Suicidal thoughts predict depression symptoms more in early adolescence

Suicidal ideation in early adolescence predicted other symptoms of depression, while depressive symptoms in middle adolescence predicted suicidal ideation, according to a study in Journal of Psychiatric Research.

“The developmental stages of early, middle and late adolescence are characterized by an evolution from concrete thinking and egocentrism to improved impulse control and future-focused decision making,” Mikael Rubin, a PhD student at the University of Texas, Austin, and colleagues wrote. “Simultaneously, pubertal changes further affect self-perception of mood and interpersonal relationships. Alongside these major mental and physical changes, the percentage of children experiencing major depressive episodes more than triples from early to late adolescence.”

Thus, the researchers assessed the de-identified data of 4,208 adolescents (90% Hispanic; 56% girls) aged 11 to 17 years with previous depression diagnoses available in urban pediatric primary care records from 2015 to 2017. They conducted Cross-Lagged Panel Network analysis of depressive symptoms collected through the Patient Health Questionnaire twice over 1 year.

Participants aged 11 to 13 years were categorized as early adolescents, and those aged 14 to 16 years were considered middle adolescents.

Among early adolescents, suicidal ideation (SI) significantly correlated with movement dysregulation (OR = 8.535); feelings of failure and appetitive disturbance were likely to endorse SI (OR = 3.675 and OR = 3.153, respectively).

In middle adolescents, feelings of failure increased the likelihood of SI (OR = 6.023) and movement dysregulation (OR = 2.798), and appetitive disturbance increased the likelihood of SI (OR = 2.684).

“Critically, our analyses identified two symptoms, feelings of failure and appetitive disturbance, that appear to consistently predict the presence of SI in both early and middle adolescence,” Rubin and colleagues wrote. “Although further validation of these findings is needed, our results suggest that these two symptoms may serve as additional indicators of potentially concerning depression-related pathology in the absence of SI endorsement or globally elevated symptoms.”

The researchers noted their results may help pediatric general practitioners with educating on, assessing and intervening in depression.

While the study established data on the often-underrepresented Hispanic population, limitations included small sample size, use of different individuals between age groups and infrequent SI endorsement. Rubin and colleagues suggested more in-depth research in reference to ethnicities should be conducted.

“In the context of risk factors, further mental health screening and intervention are critical, especially considering the evidence that youth, and particularly those from racial/ethnic minority groups, often do not receive much needed mental health services,” they wrote. “These results highlight several symptoms that may be important to consider for future research.”