Trajectories of Suicidal Thoughts and Behaviors From Preschool Through Late Adolescence.

Abstract Objective Suicidal thoughts and behaviors (STBs) represent a significant and escalating public health concern in youth. Evidence that suicidal thoughts and behaviors can emerge in the preschool years suggests that some pathways leading to clinically significant STBs begin early in life. Method The current prospective longitudinal study examined the developmental trajectories of STBs in children from ages 3 to 17, oversampled for preschool-onset depression. Results Three unique trajectories of STBs across childhood and adolescence were identified: a Low class (n = 273) characterized by low rates of STBs, an Early-Persistent class (n = 21) characterized by steadily increasing STBs, and a Late-Onset class (n = 21) characterized by low rates of STBs through age 10 followed by a dramatic increase from ages 11-14 years. Preschool measures of depression symptoms, externalizing symptoms, impulsivity, and lower income-to-needs were associated with both high-risk STB classes. Both high-risk STB classes reported greater functional impairment, more externalizing symptoms, and more cumulative stressful life events in adolescence relative to the Low class; the Late-Onset class also reported poorer academic functioning relative to both the Early-Persistent and Low classes. Conclusion A significant minority of this prospectively followed group of preschool children evidenced STBs by and/or after age 10. Although relatively rare prior to age 10, approximately half of the children who experienced STBs in adolescence first exhibited STBs in early childhood and comprised a trajectory suggesting increasing STBs. In contrast, approximately half first exhibited STBs in early adolescence. Early screening and identification of at-risk youth during both preschool and late childhood is important for early intervention regarding STBs.