Adult Associations of Childhood Suicidal Thoughts and Behaviors: A Prospective, Longitudinal Analysis
Open accessAbstract
Objective Suicidal thoughts and behavior (STBs) have their peak period of onset in adolescence, but little is known about how such behavior is associated with later functioning. The aim of this study is to test whether childhood STBs are related to adult psychiatric, suicidal, and functional outcomes.Method This is a prospective, population-based community study of 1,420 participants assessed with structured interviews up to 7 times in childhood/adolescence (ages 9-16 years; 6,674 observations) for STBs including passive and active ideation, plans, and attempts. Participants were then assessed 4 times in young adulthood (ages 19, 21, 24, and 30 years; 4,556 observations of 1,273 participants) for psychiatric diagnoses, STBs, and functional outcomes.Results By age 16 years, 7.0% of participants had reported some type of STBs, with 3.9% reporting an attempt. Both ideation only and suicide attempts were associated with higher levels of anxiety disorders and STBs in adulthood, as well as poor functioning across financial, health, risky/illegal, and social domains. These observed effects generally were attenuated after adjusting for other psychiatric and psychosocial factors that predict childhood STBs (particularly maltreatment, depression, and disruptive behavior disorders). The exception was adult suicidal behavior, which was predicted by both childhood ideation and attempts, even in the fully adjusted model. Children and adolescents with STBs were more likely to have had a disrupted transition to adulthood.Conclusion Childhood STBs are a marker for a multitude of poor psychiatric and functional outcomes in adulthood, but these effects are largely accounted for by other factors. In contrast, childhood STBs are a robust risk factor for adult suicidal thoughts and behavior.
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Earlier onset age of suicidal thoughts and behaviors is prospectively associated with more severe psychopathology and poorer functioning across domains in adulthood.
“Furthermore, an earlier onset age of suicidal thoughts and behaviors is prospectively associated with more severe psychopathology and poorer functioning across various domains in adulthood (22).”
From Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems (2022) · cites this paper as [22]
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“The link between suicidal symptoms, psychosocial and school function seems to be bidirectional; Adolescent self-harm or suicidal behavior are found to be associated with later mental health disorders and worse long-term functioning in young adulthood [38, 39].”
BackgroundČolić, L., Villa, L. M., Dauvermann, M. R., van Velzen, L. S., Sankar, A., Goldman, D. A., Panchal, P., Kim, J. A., Quatrano, S., Spencer, L., et al. (2022) · JCPP Advances · doi:10.1002/jcv2.12118 · Cited by 10 · see citing works
“Although adolescent onset of SI and SBs confers risk for future SI and SBs (Copeland et al., 2017), there is substantial individual variation in the future risk (Goldston et al., 2016).”
Martínez-Levy, G. A., Campos, A. I., Rabinowitz, J. A., García‐Marín, L. M., Benjet, C. L., Méndez, E., Rentería, M. E., & Cruz-Fuentes, C. S. (2021) · American Journal of Medical Genetics Part B Neuropsychiatric Genetics · doi:10.1002/ajmg.b.32864 · Cited by 12 · see citing works
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“Suicidal ideation or behavior at a young age (i.e., suicidality) are not solely predictors of subsequent suicidal death but are also associated with a range of negative outcomes, such as increased mental and general medical morbidity [2].”
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“Furthermore, adolescent STBs confer risk for suicide death and are associated with significant academic, social, and functional impairment that continues into adulthood (CDC, 2023, Copeland et al., 2017; Foley et al., 2006).”
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“These high rates are alarming as STBs during adolescence are associated with significant interper - sonal and health impairment, both concurrently (Glenn & Klonsky, 2013) and into adulthood (Copeland et al., 2017).”
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“Effective treatments of suicidal ideation are limited for adolescents with major depressive disorder (MDD) [6–8].”
BackgroundAge-stratified predictions of suicide attempts using machine learning in middle and late adolescence
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“Prior research showing differences in health outcomes between young suicide attempters and controls suggested the possibility that self-harm may not have an independent causal effect, but may be more properly understood as a proxy for severe psychiatric disorders or other vulnerabilities more common among self-harming…”
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“…and/or self-harm onset has been associated with a number of adverse outcomes, including: poorer functional, interpersonal, and social outcomes (Copeland et al., 2017; Reinherz et al., 2006), increased risks of experiencing mood and/or anxiety disorders (Fergusson et al., 2005; Herba et al.,…”
Suicidal Thoughts and Behaviors Increased Among Young Adults. Why?
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“Youth experiences with SITBs are associated impairments in both academic and socioemotional functioning (Copeland et al., 2017).”
Increased Exposure to Violence and Risk of Neurodevelopmental Disorders in Children
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Suizidalität im Kindes- und Jugendalter
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“…suicidal ideation (SI) is one of the most potentially life threatening because it increases risk for both immediate and future suicide attempts (Copeland et al., 2017) and is more frequent in youth with histories of maltreatment and involvement with the child welfare system (CWS) than in other…”
BackgroundInfluentialCampbell, P. G., Proulx, J. D. E., Sollis, K., Cruwys, T., Calear, A. L., Rathbone, J. A., Sheanoda, V., & Reynolds, K. J. (2025) · The Lancet Psychiatry · doi:10.1016/s2215-0366(25)00243-3 · Cited by 1 · see citing works
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“Left unaddressed, SI and NSSI are linked to worse broad mental health outcomes in adulthood (Copeland et al. 2017; Daukantaitė et al. 2021), which can also be risk factors for SA.”
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“These outcomes are a public health concern, as they are known precursors to suicide [2, 3] and are strong predictors of psychiatric disorder in adulthood [4–6].”
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“Moreover, pre-adolescent and adolescent SITBs lead to significant short-and long-term social, psychological, and financial impairment (Copeland et al., 2017; Thompson et al., 2025; Whalen et al., 2022), including increased SITB severity over time (Glenn et al., 2017; Miranda et al., 2022; Ribeiro…”
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“On the other hand, Copeland et al. (2017) found, in a 20-year longitudinal study from adolescence, that having suicidal ideation in childhood and adolescence was a risk factor for suicidal behaviors in adulthood.”
BackgroundSuizidalität im Kindes- und Jugendalter
Plener, P. L., & Kaess, M. (2024) · Springer Reference Medizin · doi:10.1007/978-3-662-66744-6_128
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“Similarly, researchers have provided evidence suggesting that childhood and adolescent suicidal ideation and attempts serve as significant predictors of suicidality and depression in adulthood (Copeland et al., 2017; Fergusson et al., 2005; Herba et al., 2007; Reinherz et al., 2006).”
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“…that such behavior significantly increases the risk of developing major mental disor - ders such as depression and post-traumatic stress disorder (Copeland et al., 2017), disrupts social relationships and academic functioning, and substantially raises the probability of premature mortality…”
Gårdvik, K. S., Torgersen, T., Rygg, M., Lydersen, S., & Indredavik, M. S. (2021) · Figshare · doi:10.6084/m9.figshare.14059621
- Authors
- Copeland, W. E., Goldston, D. B., & Costello, E. J.
- Affiliations
- Duke Medical Center (US)
- Corresponding author
- Copeland, William E.
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2017-11
- Volume
- 56
- Issue
- 11
- Pages
- 958-965.e4
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC6501553
- OpenAlex
- W2756260596
- Cited by
- 104
- References
- 32
- Citations by year
- 2026: 6 · 2025: 14 · 2024: 18 · 2023: 10 · 2022: 11 · 2021: 19 · 2020: 8 · 2019: 11 · 2018: 6 · 2017: 1
- FWCI
- 8.82
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH104576, R01MH117559, R01MH048762)
- National Institute on Drug Abuse (R01DA036523, P30DA023026, R01DA011301)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD093651)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- suicide attempts, suicide prevention, anxiety disorders, functional outcome, coming of age, child abuse, depression, disruptive behavior disorders
- MeSH terms
- Adolescent, Adult, Anxiety Disorders, Child, Female, Humans, Longitudinal Studies, Male, Suicide, Attempted, Young Adult, Suicidal Ideation
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