Population-based surveillance of suicidality among adolescents who do not endorse suicide risks and implications for screening.

Objective: Suicide screening guidelines based on findings from aggregated data conceal subpopulation vulnerabilities. Risk factors for a suicide attempt (SA), such as suicidal ideation (SI), may differ in frequency or be absent in certain ethnoracial youth subgroups. Thus, accurate identification of suicide risk remains a challenge, and guidelines are inconsistent.

Methods: This cross-sectional study used data from the 2019 and 2022 waves of the Minnesota Student Survey of 8^th, 9^th, and 11^th graders. Students in 12 ethnoracially diverse groups self-reported their race and ethnicity, past-year SI and SA, and past two-week symptoms of depression and anxiety. We used stratified chi-squared tests by sex and ethnoracial group for bivariate analyses. Logistic regression models adjusted for food insecurity, unstable housing and mental health treatment, examined odds of SA.

Results: About 3.0% of male students attempted suicide in the past-year. Of these youth, 35.9% denied depressive symptoms, 39.8% denied anxiety symptoms, and 14.8% denied SI, especially Somali (47.8%) and multiracial (26.3%) male students. Among the 7.3% of female students who attempted suicide during the preceding year, 25.4% denied depressive symptoms, 24.6% denied anxiety symptoms, and about 8.0% denied SI, especially Somali (29.7%) and Black (12.5%) female students. Students who reported depressive or anxiety symptoms, especially male students, had increased odds of SA.

Conclusions: A higher proportion of male, certain Black subgroups, and multiracial students reported a past-year SA without endorsing symptoms of depression, anxiety or SI. Future research should assess for whom screening tools work, mitigate screening limitations, and normalize minoritized experiences.