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Factors Associated with Distinct Patterns of Suicidal Thoughts, Suicide Plans, and Suicide Attempts Among US Adolescents


The current study examined demographic, psychosocial, and substance use factors associated with distinct patterns of past 12-month suicide thoughts, plans, and attempts among adolescents drawn from a nationally representative sample of high schoolers. Data were from the 2015, 2017, and 2019 National Youth Risk Behavior Survey. Four mutually exclusive 12-month suicidal behavior patterns were identified: suicide thoughts only (pattern 1), suicide thoughts and plans without suicide attempt (pattern 2), suicide attempt with thoughts and/or plans (pattern 3), and suicide attempt without thoughts or plans (pattern 4). Multinomial logistic regression analyses were conducted to examine factors correlated with these distinct patterns. Psychosocial and substance use factors were modeled as independent predictors, controlling for demographic characteristics, as well as simultaneously to represent the potential for co-occurrence. The analytic sample included 7491 respondents. About 24% (n = 1734) of youth endorsed pattern 1, 38% (n = 2779) pattern 2, 35% (n = 2716) pattern 3, and 3% (n = 262) pattern 4. All psychosocial and substance use factors measured were individually associated with greater odds of suicide attempts with thoughts or plans (pattern 3) than patterns 1 or 2. Black and male youth were at greater odds of suicide attempts without thoughts or plans (pattern 4) than all other patterns. When modeled simultaneously, respondents who were bullied online, sad or hopeless, had a history of sexual violence, used cigarettes, and misused prescription opiates retained greater odds of suicide attempts with thoughts or plans (pattern 3) than patterns 1 or 2. Findings suggest screening for suicidal behaviors should include factors that differentiate between varying suicidal expressions and that may cue providers to intervene in the absence of suicide thoughts and plans.

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Dr. Sheftall’s time was supported, in part, by grants from the American Foundation for Suicide Prevention (AFSP; YIG-1–152-19-Sheftall) and the National Institute of Mental Health (NIMH; 1R21MH116206-01A1). Dr. Lindsey’s time was supported, in part by a grant from the National Institute of Mental Health (NIMH; 1R34MH119290-01).

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Correspondence to Meghan Romanelli.

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Ethics Approval

Primary Data Source-National YRBS: For all years, the CDC’s Institutional Review Board (IRB) approved the YRBS protocol. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This study was determined as not human subjects research as data were not directly obtained by these researchers through intervention/interaction and identifiable private information was not utilized. A secondary data analysis was completed of the National YRBS, publicly available and de-identified data. Data is available for download at:

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Informed consent was obtained from all respondents of the National YRBS. Location parental permission procedures were followed.

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The authors declare no competing interests.

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Romanelli, M., Sheftall, A.H., Irsheid, S.B. et al. Factors Associated with Distinct Patterns of Suicidal Thoughts, Suicide Plans, and Suicide Attempts Among US Adolescents. Prev Sci 23, 73–84 (2022).

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  • Suicidal ideation
  • Suicide
  • Attempted
  • Adolescent mental health
  • Suicide assessment