Emotional and behavioral problem profiles of preteens with self-injurious thoughts and behaviors: a multicultural study
Open accessAbstract
Objective Self-injurious thoughts and behaviors (SITB) among preteen children have risen to the attention of researchers, practitioners, and policymakers. To shed light on potential treatment/prevention targets, we sought to identify empirically derived emotional and behavioral problem profiles of preteens with SITB, and to determine whether these profiles differ by age, gender and society.Method Caregivers of 46,719 children aged 6 to 12 years from 42 societies across the world completed the Child Behavior Checklist for ages 6-18 (CBCL/6-18). There were 1,656 children whose caregivers indicated that their child experienced SITB. We conducted a latent profile analysis (LPA) using scores from eight CBCL/6-18 problem scales to derive problem profiles of children with SITB. Multilevel modelling was used to estimate differences in the profiles by SITB, society, sex, and age.Results A 4-profile model provided the best fit to the data, with profiles reflecting low problems (39.7%), mild problems (42.6%), moderate problems (15.4%), and rule-breaking/thought problems (2.3%). The low problems profile had CBCL problem scale scores nearly indistinguishable from those of children without SITB. Children in the rule-breaking/thought problems group were mostly female, whereas children in the other profile groups were mostly male. Children with the rule-breaking/thought problems profile also were most likely to have both suicidal thoughts and self-harm behaviors.Plain language summary In this study, authors analyzed emotional and behavioral profile of preteens who experienced self-injurious thoughts and behaviors (SITB). Caregivers of over 46,000 children aged 6-12 from 42 countries completed the Child Behavior Checklist. The authors found that most preteens with SITB had low levels of other mental health problems. This study highlights the needs to screen all children for SITBs, not just those who have have significant mental health problems.Conclusion Problem profiles of preteens with SITB are heterogeneous, with most having relatively low levels of other psychopathology. Selectively screening only children with clinically significant mental health problems for suicidal thoughts and self-harm behaviors (eg, asking about suicidal thoughts only among children with depression) risks missing many children experiencing SITB.
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There is a lack of clear suicide-risk markers in preadolescents that might otherwise make targeted suicide-risk screening more effective.
“the lack of clear suicide-risk markers in preadolescents5 that might otherwise make targeted suicide-risk screening more effective.”
From Asking Preadolescents About Suicide Is Not Associated With Increased Suicidal Thoughts (2026) · cites this paper as [5]
The Discussion reports that 82% of preteens with self-injurious thoughts and behaviors had low or mild caregiver-rated problem profiles, and says screening only children with clinically significant mental health problems would miss many cases. It recommends universal screening rather than making screening contingent on those problems. This supports a limitation of targeted screening based on mental-health indicators, but not the broader assertion that preadolescents lack clear suicide-risk markers generally. (LLM, conf=0.82)
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Cites
KAUFMAN, J., BIRMAHER, B., BRENT, D., RAO, U., FLYNN, C., MORECI, P., WILLIAMSON, D., & RYAN, N. (1997) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199707000-00021 · Cited by 10,148 · see citing works
Culture, leadership, and organizations: the GLOBE study of 62 societies
(2005) · Choice Reviews Online · doi:10.5860/choice.42-4132 · Cited by 5,058 · see citing works
Manual for ASEBA School-Age Forms & Profiles
Achenbach, T. M. (2001) · Medical Entomology and Zoology · Cited by 4,676 · see citing works
Ferguson, S. L., Moore, E. W. G., & Hull, D. M. (2019) · International Journal of Behavioral Development · doi:10.1177/0165025419881721 · Cited by 969 · see citing works
Ask Suicide-Screening Questions (ASQ): A Brief Instrument for the Pediatric Emergency Department
Horowitz, L. M., Bridge, J. A., Teach, S. J., Ballard, E., Klima, J., Rosenstein, D. L., Wharff, E. A., Ginnis, K., Cannon, E., Joshi, P., et al. (2012) · Archives of Pediatrics & Adolescent Medicine · doi:10.1001/archpediatrics.2012.1276 · Cited by 593 · see citing works
Annual Research Review: A meta‐analytic review of worldwide suicide rates in adolescents
Glenn, C. R., Kleiman, E. M., Kellerman, J., Pollak, O., Cha, C. B., Esposito, E. C., Porter, A. C., Wyman, P. A., & Boatman, A. E. (2020) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13106 · Cited by 391 · see citing works
Clinical and social outcomes of adolescent self harm: population based birth cohort study
Mars, B., Heron, J., Crane, C., Hawton, K., Lewis, G., Macleod, J., Tilling, K., & Gunnell, D. (2014) · BMJ · doi:10.1136/bmj.g5954 · Cited by 311 · see citing works
Suicide Trends Among Elementary School–Aged Children in the United States From 1993 to 2012
Bridge, J. A., Asti, L., Horowitz, L. M., Greenhouse, J. B., Fontanella, C. A., Sheftall, A. H., Kelleher, K. J., & Campo, J. V. (2015) · JAMA Pediatrics · doi:10.1001/jamapediatrics.2015.0465 · Cited by 303 · see citing works
Prevalence and Correlates of Suicide and Nonsuicidal Self-injury in Children
Liu, R. T., Walsh, R. F. L., Sheehan, A. E., Cheek, S. M., & Sanzari, C. M. (2022) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2022.1256 · Cited by 296 · see citing works
Suicide in elementary school-aged children and early adolescents
Sheftall, A. H., Asti, L., Horowitz, L. M., Felts, A., Fontanella, C. A., Campo, J. V., & Bridge, J. A. (2016) · Pediatrics · doi:10.1542/peds.2016-0436 · Cited by 271 · see citing works
DeVille, D. C., Whalen, D., Breslin, F. J., Morris, A. S., Khalsa, S. S., Paulus, M. P., & Barch, D. M. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.20956 · Cited by 270 · see citing works
McIntyre, L., Williams, J. V. A., Lavorato, D. H., & Patten, S. B. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.11.029 · Cited by 197 · see citing works
Evans, R., White, J., Turley, R., Slater, T., Morgan, H., Strange, H., & Scourfield, J. (2017) · Children and Youth Services Review · doi:10.1016/j.childyouth.2017.09.020 · Cited by 180 · see citing works
Suicidal Thoughts and Behaviors Among LGBTQ Youth: Meta-Analyses and a Systematic Review
Hatchel, T., Polanin, J. R., & Espelage, D. L. (2021) · Archives of Suicide Research · doi:10.1080/13811118.2019.1663329 · Cited by 172 · see citing works
Measuring Sexual and Gender Minority Populations in Health Surveillance
Patterson, J. G., Jabson, J. M., & Bowen, D. J. (2017) · LGBT Health · doi:10.1089/lgbt.2016.0026 · Cited by 161 · see citing works
Cumulative minority stress and suicide risk among LGBTQ youth
Green, A. E., Price, M. N., & Dorison, S. H. (2022) · American Journal of Community Psychology · doi:10.1002/ajcp.12553 · Cited by 133 · see citing works
Aguinaldo, L. D., Sullivant, S., Lanzillo, E. C., Ross, A., He, J.-P., Bradley-Ewing, A., Bridge, J. A., Horowitz, L. M., & Wharff, E. A. (2021) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2020.11.006 · Cited by 131 · see citing works
Epstein, S., Roberts, E., Sedgwick, R., Polling, C., Finning, K., Ford, T., Dutta, R., & Downs, J. (2020) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-019-01327-3 · Cited by 127 · see citing works
Long-Term Associations of Childhood Suicide Ideation
Herba, C. M., Ferdinand, R. F., van der Ende, J., & Verhulst, F. C. (2007) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e318149e66f · Cited by 108 · see citing works
Cross-informant agreement of the Dysregulation Profile of the Child Behavior Checklist
Althoff, R. R., Rettew, D. C., Ayer, L. A., & Hudziak, J. J. (2010) · Psychiatry Research · doi:10.1016/j.psychres.2010.05.002 · Cited by 96 · see citing works
Advancing Research in Child Suicide: A Call to Action
Ayer, L. A., Colpe, L. J., Pearson, J. L., Rooney, M. E., & Murphy, E. R. (2020) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2020.02.010 · Cited by 84 · see citing works
Screening pediatric medical patients for suicide risk: Is depression screening enough?
Horowitz, L. M., Mournet, A. M., Lanzillo, E., He, J.-P., Powell, D. S., Ross, A. M., Wharff, E. A., Bridge, J. A., & Pao, M. (2021) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2021.01.028 · Cited by 78 · see citing works
Romanelli, M., Sheftall, A. H., Irsheid, S. B., Lindsey, M. A., & Grogan, T. M. (2021) · Prevention Science · doi:10.1007/s11121-021-01295-8 · Cited by 71 · see citing works
Ayer, L. A., Danielson, C. K., Amstadter, A. B., Ruggiero, K., Saunders, B. E., & Kilpatrick, D. G. (2011) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2011.01.004 · Cited by 63 · see citing works
Rescorla, L. A., Althoff, R. R., Ivanova, M. Y., & Achenbach, T. M. (2019) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-018-01268-3 · Cited by 49 · see citing works
Suicide Risk Screening in Pediatric Outpatient Neurodevelopmental Disabilities Clinics
Rybczynski, S., Ryan, T. C., Wilcox, H. C., Eck, K. V., Cwik, M., Vasa, R. A., Findling, R. L., Slifer, K., Kleiner, D., & Lipkin, P. H. (2021) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000001026 · Cited by 41 · see citing works
Assessing for suicidal behavior in youth using the Achenbach System of Empirically Based Assessment
Meter, A. V., Algorta, G. P., Youngstrom, E. A., Lechtman, Y., Youngstrom, J. K., Feeny, N. C., & Findling, R. L. (2017) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-017-1030-y · Cited by 33 · see citing works
Sheftall, A. H., Vakil, F., Armstrong, S. E., Rausch, J. R., Feng, X., Kerns, K. A., Brent, D. A., & Bridge, J. A. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.04.021 · Cited by 30 · see citing works
Ivanova, M. Y., Achenbach, T. M., Turner, L. V., Almqvist, F., Begovac, I., Bilenberg, N., Bird, H., Broberg, A. G., Calderón, M. A. C., Chahed, M., et al. (2022) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13569 · Cited by 10 · see citing works
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Asking Preadolescents About Suicide Is Not Associated With Increased Suicidal Thoughts
Hennefield, L., Luking, K. R., Tillman, R., Barch, D. M., Luby, J. L., & Thompson, R. J. (2026) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2025.03.025 · Cited by 8 · see citing works
“…there have been increased calls for more systematic suicide-risk screening in preadolescents 4 amidst mounting evidence that pro fi les of preadolescents with STBs are highly variable and not reliably associated with elevated psychopathology symptoms 5 or documented mental health diagnoses.”
Ayer, L. A., Hassler, G., Ohana, E., Sheftall, A. H., Anderson, N. W., & Griffin, B. A. (2024) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13999 · Cited by 5 · see citing works
Uncovering Genetic Risk Beyond Diagnoses in Suicidal Thoughts and Behaviors: Insights from All of UsPreprint
Lee, P. H., Sanzo, B. T., Lee, Y. A., Jung, D. H., Gilman, J. M., Nock, M. K., Smoller, J. W., Liu, R. T., & Kessler, R. C. (2025) · medRxiv · doi:10.1101/2025.04.18.25326075 · Cited by 1 · see citing works
Liu, R. T. (2024) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2024.01.004
Ishida, M., Sasaki, Y., Usami, M., Yoshimura, Y., Ito, M., Mikami, K., Tsujii, N., Kihara, H., Yanagi, Y., Inomata, T., et al. (2025) · Psychiatry and Clinical Neurosciences Reports · doi:10.1002/pcn5.70263
“To address the absence of standardized methods for evaluating suicide ‐ related behaviors in prepubertal children, 26 we combined diagnostic interviews with self ‐ administered depression and anxiety scales, Abbreviations: ADHD ‐ RS, Attention ‐ Deficit/Hyperactivity Disorder Rating Scale; CI,…”
Walsh, R. F. L., Sheehan, A. E., Burke, T. A., & Liu, R. T. (2026) · Translational Psychiatry · doi:10.1038/s41398-026-03980-0
“Similarly, in a large multi-national study of youth, the majority of preadolescents with STB had generally low levels of psychopathology [35].”
- Authors
- Ayer, L., Ohana, E., Ivanova, M. Y., Frering, H. E., Achenbach, T. M., & Althoff, R. R.
- Affiliations
- RAND Corporation (US)
- University of Vermont (US)
- Corresponding author
- Ayer, Lynsay
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2024-09
- Volume
- 63
- Issue
- 9
- Pages
- 931-942
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC11269522
- OpenAlex
- W4391188839
- Cited by
- 6
- References
- 29
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2
- FWCI
- 3.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (acceptedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (1R21MH128522)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- self-injurious thoughts and behaviors, preadolescents, suicidal ideation, self-harm, Child Behavior Checklist, cross-cultural comparison, gender differences, age differences, child mental health screening, rule violations
- MeSH terms
- Problem Behavior, Child, Child Behavior, Cross-Cultural Comparison, Female, Humans, Male, Self-Injurious Behavior, Suicidal Ideation
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