Suicide is a leading cause of death among youth, yet understanding predictors of suicide risk in preadolescents remains limited. While studies on adolescent suicide are prevalent, research on preadolescents is scarce, often using non-nationally representative samples or focusing solely on suicide deaths. Existing data suggests economic disadvantage and female sex may be associated with suicidal ideation or behavior, but findings are mixed and sample sizes small. Prior analysis of Adolescent Brain Cognitive Development (ABCD) study data revealed sex differences in suicide risk, but limited conclusions due to methodological constraints. Data on diagnostic predictors in nationally representative samples is also lacking, and there is a need to understand which psychiatric diagnoses predict suicidal ideation only or suicide attempts among those with ideation. Finally, information on treatment utilization among suicidal preadolescents is needed to identify those who do not access mental health services. This study uses the ABCD Study to examine sociodemographic and diagnostic predictors of suicidal ideation and attempts in a large, nationally representative sample of US preadolescents, and also examines predictors of treatment utilization among suicidal youth.

Previous research on suicide risk in preadolescents has yielded mixed results. Some studies suggest an association between economic disadvantage and suicidal ideation/behavior, while others indicate a link between female sex and increased risk. However, studies on racial differences have produced inconsistent findings. Prior research using ABCD Study data found sex differences in suicide risk, with higher rates of suicidal ideation among males but not suicide attempts. Regarding diagnostic predictors, suicidal preadolescents are more likely to have psychiatric disorders, particularly multiple ones. While depression is frequently studied, anxiety disorders, disruptive behavior disorders, and ADHD may also play a role. However, prior research lacked nationally representative samples and did not differentiate between suicidal ideation and attempts. Information on treatment utilization rates among suicidal preadolescents is also limited, with existing population-based studies focusing primarily on adolescents, revealing that a significant proportion do not receive mental health services.

This study utilized the ABCD Study's National Data Archive ABCD 2.01 baseline dataset, collected between 2016 and 2018. The dataset comprises 11,875 9- and 10-year-old children residing in the US. Data on lifetime history of suicidal ideation and attempts, psychiatric disorders, and sociodemographic characteristics were collected from both children and their parents/guardians using the K-SADS-PL DSM-5. Sociodemographic variables included sex, race/ethnicity (collapsed into broader categories to maintain power), family income, parental education, and parental marital status. Youth also reported sexual orientation. The K-SADS-PL DSM-5 also assessed lifetime DSM-5 criteria for various mental health disorders (including MDD, anxiety disorders, disruptive behavior disorders, ADHD, eating disorders, and psychotic disorders, some categories collapsed due to low prevalence). Parental reports of mental health treatment utilization were also included. Given low inter-informant agreement in previous ABCD studies, child and parent reports were combined to maximize capture of suicide risk. Statistical analyses included cross-tabulations to estimate prevalence rates and bivariate and multivariate logistic regression analyses to evaluate sociodemographic and diagnostic correlates of suicidal ideation, suicide attempts (among those with ideation), and treatment utilization. The Benjamini-Hochberg procedure was used to adjust for multiple comparisons.

The study found a lifetime prevalence of 14.33% for suicidal ideation and 1.26% for suicide attempts among preadolescents. Multivariate logistic regression analyses revealed several significant predictors. For suicidal ideation, female sex, Hispanic ethnicity, and identifying as Black were associated with decreased odds, while identifying as a sexual minority, being multiracial, having unmarried parents, and being in the second or third quintile for family income were associated with increased odds. For suicide attempts (among those with suicidal ideation), identifying as gay or bisexual and being in the first or second quintile of family income were associated with increased odds. Regarding diagnostic predictors of suicidal ideation, having any psychiatric condition and particularly two or more disorders were associated with higher odds; specifically, MDD, GAD, conduct disorder, ODD, and ADHD were significant predictors. For suicide attempts, having two or more diagnoses significantly increased the odds; social anxiety disorder was a significant predictor, while separation anxiety was associated with lower odds. Analysis of treatment utilization among youth with suicidal ideation revealed that having any mental health diagnosis (especially two or more) significantly increased the odds of receiving treatment, and female, Black, or Hispanic youth had lower odds of receiving treatment. Specifically, 34.59% of youth with suicidal ideation and 54.82% of youth with suicide attempts received treatment.

The findings underscore the alarmingly high rates of suicidal ideation and attempts among preadolescents. The study's results demonstrate that sex differences in suicide risk may differ between preadolescents and adolescents, with males exhibiting higher rates of suicidal ideation in this younger age group. The association between comorbid psychopathology and suicidal ideation/attempts highlights the importance of considering multiple disorders in assessing and managing suicide risk. The significant role of social minority status and low family income emphasizes the need for targeted interventions addressing social inequities. Lower rates of treatment utilization among certain demographic groups point to systemic barriers in accessing mental health care. The finding that MDD strongly predicted suicidal ideation but not attempts suggests a need for a more nuanced understanding of the relationship between depression and suicidal behavior.

This study demonstrates concerningly high rates of suicidal ideation and attempts in preadolescent children, highlighting a critical need for targeted preventative and treatment efforts. Future longitudinal studies are needed to further explore the temporal relationships between risk factors and suicidal behavior. The study's findings emphasize the importance of considering sociodemographic and diagnostic factors when developing interventions. Improving access to mental health services, particularly for marginalized groups, is crucial.

The cross-sectional design limits causal inferences. Collapsing some sociodemographic and diagnostic categories reduced the granularity of analyses. The reliance on parental reports of treatment utilization may underestimate actual service engagement. Future research using longitudinal data and more detailed assessments of treatment utilization is needed.