Beyond Depression Severity: Symptom-Specific Associations of Suicidal Thoughts and Behaviors

Suicidal thoughts and behaviors (STBs) emerge during adolescence and often persist or escalate into adulthood. Although depression is a well-established risk factor, it remains unclear how specific depressive symptoms distinctly predict the escalation of STBs over time.

Using data from the National Longitudinal Study of Adolescent to Adult Health, we applied adjacent-category logit models, an ordinal regression approach that estimates the odds of progression between levels of suicidality, to examine how individual depressive symptoms predicted STBs cross-sectionally, longitudinally, and in terms of escalation.

In cross-sectional models, poor appetite, sadness, feelings of worthlessness, and sleep disturbance were significantly associated with suicidal ideation (SI), while psychomotor retardation and identifying as White were associated with lower odds. Longitudinally, sadness, being female, and prior ideation predicted later SI, while poor appetite was inversely associated. Feelings of worthlessness, poor appetite, and prior suicide attempts predicted progression from ideation to attempt. No depressive symptoms significantly predicted progression to serious suicide attempts. In transitional models, sadness, being female, younger age, and identifying as a racial/ethnic minority predicted escalation in suicidal severity over time.

The findings suggest that targeting specific symptoms, rather than overall depression severity, may improve early identification and intervention for adolescents at risk of escalating suicide risk.