Antecedents and Consequences of Chronic Suicidal Ideation in Adolescence

The purpose of this study is to clarify developmental trajectories of suicidal ideation during adolescence and their association with later suicide attempts, Major Depression, diagnoses and additional risk behaviors in an urban sample of African American participants. Suicidal ideation is a primary precursor on the pathway to suicide attempt and death by suicide. Additionally, persistent ideation independently carries with it a substantial burden to the individual and society and is associated with deleterious outcomes and psychopathology. Few studies have investigated the longitudinal trajectory of suicidal ideation. Ethnic minorities are rarely included in these studies.  Suicide prevention efforts occur in schools nationwide, yet we do not have guidance regarding the most beneficial timing during the course of early development for the implementation of suicide prevention programs.  Therefore, in order to most appropriately target suicide prevention efforts, further understanding regarding the developmental trajectories of ideation is needed, particularly among ethnic minorities. This will be accomplished using a community-based longitudinal prevention intervention trial, which began data collection in the Baltimore City public schools in 1993.  Participants, currently in their mid 20’s, were assessed annually using a variety of methods and measures. Results of these analyses aim to 1) longitudinally follow community-residing African American young people through the peak period of risk for a first suicide attempt to highlight the demographic, behavioral and clinical features that distinguish adolescent suicide ideators who make a suicide attempt from those who do not; 2) elucidate a critical window of opportunity for school–based suicide prevention.  Subtypes of the developmental course of suicidal ideation across adolescence were identified using longitudinal latent class analyses with 678 African-American adolescents (54.4% male; 75% free or reduced lunch). Two subtypes (i.e., ideators and non-ideators) were identified, and 37% of ideators reported a future suicide attempt. Ideators were also more likely to meet diagnostic criteria for Major Depressive Disorder (MDD) as compared to non-ideators and were more likely to report high-risk sexual behaviors than the non-ideator subtype. Importantly, the peak onset of suicidal ideation occurred in 7^th grade. Results of these analyses emphasize the critical clinical and behavioral correlates of suicidal ideation and highlight the importance of earlier intervention.