Multi-dimensional prediction of suicidality and non-suicidal self-injury transition in children: from general psychopathological, behavioural, and neurobiological perspectives

IMPORTANCE Accurate prediction of suicide or non-suicidal self-injury (NSSI) among children within a uniform time frame is an essential but challenging task. Furthermore, few studies have comprehensively considered clinical, behavioural, and neurobiological factors to produce multi-dimensional prediction models. OBJECTIVE To examine predictive effects of general psychopathology, behavior inhibition system, and brain signature on children’s suicidality or NSSI transition. DESIGN, SETTING, AND PARTICIPANTS We adopted a retrospective and longitudinal methodology by utilising the data from the Adolescent Brain Cognitive Development (ABCD) cohort. In total, 9332 individuals aged 9-10 years without any suicidality or non-suicidal self-injury (NSSI) history at baseline were included in our analyses. Then, four subgroups were generated based on whether they had developed suicide ideation (Healthy control [HC]-SI), NSSI (HC-NSSI) or suicide attempt (HC-SA) in a year, while the remaining group was considered a control group (HC-HC). MAIN OUTCOMES AND MEASURES Participants suicidal behaviors and non-suicidal self-injury behaviors were assessed with the Kiddle Schedule for Affective Disorders and Schizophrenia. Meanwhile, general psychopathology (i.e., p-factor ) was calculated based on scores of Child Behavior Checklist, behavioral inhibition system (BIS) was assessed though BIS/BAS scale, and the brain morphometrics were also collected though sMRI. Multinomial logistic regression models were used for assessing the predictive effects of general psychopathology, behavioral inhibition system, and whole-brain cortical area on children’s STB and NSSI transition. RESULTS As a result, we found higher general psychopathology in baseline predicted higher NSSI (1.52 [1.28-1.80]), SI (OR=1.34 [95%CI 1.17-1.53]) and SA (2.05 [1.34-3.14]) risk in a year. From a behavioural perspective, higher BIS sensitivity predicted higher SI (2.05 [1.61, 2.61], and NSSI (1.68 [1.24, 2.28]) in a year. From a neurobiological perspective, abnormalities in the cortical area of the superior insula, inferior frontal area, superior temporal area, and superior precentral area were all shown to be associated with children’s NSSI, SI and SA in the future. CONCLUSIONS AND RELEVANCE This study is the first to look at the predictive factors for the different transitions of NSSI and suicidal behaviour from the biopsychosocial framework. Our findings offered empirical evidence on the predictive effect of baseline general psychopathology, BIS sensitivity and biological marker on children’s suicidality or NSSI in a year, providing early biomarkers for all types of transition. In this case, the early identification of those factors may facilitate the development of early prevention or intervention that could potentially alleviate more relevant public health issues. Question Could general psychopathology, behavior inhibition system, and brain signature predict suicidality or NSSI transition in children? Findings In a longitudinal observational study (9332 children), higher general psychopathology at baseline predict higher risk of suicidality and NSSI transition in a year. Meanwhile, higher BIS sensitivity also predict higher risk of suicidality and NSSI transition. To note, abnormalities in the cortical area of the superior insula, inferior frontal area, superior temporal area, and superior precentral area were all shown to be associated with children’s suicidality and NSSI transition. Meaning The early identification of biopsychosocial factors associated with suicidality or NSSI transition in children could facilitate early prevention. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study used (or will use) ONLY openly available human data that were originally located at the ABCD Study (https://abcdstudy.org) and are held in the NIMH Data Archive (NDA). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced are available online at