Journal Article Annotations
2025, 3rd Quarter

Child and Adolescent Psychiatry

Annotations by Sneha Jadhav, MD
September, 2025

Mental Health Antecedents and Correlates of 2 Distinct Developmental Pathways to Suicidal Ideation.

PUBLICATION #1 — Child and Adolescent Psychiatry

Mental Health Antecedents and Correlates of 2 Distinct Developmental Pathways to Suicidal Ideation.

Marie-Claude Geoffroy, Sasha MacNeil, Vincent Paquin, Ayla Inja, Alain Girard, Élise Chartrand, Natalie Castellanos-Ryan, Charles-Édouard Notredame, Ian Colman, Massimiliano Orri, Gustavo Turecki, Sylvana Côté.

Abstract: JAMA Psychiatry. 2025 Sep 1;82(9):916-925. doi: 10.1001/jamapsychiatry.2025.1273.

Importance:
Suicidal ideation is increasingly common in youth. Trajectories and associated mental health symptoms across development remain poorly understood.

Objective:
To describe trajectories of suicidal ideation from early adolescence to young adulthood and identify preceding and co-occurring mental health symptoms to inform optimal prevention.

Design, setting, and participants:
This cohort study used data from a contemporary, longitudinal cohort study, the Québec Longitudinal Study of Child Development (QLSCD), including reports from participants, parents, and teachers. The QLSCD is a population-based birth cohort study of 2120 singletons born between 1997 and 1998 in Québec, Canada, and followed up to age 25 years (2023). Data were analyzed from September 2024 to February 2025.

Main outcomes and measures:
Serious suicidal ideation in the past 12 months was assessed by a question to participants at ages 13, 15, 17, 20, 23, and 25 years.

Exposures:
Mental health symptoms (eg, internalizing, externalizing) as reported by parents, teachers, and self-reports on validated questionnaires and standardized across 5 developmental periods: preschool (3-5 years), childhood (6-12 years), early adolescence (13 years), mid-late adolescence (15-17 years), and young adulthood (20-25 years).

Results:
A total of 1635 participants (845 female [51.7%]; participant number is weighted to account for selective attrition) provided answers on suicidal ideation, with survey weights applied. A total of 3 trajectories were identified: minimal/no ideation (1433 [87.6%]), onset in early adolescence (117 [7.1%]), and onset in young adulthood (86 [5.2%]). Relative to minimal/no ideation, onset in early adolescence was associated with elevated symptoms across nearly all mental health indicators from childhood through adulthood. This included both internalizing (eg, childhood depressive symptoms: risk ratio [RR], 1.75; 95% CI, 1.45-2.05) and externalizing (eg, childhood disruptive symptoms: RR, 1.60; 95% CI, 1.29-1.91) symptoms and maternal antisocial symptoms (RR, 1.39; 95% CI, 1.11-1.66). In contrast, onset of suicidal ideation in young adulthood was associated with internalizing symptoms (eg, mid-late adolescence depressive symptoms: RR, 1.84; 95% CI, 1.28-2.39) emerging in adolescence and worsening mental distress in young adulthood.

Conclusions and relevance:
Results of this cohort study revealed 2 pathways to suicidal ideation: onset in early adolescence, with persistent childhood internalizing/externalizing symptoms, and onset in young adulthood linked to internalizing symptoms emerging in adolescence without prior distress. Findings suggest timely addressing mental health symptoms and developmental stage-specific prevention.

Annotation

The finding:
The study found three trajectories of suicidal ideation: Minimal/No Ideation (87.6%), Early Adolescent Onset (7.1%), Young Adult Onset (5.2%). Early-onset group showed elevated disruptive symptoms from childhood onwards. Suicidal ideation was associated with persistent internalizing and externalizing symptoms. There was strong association with maternal antisocial traits. Late-onset group was linked to internalizing symptoms emerging in adolescence and worsening in young adulthood. There was a notable lack of externalizing symptoms in childhood.

Strength and weaknesses:
The study has a Longitudinal design spanning over two decades (ages 3–25) and uses multi- informant data (parents, teachers, self). It used validated measures and survey weighting to account for attrition.

Limitations include use of self-reported suicidal ideation which could lead to underreporting or recall bias. The study did not include clinical diagnoses—symptoms were assessed via questionnaires, not structured interviews. The study is based on a specific population and may have limited generalizability.

Relevance:
Disruptive behaviors in childhood are often secondary to poor impulse control which plays an important role in mood regulation and suicidal ideation/ comments at that age. This may be an important factor in adult presentation as well and may have limited response to anti- depressants. History of such traits may help alter the treatment protocols early on to include therapy or medication directed at impulse regulation. Early-onset may require more intensive, multimodal interventions due to chronicity and comorbidity. Late-onset may benefit from targeted treatment of emerging internalizing symptoms.

Maternal psychopathology may be an important risk marker.