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Developmental Trajectories of Suicidal Thoughts and Behaviors From Adolescence Through Adulthood

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Objective

Little is known about the patterns among individuals in the long-term course of suicidal thoughts and behaviors (STBs). The objective of this study was to identify developmental trajectories of STBs from adolescence through young adulthood, as well as risk and protective covariates, and nonsuicidal outcomes associated with these trajectories.

Method

A total of 180 adolescents (ages 12–18 years at recruitment) were repeatedly assessed over an average of 13.6 years (2,273 assessments) since their psychiatric hospitalization. Trajectories were based on ratings of STBs at each assessment. Covariates included psychiatric risk factors (proportion of time in episodes of psychiatric disorders, hopelessness, trait anxiety, impulsivity, and aggression in adulthood, sexual and physical abuse, parental history of suicidal behavior), protective factors (survival and coping beliefs, social support in adulthood, parenthood), and nonsuicidal outcomes (social adjustment and functional impairment in adulthood, school drop-out, incarcerations).

Results

Using a Bayesian group-based trajectory model, 4 trajectories of STBs were identified: an increasing risk class (11%); a highest overall risk class (12%); a decreasing risk class (33%); and a low risk class (44%). The 4 classes were associated with distinct patterns of correlates in risk and protective factors and nonsuicidal outcomes.

Conclusion

Adolescents and young adults have heterogeneous developmental trajectories of STBs. These trajectories and their covariates may inform strategies for predicting STBs and targeting interventions for individuals at risk for suicidal behavior.

Section snippets

Participants

The 180 participants in this study were recruited from adolescents consecutively discharged from a psychiatric inpatient unit between September 1991 and April 1995. Inclusion criteria were as follows: age 12 to 19 years at hospitalization; hospitalization for 10 or more days (the national length of stay was an average of 23.6 days at study initiation)33; ability to complete the assessments in the hospital; and residency in North Carolina or Virginia at recruitment. Exclusion criteria were a

Identification of Trajectories

Four latent class trajectories were identified using MCMC simulation approaches: a class with increasing risk beginning in adulthood (11%; “increasing class”); a class that began at high risk in adolescence but gradually decreased risk through young adulthood (12%; “highest overall risk class”); a class with markedly decreasing risk from adolescence through young adulthood (33%; “decreasing class”); and a class that remained at relatively low risk throughout the follow-up (44%; “lowest risk

Discussion

In this longitudinal study of high-risk adolescents followed up through adulthood, we used a Bayesian approach to identify 4 distinct developmental trajectories of STBs. Each of the participants in this study had differing probabilities of being associated with each of the 4 trajectories. Previous studies have described the risk of individuals who are suicidal as a single group, examined trajectories of other risk factors in relation to STBs, examined trajectories of STBs in a priori–defined

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    • Cited by (0)

    This longitudinal study was initiated with funding from the William T. Grant Foundation. The research receives current support from the National Institute of Mental Health of the National Institutes of Health (R01 MH048762). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

    Dr. Erkanli served as the statistical expert for this research.

    The authors appreciate the assistance of Andrew M. Mitchell, MMFT, Wake Forest University School of Medicine, with this study.

    Disclosure: Dr. Goldston has received support from the National Institute of Mental Health, the National Institute on Alcohol Abuse and Alcoholism, the Department of Defense (via contract with the Henry M. Jackson Foundation), the Substance Abuse and Mental Health Services Administration (via contract with ICF International), the American Foundation for Suicide Prevention, and the James B. Duke Endowment. Dr. Erkanli has received support from the National Institute of Mental Health, the National Institute on Drug Abuse, and the National Institute of Biomedical Engineering and Bioengineering. Dr. Daniel has received support from the National Institute of Mental Health, the National Institute of Child Health and Human Development, the Kate B. Reynolds Charitable Trust, the NC Department of Health and Human Services, and Centerpoint Human Services. Dr. Heilbron has received support from the National Institute on Alcohol Abuse and Alcoholism, the Department of Defense (via contract with the Henry M. Jackson Foundation), the James B. Duke Endowment, and the Marcus Foundation. Dr. Weller has received support from Pfizer, the National Institute of Mental Health, and the Department of Defense (via contract with the Henry M. Jackson Foundation). Dr. Doyle has received support from the National Institute of Mental Health and the Institute for Race and Public Policy’s Faculty Fellowship Program at the University of Illinois, Chicago.

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