(PS2-C75) Forms of Suicidal Ideation and Suicide Attempts in a Large Sample of Children: Sex Differences in Prevalence, Incidence, Transitions, and Agreement Across Waves

Background: From 2012 to 2017, the rate suicide among children in the US has increased almost 15% annually (Mishara & Stijelja, 2021). Most data on the prevalence of suicidal ideation (SI) and suicide attempts (SAs) derives from high risk samples with parents as main informants. Recent voices have highlighted the importance of asking children these questions, as parents are not reliable informants of child’s suicidality (DeVille et al., 2020). This study provides self-reported information on the prevalence, incidence, transition, and agreement rates on different forms of SI (passive, non-specific, and active) and SAs in childhood and examines sex differences.

Methods: Three waves (W) of yearly assessments from the Adolescent Brain Cognitive Development (ABCD) Study were used. A sample of 9,922 children (9 and 10 years old, 47.6% female) who answered the KSADS-5 questions about lifetime SI and SAs at each wave were included (83.5% of the total sample).

Results: Over the three years, 1,738 (17.5%) children thought about suicide: 856 (8.6%) reported lifetime SI at W1, 506 (5.1%) reported first-time SI at W2 and 375 (3.8%) reported first-time SI at W3. Passive SI was the most severe form of SI reported (7.1%), followed by non-specific SI (6%) and active SI (4.4%). More boys than girl thought about suicide at W1 (X² = 11.87, p < 0.001) and more girls than boys reported new SI at W3 (X²= 21.62, p < 0.001). A total of 191 (1.9%) children attempted suicide: 76 (39.8%) reported a lifetime SA W1, 52 (27.2%) reported a first-time SA at W2 and 63 (33%) reported a first-time SA at W3. More than half of the children who attempted suicide reported non-specific SI as the most severe form of SI they experienced, followed by active SI (36.6%). We did not find sex differences in SAs. Among children without SI and SA at W1 (N = 9,057), 9.7% started thinking about suicide and 0.8% attempted suicide at follow up. Girls were more likely to transition to SI (X²= 11.55, p < 0.001) and to SA (X²= 11.87, p = 0.51, marginal association) than boys. Among children with SI-only at W1 (N = 789), 39 (4.9%) attempted suicide at follow up. Of those 39 children, 16 reported passive SI (41%) and 15 reported non-specific SI (38.5%) as the most severe forms of SI they experienced at W1. We did not find sex differences in the transition. More than half of the children who reported lifetime SI and SA at W1 did not report again lifetime SI and SA, respectively, at follow up. Boys and girls did not differ in their level of agreement.

Discussion: Over the three-year period, the prevalence of SI was high, with passive SI being the most frequently form reported. Sex differences emerged over time in the expected direction, but only for SI, with girls reporting higher prevalence of new SI than boys at W3. Non-active forms of SI, especially non-specific SI (i.e., desire to kill oneself, but not plan), were more frequently identified among children who attempted suicide or transitioned from SI to SA. Based on these preliminary findings, clinicians should consider non-specific as well as active ideation to determine level of risk. Over the three years, children were inconsistent in their report of events. Severity of SI or SA, cognitive development or the format of the questions could be factors potentially related to an inconsistent report.