Mental health problems and risk of suicidal ideation and attempts in adolescents

Abstract

Background: Obtaining recent estimates of the prevalence of suicide-related outcomes across adolescence, and its associated mental health problems (MHPs) is important for clinical practice. We estimated prevalence of suicide-related outcomes at ages 13, 15, 17 and 20y (2011-2018) in a contemporary population-based cohort and documented associations with MHPs throughout adolescence. Methods: Data were from 1618 participants from the Quebec Longitudinal Study of Child Development. Internalizing (depression, anxiety) and externalizing (oppositional/defiance, conduct, attention deficit and/or hyperactivity) MHPs were assessed with validated questionnaires. Outcomes were self-reported passive and serious suicidal ideation, and suicide attempt. Results: Lifetime prevalence for passive suicidal ideation (13-17y), serious suicidal ideation, and suicide attempt (13-20y) were 21.7%, 11.9%, and 6.7%, respectively. Prevalence was twice as high for females than for males. Overall, rates of passive (15y-to-17y, 11.80%-18.40) and serious ideation (13y-to-20y, 3.30%-9.50%) increased over time, but were stable for attempt (13y-to20y, 3.50%-3.80%). In univariable analyses, all MHPs were associated with suicide-related outcomes at all ages (Risk Rate Ratios range: 2.57-3.10 for passive ideation to 2.10-4.36 for suicide attempt), and associations were similar for males and females (sex-interaction Ps>.05). Magnitude of associations were generally stronger for more severe suicide-related outcomes (passive ideation<serious ideation<attempt). In multivariable analyses, internalizing problems were associated with suicidal ideation, while both depressive and conduct symptoms were associated with attempt. Conclusion: Suicidal ideation and attempt were common, especially for females and youth presenting depressive and conduct problem symptoms. Clinicians should systematically assess suicidal risk in teens, especially in those presenting MHPs.