Characteristics Differentiating Preadolescents With Suicidal Ideation From Those Who Display Suicidal Behaviors

Background Increases in suicide attempts in preadolescents represent a serious public health concern. This study aimed to identify prospective and concurrent risk factors that differentiate children with suicidal ideation (SI) from those with a suicide attempt (SA) across childhood. Method 195 participants comprised of 8–12‐year‐olds from the Pediatric Suicidality Study, which followed a sample of preschoolers enriched for depression into preadolescence. Clinical diagnostic interviews and surveys to assess children's thoughts, behaviors, and experiences were administered to caregivers (preschool, preadolescence) and children (preadolescence). Results Three groups were created based on preadolescents' lifetime history of SI/SA: Suicide Attempt (SA; n = 25), Suicide Ideation without Attempt (SI‐only; n = 102), and No SI/SA ( n = 68). Compared to preadolescents with SI‐only, preadolescents with SA exhibited increased depression (OR = 1.52), anxiety (OR = 1.32), maladaptive guilt (OR = 3.31), catastrophizing (OR = 1.24), stressful (OR = 1.20) and traumatic events (OR = 1.82) by preadolescence. Preadolescents with SA also exhibited increased anxiety (OR = 1.07) and maladaptive guilt during preschool (OR = 4.10). Family SA and social relationships did not differentiate groups. Conclusions Findings demonstrate unique and separable risk factors for SI and SA in children under age 13 with clinical implications for assessing suicide risk. Alongside depression and anxiety, assessments of maladaptive guilt may be important to identify at‐risk children for increased monitoring and intervention.