Examining Factors Associated with Escalatory Suicide Risk Among US Adolescents

Background and Purpose: As the second leading cause of death among US youth aged 10-19 years, suicide is a major public health concern. To date, not much research has considered what risk factors influence the progression from suicidal thoughts to actions. Instead, extant literature often combines youth with suicidal thoughts, plans, or attempts and compares them with non-suicidal youth, leading to evidence of broad suicide correlates. This study, grounded by the ideation-to-action framework, examined factors that distinguished suicidal ideators from suicide attempters—representing escalating suicide risk—among a nationally representative sample of high school students.

Methods: Data were obtained from the 2017 National Youth Risk Behavior Survey. The analytic sample consisted of students who reported having suicidal thoughts, a suicide plan, and/or a suicide attempt within the past 12 months. From this data, four mutually exclusive groups were created based on their experiences of suicidality: 1) youth with suicidal thoughts, but no plans or attempts; 2) youth with suicidal thoughts and plans, but no attempts; 3) youth with suicidal thoughts, plans, and attempts, and; 4) youth who attempted suicide, but did not report having thoughts or plans. Multinomial logistic regression was used to predict group membership and examine what factors might distinguish youth who only think about suicide from those who attempt suicide. Along with sociodemographic characteristics (e.g., race, sex, age, sexual identity), risk factors including experiences of bullying, sexual violence, and hopelessness and difficulty concentrating—as proxies for depressive symptoms—were examined as predictors. A weight based on student sex, race/ethnicity, and grade was applied to adjust non-response and oversampling.

Results: The data analytic sample included 2,229 respondents who confirmed that they had suicidal thoughts, plans, and/or attempts. About 26% (n=585) of youth reported suicidal thoughts without plans or attempts and 37% (n=828) had suicidal thoughts and plans, but no suicide attempt. Close to 34% (n=755) of the sample reported thoughts and plans along with attempted suicide in the past year, while almost 3% (n=61) attempted suicide, but did not endorse having suicidal thoughts or plans. Compared to those who only endorsed suicidal thoughts, youth with thoughts and plans were significantly more likely to be multiracial (OR_adj= 1.44). Youth reporting thoughts, plans, and attempts were more likely than youth who only endorsed suicidal thoughts to: be Black (OR_adj= 2.38) or multiracial (OR_adj= 1.89); have experienced electronic bullying (OR_adj= 1.87); report a history of sexual assault (OR_adj= 2.71), and; indicate feelings of hopelessness (OR_adj= 1.54) or difficulties concentrating (OR_adj= 1.63). Respondents who had a suicide attempt in the past year, but no reported thoughts or plans, were more likely to be Black (OR_adj= 5.16) and have a history of sexual assault (OR_adj= 5.47) than youth with suicidal thoughts only.

Conclusions and Implications: Several factors distinguished suicidal ideators from suicide attempters. Indeed, race, depressive symptoms, and experiences of bullying or sexual violence predicted youth’s progression from thinking about suicide to acting on these ideations. Prevention/intervention programs targeting these factors may remediate escalatory suicidal behaviors among youth experiencing suicidal thoughts.