(PS2-B27) Adolescent Anxiety Symptoms and Suicidal Ideation: A Longitudinal Mediation Model

Suicide is the 2^nd leading cause of death among adolescents (Centers for Disease Control and Prevention, 2019). The COVID-19 pandemic may have further exacerbated adolescent suicide risk. The number of emergency department visits in the U.S. for suspected suicide attempts among adolescent girls were 50.6% higher in early 2021 than during the same period in early 2019, and 3.7% higher for adolescent boys (Yard et al., 2021). Suicidal ideation (SI) is one of the strongest predictors of future suicide attempts (Brown et al., 2000). Understanding mechanisms that contribute to adolescent suicidal ideation is important for bolstering the effectiveness of suicide prevention efforts in this population.

While several cross-sectional studies have found a positive relation between anxiety symptoms and suicidal thoughts and behaviors, there have been few longitudinal studies in this area, precluding investigation of underlying mechanisms. In line with the Interpersonal Theory of Suicide (IPTS; Joiner, 2005), the present study examined whether anxiety symptoms lead to feelings of burdensomeness towards others (i.e., perceived burdensomeness; PB), or social disconnection (i.e., thwarted belongingness; TB), which in turn, increase severity of SI.

We examined these mediational hypotheses in a sample of 147 high-risk adolescents (M_age = 14.91, 76.2% female, 85.5% White), who had been hospitalized for suicidal thoughts or behavior and enrolled in a randomized clinical trial. Participants completed self-report measures of current anxiety symptoms (SCARED), feelings of PB/TB (INQ), SI severity (SIQ-JR), and depressive symptoms (CDI-2) at baseline, 6 months, and 12 months. Two path models, with PB and TB as single mediators, were conducted in Mplus. Covariates included age, sex, and treatment condition as well as baseline SI severity, depressive symptoms, and PB or TB.

There was not a direct effect of baseline anxiety symptoms on 12-month SI severity in either path model. Additionally, 6-month TB was not a mediator of the relation between baseline anxiety symptoms and 12-month SI severity. However, 6-month PB was found to mediate the relation between baseline anxiety symptoms and 12-month SI severity. Results suggest that PB may be an important mechanism underlying the relation between anxiety symptoms and adolescent SI. Youth with more severe anxiety symptoms may believe that their anxiety-related impairment is burdensome on family and friends, which may increase SI. Interventions that address feelings of PB among youth with significant anxiety may help reduce suicide risk.