Sex Differences in Behavioral and Psychopathological Trajectories From Late Childhood to Early Adolescence: Implications for Suicidality Risk.

Background: Although the link between psychopathological and behavioral issues and suicidality is well-established, existing studies often focus on static timepoints, neglecting their dynamic nature and sex differences. This study investigates the trajectories of these symptoms from late childhood to early adolescence and their association with suicidality, while also examining variations by sex. Methods: We included 7849 unrelated children from the Adolescent Brain Cognitive Development (ABCD) cohort, with assessments conducted over a 3-year follow-up period. Caregiver-reported psychopathological and behavioral symptoms were assessed using the Child Behavior Checklist (CBCL) at baseline (ages 9-10) and during three subsequent annual follow-ups. Youth-reported suicidality was assessed at both baseline and the 3-year follow-up (ages 12-13) using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Results: Latent class growth analysis (LCGA) identified three trajectory groups for total problems, internalizing, and externalizing behaviors, and two trajectory groups for each dimension. All high symptom trajectory groups had a higher risk of suicidality compared to low symptom trajectory groups, with adjusted odds ratios (ORs) ranging from 1.35 to 3.15 (all Conclusions: Trajectories of psychopathological and behavioral symptoms from late childhood to early adolescence are modestly associated with suicidality during this critical transition. Withdrawn/depressed symptoms strongest predicted risk in boys, whereas anxious/depressed symptoms were most salient in girls. Attention problems consistently predicted suicide attempts across both sexes. These findings emphasize the need for ongoing monitoring and early intervention for at-risk youth to potentially reduce adolescent suicidality.