A network analysis of symptom-level associations between suicidality, depression and anxiety in Spanish adolescents

Suicidal ideation and behavior represent a serious public health concern, particularly during adolescence, and are closely linked to symptoms of depression and anxiety. Although previous studies have examined the network structure of suicidality and emotional symptoms, gaps remain regarding how different stages of suicidal ideation and behavior relate to internalizing symptoms. This study aimed to estimate the lifetime prevalence of suicidal ideation and behavior, examine the associations between depressive and anxiety symptoms and distinct forms of suicidal behavior, and compare symptom networks between adolescents who had or had not reported such experiences.

A total of 4160 Spanish adolescents participated in this nationwide study, completing the Paykel Suicide Scale and the Assessment System of Children and Adolescents.

12.7 % of participants reported suicidal ideation and 3.6 % had attempted suicide, with higher rates among girls and older adolescents. Network analyses revealed that worthlessness, anhedonia, sadness, crying, panic attacks and intrusive thoughts were consistently associated with both passive and active suicidal ideation and attempts. Moreover, adolescents who had experienced suicidal ideation or attempts displayed stronger interconnections among depressive symptoms and between depressive and anxiety symptoms.

The sample was partially based on convenience sampling, and the large amount of network comparisons limited power.

These findings provide a comprehensive view of the psychopathological structure underlying suicidality in adolescence and contribute to the identification of key emotional symptoms that may be targets for early intervention and prevention strategies.