Preadolescent Suicidal Thoughts and Behaviors: An Intensive Longitudinal Study of Risk Factors

Renee J Thompson; Diana J Whalen; Kirsten Gilbert; Rebecca Tillman; Laura Hennefield; Meghan Rose Donohue; Caroline P Hoyniak; Deanna M Barch; Joan L Luby

doi:10.1016/j.jaac.2024.03.018

Preadolescent Suicidal Thoughts and Behaviors: An Intensive Longitudinal Study of Risk Factors

J Am Acad Child Adolesc Psychiatry. 2024 Apr 9:S0890-8567(24)00184-9. doi: 10.1016/j.jaac.2024.03.018. Online ahead of print.

Authors

Renee J Thompson¹, Diana J Whalen², Kirsten Gilbert², Rebecca Tillman², Laura Hennefield², Meghan Rose Donohue², Caroline P Hoyniak², Deanna M Barch², Joan L Luby²

Affiliations

¹ Washington University in St. Louis, St. Louis, Missouri. Electronic address: renee.thompson@wustl.edu.
² Washington University in St. Louis, St. Louis, Missouri.

PMID: 38604472
DOI: 10.1016/j.jaac.2024.03.018

Abstract

Objective: Dramatic increases in rates of suicidal thoughts and behaviors (STBs) among youth highlight the need to pinpoint early risk factors. This study used intensive longitudinal sampling to assess what the concurrent associations were between risk factors and STB status, how proximal changes in risk factors were related to STB status, and how risk factors prospectively predicted changes in STB status in a preadolescent sample enriched for early childhood psychopathology.

Method: A total of 192 participants were included from the Parent-Child Interaction Therapy-Emotional Development (PCIT-ED) Study, a longitudinal study of children with and without preschool depression. Participants 7 to 12 years of age completed a diagnostic interview, followed by 12 months of intensive longitudinal sampling, assessing experiences of suicidal ideation and 11 psychosocial variables with known links to STBs in adolescents and adults. Preadolescents with STB history (high-risk) received surveys weekly, and those without STB history (lower-risk) received surveys monthly.

Results: Female sex, elevated depressive symptoms, greater use of expressive suppression and rumination, emotional clarity, and perceived burdensomeness were uniquely concurrently associated with the likelihood of STB endorsement. Within the high-risk group, (1) increases in depression, expressive suppression, rumination, and perceived burdensomeness, and decreases in positive affect from week_t to week_t+1 were associated with a higher likelihood of a positive STB status at week_t+1; and (2) higher expressive suppression, perceived burdensomeness, and caregiver criticism and conflict at week_t compared to participants' mean levels prospectively predicted increases in the likelihood of a positive STB report from week_t to week_t+1.

Conclusion: Psychosocial factors influencing STBs in adolescents and adults also affect preadolescents in day-to-day life. Expressive suppression and perceived burdensomeness consistently emerged as novel risk indicators and potential targets for treatment. In addition, increases in depression, rumination, and caregiver criticism and conflict, as well as decreases in positive affect, might prompt heightened STB screening and assessments for preadolescents with a history of STBs.

Keywords: children; depression; intensive longitudinal methods; suicidal thoughts; suicide behavior.