Low Self-Esteem Predicts Persistent Suicidal Ideation Across Adolescence and Young Adulthood: A 14-year Longitudinal Study.

Abstract

Repeated or persistent suicidal ideation (SI) and suicide attempts (SA) are among the most robust risk factors for later suicide mortality, yet few studies have identified factors that consistently predict their recurrence over time. Using data from the U.S. National Longitudinal Study of Adolescent to Adult Health, which followed a nationally representative cohort of U.S. adolescents over 14 years, we examined whether adolescent self-esteem predicts SI and SA across adolescence and young adulthood. A total of 6,504 adolescents were assessed at Wave 1 (1994-1995), with follow-up interviews conducted at one, seven, and fourteen years. Self-esteem and demographic characteristics were measured at baseline, whereas SI, SA, and established risk factors for suicidality (i.e., depressive symptoms, substance use, violent victimization, childhood maltreatment, and recent exposure to suicide attempts) were assessed at each wave. Time-lagged logistic regression models showed that adolescent self-esteem predicted SI at all follow-ups, even after adjusting for demographic factors, concurrent risk factors, and prior suicidality. In contrast, SA was more consistently predicted by concurrent risk factors. We discuss the implications of these findings for suicide prevention and intervention.