they had control of evaluation (t = 3.76, df = 2, p = <.05), and
their lives (sense of control), whereas 34.9% sense of control (t = 2.08, df = 2, p = .05).
described difficulties in this category. The There were no statistically significant differ-
highest and lowest scores for all categories of ences for physical self-concept, social accep-
self-concept are summarized in Table 2. tance, and intellectual self-concept.

Group Differences Association Between Symptoms of

Considering group distribution, the
chi-square analysis showed a higher propor-
tion of IC with low family self-concept
(v2 = 8.97, df = 2, p = <.05). This pattern
was also found for personal self-evaluation
(v2 = 17.31, df = 2, p = <.05). There were
no significant statistical differences between
IC and NIC for the remaining categories.
Depression and Self-Concept
To determine the association of each
subcategory of self-concept to the total scores
of depressive symptomatology, a linear
regression analysis was performed. The
results show that personal self-evaluation,
family self-concept, and social acceptance
explain 41.3% of the variation of depression
CHAVEZ-HERNANDEZ ET AL.
for NIC, whereas for IC, personal self-
evaluation and sense of control explain
30.7% of the variation.
CONCLUSIONS
The results of this study contribute to
the clarification of international concerns
about depression and suicide risk in children.
A high percentage (36%) of the total sample
presented suicidal ideation, coinciding with
official reports (INEGI, 2016) and previous
studies (De la Torre et al., 2009). The high
prevalence (34.7%) of symptoms of depression
also concurs with previous reports of a preva-
lence of symptoms above 30% (Gallegos
et al., 2013) and also matches the 29% preva-
lence of suicidal ideation related to depression
and low self-esteem found in Mexican samples
by De la Torre et al. (2009). However, official
statistics from Mexico (SSA, 2006) have
reported a significantly lower prevalence
(2.5%) of symptoms of depression. Nonethe-
less, although those official statistics are a dec-
ade old, it is noteworthy and a potential
concern that 80% of those children were only
treated with psychiatric medications, while
perhaps minimizing a comprehensive under-
standing of child depression including family,
social, and cultural factors.
It is important to highlight that one
third of the sampled children of this study
scored below average in all self-concept cat-
egories, with higher prevalence for specific
subcategories. About 50.6% scored below
average in personal self-evaluation, which
means that half of the sampled children had
a negative image of themselves.
The results of this study showed a sig-
nificant association between depression and
suicide risk through self-concept, supporting
previous findings (Garaigordobil et al., 2008;
McCabe et al., 2011). As expected, signifi-
cant differences were noted between the
groups of IC and NIC. One fifth of the total
sample presented symptoms of depression,
but this percentage decreases to one tenth
for NIC and increases to one third for IC.
This difference may be due to the fact that
5
IC have lower levels of family self-concept,
personal self-evaluation, and sense of
control.
Notably, IC showed higher levels of
depressive symptomatology, possibly due to
difficulties originating in their families and
their upbringing before institutionalization.
The importance of personal self-evaluation,
family self-concept, and social acceptance
was confirmed by the regression analyses.
Noteworthy variations (41.3% for NIC vs.
30.7% for IC) suggest that interventions
aimed at increasing self-concept in children
would have a significant impact reducing
symptoms of depression. Those differences,
however, do not discard the occurrence of
severe cases of depression in NIC.
Expressions of dysphoria, sadness, or
depression in children are not always easily
recognizable by caregivers or tutors, and those
symptoms may aggravate and possibly lead to
expressions of self-harm because of inherent
complications for early detection of risk
behaviors and signs of alarm. Continuous
evaluations of depression in children and their
correlations should be conducted in diverse
populations, such as foster care institutions,
indigenous communities, and migrants. How-
ever, difficulties with conducting studies of
risk behaviors in Mexican children range from
misconceptions (such as considering that chil-
dren do not get depressed), to administrative,
government, or academic obstacles (by assum-
ing child depression as an irrelevant issue).
Despite the strength of a paired-groups
method, a limitation of this study is the small
size of the sample. This limitation partially
responds to administrative obstacles, as it was
difficult to obtain permission for instrument
application in both NIC and IC populations.
In fact, sampling IC in foster institutions
involved enormous efforts and lengthy
bureaucratic processes, while for NIC, it was
impossible to sample public schools.
The implementation of strategies for
diagnosing and addressing children at risk
and emotional suffering is relevant and
unpostponable, with suggested psycho-edu-
cative interventions for universal, selective,
and indicated prevention.
6 SUICIDAL IDEATION
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