Sex Differences in Behavioral and Psychopathological Trajectories From Late Childhood to Early Adolescence: Implications for Suicidality Risk

Background Although the link between psychopathological and behavioral issues and suicidality is well‐established, existing studies often focus on static timepoints, neglecting their dynamic nature and sex differences. This study investigates the trajectories of these symptoms from late childhood to early adolescence and their association with suicidality, while also examining variations by sex. Methods We included 7849 unrelated children from the Adolescent Brain Cognitive Development (ABCD) cohort, with assessments conducted over a 3‐year follow‐up period. Caregiver‐reported psychopathological and behavioral symptoms were assessed using the Child Behavior Checklist (CBCL) at baseline (ages 9–10) and during three subsequent annual follow‐ups. Youth‐reported suicidality was assessed at both baseline and the 3‐year follow‐up (ages 12–13) using the Kiddie Schedule for Affective Disorders and Schizophrenia (K‐SADS). Results Latent class growth analysis (LCGA) identified three trajectory groups for total problems, internalizing, and externalizing behaviors, and two trajectory groups for each dimension. All high symptom trajectory groups had a higher risk of suicidality compared to low symptom trajectory groups, with adjusted odds ratios (ORs) ranging from 1.35 to 3.15 (all p < 0.05). Persistent high anxious/depressed symptoms showed the strongest association with suicidal ideation (SI; adjusted OR = 1.96, p < 0.001), while persistent high attention problem was most strongly associated with suicide attempts (adjusted OR = 2.87, p < 0.001). Persistently high anxious/depressed symptoms most strongly predicted suicide‐related outcomes in girls (OR = 2.17, 95% confidence interval CI: 1.73–2.71), whereas high‐increasing withdrawn/depressed symptoms showed the strongest association in boys (OR = 2.00, 95% CI: 1.53–2.60). Persistently high attention problems consistently and most strongly predicted suicide attempts in both sexes (boys: OR = 3.41, 95% CI: 1.52–7.65; girls: OR = 2.98, 95% CI: 1.72–5.14). Conclusions Trajectories of psychopathological and behavioral symptoms from late childhood to early adolescence are modestly associated with suicidality during this critical transition. Withdrawn/depressed symptoms strongest predicted risk in boys, whereas anxious/depressed symptoms were most salient in girls. Attention problems consistently predicted suicide attempts across both sexes. These findings emphasize the need for ongoing monitoring and early intervention for at‐risk youth to potentially reduce adolescent suicidality.