Adolescent Behavioral Health Outcomes of Child Welfare Involved Youth with and without Childhood Suicidal Ideation

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Sheftall, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8059053/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract We examined whether child welfare–involved children aged 7–11 with suicidal ideation (SI) experience worse adolescent behavioral health compared to peers without SI. Using longitudinal data from the National Survey of Child and Adolescent Wellbeing I and II (N = 1,641), propensity score weighting balanced baseline characteristics. We compared groups on adolescent outcomes (ages 12–15) from youth and caregiver reports. Children with SI at ages 7–11 had twice the odds of adolescent SI and four times the odds of self-reported self-injury, though caregiver reports did not confirm the latter. No significant differences emerged for other behavioral health outcomes. Thus, child welfare–involved youth showing SI early face elevated risk for persistent SI and self-injury, even after controlling for maltreatment and prior symptoms. These findings highlight the need for early identification and monitoring of SI, and for further research on underlying mechanisms and replication. suicide child maltreatment mental health alcohol Figures Figure 1 Introduction Youth self-injurious thoughts and behaviors (SITB) have increased over the past decade, with an alarming rise among preteen children (Ayer et al., 2020 ; Bridge et al., 2015 ; Bridge et al., 2023 ; Liu et al., 2022 ). Children in the Child Welfare System (CWS) are especially vulnerable to SITB and face a range of adversities that elevate risk for suicide, such as unstable home environments, lack of access to quality mental health care, and exposure to child maltreatment (Conn et al., 2015 ; Horwitz et al., 2012 ). Approximately one quarter of youth in the CWS report suicidal ideation (SI), compared to 11% of those not in the CWS (Anderson, 2011 ; Evans et al., 2017 ) and experts emphasize that there is an “urgent need to recognize and reduce risk for suicide in the [CWS]” (Horowitz et al., 2021 ). Even more concerning is the age of the youth experiencing SITBs in the CWS. Younger children in the CWS may be thinking about suicide even more than older youth: one recent study found that across all racial/ethnic groups, 7- to 10-year-old CWS-involved males and females reported higher rates of SI (~ 26%) than any other demographic group of youth, except for 15–16 year old females (~ 27%) (Hassler et al., 2025 ). However, while the high level of SITB risk among young CWS-involved youth is well established, there is little known about whether preteen SITB could be an early indicator of more severe or specific types of behavioral health problems in adolescence. These problems include continued SITB, posttraumatic stress (PTS), internalizing problems (e.g., depression and anxiety symptoms), externalizing problems (e.g., aggressive behavior, conduct problems), and alcohol use. Recent research has shown associations between preteen SITB and later outcomes. For instance, one study found that preteen SI predicted poor academic outcomes among CWS-involved youth, after controlling for preteen mental health problems (Anderson et al., 2024 ). Another indicated that preteen SITB is also indicative of emotion regulation difficulties (Sheftall et al., 2021 ) which predicted more severe and co-occurring behavioral health symptoms beyond the impact of maltreatment and other CWS-related adversities (Cloitre et al., 2019 ). Further, prior SITB is a well-documented risk factor for later SITB (Franklin et al., 2017 ) —suggesting preteen SITB may indeed predict worse outcomes. However, experiences related to CWS involvement (e.g., familial disruption and maltreatment) can influence later behavioral health outcomes as well (Conn et al., 2015 ; Green et al., 2020 ; Kaplow & Widom, 2007 ). Longitudinal research that considers the complexity of risk factors present in CWS involved youth is needed so we can determine how preteen SITB impacts adolescent outcomes in this high-risk population of youth. This type of study can inform future research and practice about the importance of preteen SITB as a risk factor for adverse outcomes relative to other well-documented factors like child maltreatment. The current study integrates data from two longitudinal, nationally representative datasets to examine how self-reported SI in the preteen years (ages 7–11) predicts early adolescent behavioral health (ages 12–15). We applied propensity score weighting techniques to ensure that preteens with and without SI were otherwise similar, prior to examining group differences in later (ages 12–15) behavioral health as reported by both caregivers and youth themselves. This is important as clear and established discrepancies between self- and caregiver reports of youth behavioral health in multiple domains exist, with each perspective providing valuable information about youth wellbeing (De Los Reyes et al., 2015 ; De Los Reyes et al., 2023 ). We hypothesized children with SITB would have a significantly higher risk for all measured behavioral health outcomes in adolescence, and youth would self-report more SITB than caregivers, consistent with prior literature (Danielle C DeVille et al., 2020 ; Jones et al., 2019 ). Methods Institutional Review Board Statement The (Blinded IRB for review) determined this study to be exempt from human subjects review due to the use of secondary, de-identified data. Data Sources We combined data from the National Survey of Child and Adolescent Well-Being (NSCAW) I & II (Dowd et al., 2013 ; Dowd et al., 2008 ) for this study. Complete information about the NSCAW datasets can be found at the National Data Archive on Child Abuse and Neglect (NDACAN) website ( https://www.ndacan.acf.hhs.gov ). NSCAW-I included 5,501 children ages birth to 14 and their families who were investigated for child abuse or neglect in the United States (U.S.) between October 1999 and December 2000 by Child Protective Services (CPS). Face-to-face interviews with children, caregivers, and child welfare caseworkers were conducted 2–6 months after the investigation was closed (baseline) and at three follow-up timepoints: 18 months (N = 4,470), 36 months (N = 4,511), and 59–96 months (N = 4,134). NSCAW-II included 5,872 U.S. children aged birth to 17.5 years who had contact with the CWS from 2008–2009 and whose investigations were closed during this period. Children, caregivers, and caseworkers were interviewed face-to-face at three timepoints: baseline (March 2008-September 2009), and approximately 18- and 36-months following baseline. Both NSCAW-I and -II included cases that did and did not receive CWS services and followed children for the full study period regardless of whether they remained in the CWS. Additional information about the design and weighting for NSCAW-I and II are published (Dowd et al., 2013 ; Dowd et al., 2008 ). Weights from NSCAW-I and II aim to provide a national representative sample of children in the child welfare system. Sample for the Current Study. This study focused on the influence of childhood SI on adolescent outcomes. All children with at least one study visit between ages 7–11 years and 12–15 years (N = 1,929) were included. Any children missing all SI observations between the 7–11 age range were omitted, leaving a final sample of N = 1,641. This subset of the eligible children did not differ substantively from the full population along any relevant covariates (See Supplemental Table 1). Table 1 shows the demographic characteristics of the sample. Table 1 Sample Characteristics (N = 1,641) Characteristic N (%) Dataset NSCAW-I 1,230 (75%) NSCAW-II 411 (25%) Sex Male 807 (49%) Female 834 (51%) Race & Ethnicity Black, non-Hispanic 515 (31%) Hispanic 310 (19%) Other/Unknown Race 107 (7%) White, non-Hispanic 709 (43%) Maltreatment Neglect 596 (36%) Other 313 (19%) Physical 356 (22%) Sexual 231 (14%) Missing 145 (8.8%) Note. NSCAW = National Survey of Child and Adolescent Wellbeing. NSCAW-I and -II were weighted to slightly different populations. Thus individual-level weights from the NSCAW I dataset were adjusted so that the weighted NSCAW I population statistics matched those from NSCAW II on race/ethnicity, sex, age distribution, Wave 1 SI, and type of alleged maltreatment using the raking procedure described in DeBell and Krosnick (DeBell & Krosnick, 2009 ) as implemented in the “anesrake” R package (Pasek & Pasek, 2018 ). Table 1 About Here Measures Independent Variable: Child Suicidal Ideation (SI) At ages 7–11, SI was measured using item 9 from the Children’s Depression Inventory (CDI) (Kovacs, 1992 ), a reliable and valid child depression scale (Doerfler et al., 1988 ; Knight et al., 1988 ). The SI item from the CDI has been used in prior studies (Anderson, 2011 ; Fulginiti et al., 2018 ) and serves as our primary independent variable of interest. This item was initially coded such that 1= “no ideation,” 2= “ideation but no desire to commit suicide,” and 3= “ideation with desire to commit suicide in the past 2 weeks.” Because very few (< 1%) of responses indicated a score of 3 (ideation with a desire to die by suicide), ideation was recoded as 0 = no ideation (originally option 1) and 1 = ideation (originally option 2 or 3). Children with multiple waves of data between ages 7–11 years were coded as SI = 1 if they expressed SI at any time at any wave in this age range. Dependent Variables: Early Adolescent Behavioral Health Table 2 summarizes the study’s adolescent (ages 12–15) outcome measures. Table 2 Study outcome measures Construct Source Scale/Item Item Text Item Responses* Suicidal Ideation Child CDI Item 9 Pick out the sentences that describe you best in the past two weeks. I do not think about killing myself I think about killing myself, but I would not do it I want to kill myself YSR Item 91 I think about killing myself not true somewhat or sometimes true very true or often true Caregiver CBCL Item 91 Talks about killing self Self-injury Child YSR Item 18 I deliberately try to hurt or kill myself not true somewhat or sometimes true very true or often true Caregiver CBCL Item 18 Deliberately harms self or attempts suicide Internalizing Behaviors Child YSR Internalizing These are scales with multiple items. See below for more information. Caregiver CBCL Internalizing Externalizing Behaviors Child YSR Externalizing Caregiver CBCL Externalizing PTS Symptoms Child TSCC PTSD Scale Alcohol Use Child YRBS, CRAFFT, Add Health Note. * Responses in bold are considered positive for ideation or self-injury. CDI = Children’s Depression Inventory; CBCL = Child Behavior Checklist; PTS = posttraumatic stress; YSR = Youth Self Report; TSCC = Trauma Symptom Checklist for Children; PTSD = Posttraumatic Stress Disorder; YRBS = Youth Risk Behavior Survey; Add Health = National Longitudinal Survey of Adolescent Health. Table 2 About Here Internalizing and Externalizing Behaviors The Child Behavior Checklist (CBCL/6–18) (Achenbach & Rescorla, 2001 ) is a caregiver-reported measure of children’s psychopathology for children aged 6–18. Caregivers rated each item on a 3-point scale (0 = not true, 1 = somewhat or sometimes true, and 2 = very true or often true) based on the prior six months. The internalizing broadband scale is a measure of internalizing problems such as anxiety and depression, containing 33 items. The externalizing scale includes 34 items related to children’s externalizing behaviors such as aggression, rule breaking and hyperactivity. In this study, the raw internalizing (Cronbach’s a = 0.89) and externalizing (Cronbach’s a = 0.93) scale scores were used. The CBCL internalizing and externalizing scores at childhood were controlled for when examining adolescent scores. For cases where the CBCL was administered more than once in the 7–11-year age range or 12-15-year age range, an average of the scores were used. The Youth Self Report (YSR/11–18) (Achenbach & Rescorla, 2001 ) is the youth version of the CBCL/6–18 with youth self-reporting on their own psychopathology and is used for ages 11–18. Youth rated each item on a 3-point scale (0 = not true, 1 = somewhat or sometimes true, and 2 = very true or often true) based on the prior six months. The internalizing broadband scale measures internalizing problems with 33 items and the externalizing scale includes 34 items. In this study, the raw internalizing (Cronbach’s a = 0.89) and externalizing (Cronbach’s a = 0.88) scale scores were used. As with the CBCL internalizing and externalizing scores, all responses in the 12-15-year-old period were averaged when multiple scores were present. Self-Injurious Thoughts and Behaviors Caregiver-reported suicidal ideation (suicidal thoughts) was defined as caregiver endorsement of a 1 or 2 on CBCL/6–18 item 91 “talks about killing self” and dichotomized as 0 = no and 1 = yes. Self-injurious behavior was defined as caregiver endorsement of a 1 or 2 on CBCL/6–18 item 18: “deliberately harms self or attempts suicide” and dichotomized as 0 = no and 1 = yes. Any instance of a positive score for ideation or self-injurious behaviors during adolescence, 12–15 years, was positive for ideation or self-injury, respectively. Adolescent self-reported suicidal ideation was measured in two ways: the same CDI item used to measure child SI; and youth endorsement of a 1 or 2 on YSR/11–18 item 91 “talks about killing self.” These were then dichotomized such that 0 = no and 1 = yes. Self-injurious behavior was defined as a 1 or 2 on YSR/11–18 item 18: “deliberately harms self or attempts suicide” and dichotomized as 0 = no and 1 = yes. Any endorsement during the 12-15-year-old period was a positive for the outcome. Posttraumatic Stress Adolescent-reported posttraumatic stress symptoms were measured with the Trauma Symptom Checklist for Children (TSCC) PTSD scale (Briere, 1996 ). The PTSD score is a sum of 10 items. Youth rate how often they experience PTSD symptoms on a four-point Likert scale from 0 = never to 3 = almost all of the time (Cronbach’s a = 0.84). Scores were averaged when there were multiple TSCCs administered during the 12-15-year-old period. Alcohol Use Questions derived from the Youth Risk Behavior Survey (YRBS) (Eaton et al., 2006 ), CRAFFT (Knight et al., 2002 ), and National Longitudinal Study of Adolescent Health (Add Health) (Harris et al., 2003 ) were used to measure alcohol use in youth ages 11 + years. For NSCAW-I, youth were asked, “In your whole life, on how many days did you drink an alcoholic beverage including beer, wine, wine coolers, and liquor? Please do not include any sips you may have had from another person’s drink.” A follow-up question was asked of those who did not indicate “I have never done this.” The follow-up question was, “In the last 30 days, on how many days did you drink an alcoholic beverage?” Response options to the follow-up question included: “1 day” up to “20 days or more” and “I have not done this in the past 30 days.” From NSCAW-II, three related questions were used: “During your life, on how many days have you had at least one drink of alcohol?” followed by, “How old were you when you had your first drink of alcohol other than a few sips?” and then, “During the past 30 days, on how many days did you have at least one drink of alcohol?” All three questions had a “0 days” or “I have never had a drink of alcohol other than a few sips” option and the subsequent question would only be asked if something other than a non-use option was chosen. For both NSCAW-I and NSCAW-II, children who reached the question related to the last 30 days and answered they had used any alcohol were coded positive for recent alcohol use. Children who indicated no alcohol use on either the final 30-day question or any of the previous questions were coded as having no alcohol use. All other children we coded as missing. Covariates and Confounders Additional variables the analysis (propensity score weighting and/or regressions) included: CBCL internalizing and externalizing scores during 7–11 age range, the most serious form of maltreatment, dataset (NSCAW-I vs. NSCAW-II), age, sex, race, ethnicity, and the number of waves in the 7–11 and 12–15 age ranges. The CBCL internalizing and externalizing scores were averaged for any children with multiple CBCLs during the 7–11 range. The most serious form of maltreatment was identified by caseworkers and coded into the following categories: neglect, physical abuse, sexual abuse, and other abuse. All demographic variables were assigned by NSCAW based on a combination of caseworker, caregiver, and child self-reports (Dowd et al., 2013 ; Dowd et al., 2008 ). The number of waves in the 7–11 and 12–15 periods were simply the number of waves of data collected for each child in each period. Missing data. A total of 1,929 children were present in NSCAW-I and NSCAW-II with at least one wave of data during both the child (age 7–11) and adolescent (age 12–15) age range. Of these, 1,641 (85%) have at least one non-missing SI observation during the 7–11 age range. We compared the weighted characteristics of the full dataset (N = 1,929) against those in the subset dataset (N = 1,641) and determined there were no significant differences between the two, indicating no selective non-response (see Supplementary Table 1). As such, no adjustments were made for non-response formally. Item-level missingness in the remaining data is generally sparse. There was one child with missing race and ethnicity information, which was merged with the “Other” race category to avoid dropping the case. Similarly, there were 145 children missing the most severe form of maltreatment. Given the relatively large number, a “Missing” category for maltreatment was added to the regressions. No other demographic variables had any missingness. The mental health variables generally had low item-level missingness, with the highest number being for the 12–15 age range alcohol use (6.2%) and lowest being for the 7–11 age range CBCL scores (0.2%). Given the low rate of unaddressed item non-response, a complete case analysis was appropriate for each outcome. Analysis Propensity Score Weighting In this study, propensity-score weighting was used to ensure better comparability between participants with and without SI at age 7–11. Potential confounders in the propensity score model were the number of waves with non-missing CDI item 9 during the 7–11 age range, maltreatment type, race and ethnicity, sex, and age at wave 1. The number of waves in the 7–11 age range was important to control for as child reported SI at any wave within this age was considered positive for SI status. Children with more waves have more opportunities to endorse SI and are more likely to code positive for SI. Including this variable in the propensity score model corrects for this effect in the regression models. We estimated the propensity score weights using generalized boosted models (GBM) via the Toolkit for Weighting and Analysis of Nonequivalent Groups (TWANG) package (Ridgeway et al., 2022 ) and controlling for the survey weights. The comparability (e.g., balance) of the two groups before and after weighting using effect size (ES) differences as well as Kolmogorov-Smirnoff (KS) statistics using a threshold of 0.1 to determine if balance was achieved was completed. Regression models The effect of our exposure (SI at ages 7–11) on several outcomes (SITB, internalizing and externalizing problems, PTS, and alcohol use at ages 12–15) using doubly robust propensity-score weighted regression analyses for each outcome was conducted. Linear and logistic regression for continuous and dichotomous outcomes, respectively, was used to estimate the impact of childhood SI on adolescent outcomes with propensity score weighting to adjust for baseline differences between 7–11-year-olds with and without SI. All continuous outcomes were log + 1-transformed and standardized to normalize the distributions and permit comparisons across analyses. Control variables included 7–11-year-old CBCL internalizing and externalizing scores, race and ethnicity, sex, maltreatment type, age (during the 12–15 age range) and an interaction between sex and age. The interaction was included as previous work in this population suggests different trajectories of SI among females and males during this age period (Hassler et al., 2025 ). Given the relatively large number of models, p-values were adjusted using the Benjamini-Hochberg procedure to control the false discovery rate (Benjamini & Hochberg, 1995 ). Results Table 3 shows the survey-weighted mental health variables during the 7–11 age range. Table 3 Ideation and CBCL scores during 7–11 age range. Characteristic N = 1,641 1 CDI Ideation 36% Raw CBCL Internalizing Score 8.0 (7.1) Raw CBCL Externalizing Score 12.8 (9.9) Note. Results are weighted using survey weights. CDI = Children’s Depression Inventory; CBCL = Child Behavior Checklist. 1 %; Mean (SD). Table 3 About Here Table 4 shows balance information for our sample before and after propensity score weighting. As shown, the groups differed substantially on CBCL internalizing and externalizing scores, age, dataset, and number of waves in the 7–11 age range prior to propensity score adjustment with ES differences ranging from 0.155 to 0.392. After weighting, all differences were minimal, and the groups were highly similar on all key control covariates used to estimate the weights (all ES differences < 0.1). Table 4 Balance Table Survey Weighted Propensity Score Weighted Characteristic No Ideation (7–11) 1 Ideation (7–11) 1 ES Diff. 2 No Ideation (7–11) 1 Ideation (7–11) 1 ES Diff. 2 CBCL Internalizing Score 3 7.2 (6.5) 9.5 (7.8) 0.331 9.0 (7.0) 9.5 (7.8) 0.068 CBCL Externalizing Score 3 11.6 (9.5) 14.9 (10.3) 0.338 14.1 (9.7) 14.9 (10.3) 0.078 Race & Ethnicity Black, non-Hispanic 29% 29% 0.012 28% 29% 0.015 Hispanic 20% 21% 0.025 19% 21% 0.051 Other/Unknown Race 5.7% 4.9% 0.037 5.0% 4.9% 0.005 White, non-Hispanic 45% 46% 0.007 48% 46% 0.052 Age at Earliest Wave 9.7 (1.6) 9.1 (1.4) 0.392 9.1 (1.5) 9.1 (1.4) 0.036 Sex Male 49% 55% 0.111 53% 55% 0.029 Female 51% 45% 0.111 47% 45% 0.029 Maltreatment Neglect 38% 43% 0.105 41% 43% 0.046 Other 21% 15% 0.156 17% 15% 0.065 Physical 27% 26% 0.017 26% 26% 0.001 Sexual 9.0% 8.0% 0.034 8.2% 8.0% 0.007 Missing 6.0% 8.4% 0.096 8.2% 8.4% 0.010 Dataset NSCAW-I 70% 77% 0.163 77% 77% 0.006 NSCAW-II 30% 23% 0.163 23% 23% 0.006 Number of Waves (7–11) 1 37% 23% 0.314 22% 23% 0.008 2 48% 56% 0.155 55% 56% 0.020 3 15% 21% 0.170 23% 21% 0.032 Note. CBCL = Child Behavior Checklist; NSCAW = National Survey of Child and Adolescent Wellbeing; ES = Effect Size; Diff = Difference. 1 Mean (SD); % 2 Difference on effect size scale. Cohen's d for continuous variables and Cohen's h for categorical variables. 3 Reported statistics are on original scale, but propensity score matching was on log-scale. Effect size differences on log-scale for propensity score weighted analyses were 0.042 and 0.057 for internalizing and externalizing scales, respectively. Table 4 About Here Table 5 shows the descriptive characteristics of all outcome variables using both the survey and propensity score weights, broken down by whether there was any ideation during the 7–11 age range. Table 5 Mental health outcomes during the 12–15-year-old age range Characteristic Survey Weighted Propensity Score Weighted Overall 1 No Ideation (7–11) 1 Ideation (7–11) 1 Overall 1 No Ideation (7–11) 1 Ideation (7–11) 1 Suicidal Ideation CDI 14% 10% 20% 15% 9.4% 20% YSR 6.8% 5.2% 9.7% 7.1% 4.0% 9.7% CBCL 7.1% 5.6% 9.7% 7.5% 4.9% 9.7% Self-Injurious Behavior YSR 3.8% 2.4% 6.3% 4.3% 1.9% 6.3% CBCL 4.4% 4.2% 4.8% 4.4% 3.9% 4.8% Alcohol Use 11% 12% 9.6% 9.9% 10% 9.6% Internalizing Score YSR 9.4 (7.4) 8.7 (6.7) 10.7 (8.4) 10.1 (7.7) 9.3 (6.7) 10.7 (8.4) CBCL 7.6 (7.2) 6.9 (6.7) 9.0 (7.8) 8.6 (7.5) 8.2 (7.0) 9.0 (7.8) Externalizing Score YSR 12.4 (8.1) 11.7 (7.7) 13.5 (8.6) 13.0 (8.1) 12.5 (7.5) 13.5 (8.6) CBCL 12.4 (10.4) 11.7 (9.8) 13.7 (11.3) 13.6 (10.7) 13.6 (10.0) 13.7 (11.3) TSCC PTSD Score 6.5 (5.1) 6.3 (4.9) 7.0 (5.4) 6.8 (5.2) 6.6 (4.9) 7.0 (5.4) Note. CDI = Children’s Depression Inventory; CBCL = Child Behavior Checklist; YSR = Youth Self Report; TSCC = Trauma Symptom Checklist; PTSD = Posttraumatic Stress Disorder; 1 %; Mean (SD) Table 5 About Here Tables 6 and 7 include the final regression results for the effects of 7–11-year-old ideation on each adolescent outcome with p-values adjusted for multiple testing. See SI Tables 2 and 3 for full regression results with unadjusted p-values. Table 6 Adolescent SITB Outcomes SITB Outcome Source Scale/Item Odds Ratio 95% CI Adjusted p-Value Suicidal Ideation Child CDI Suicidal Ideation 2.57 1.56–4.23 0.002 YSR Suicidal Ideation 2.92 1.42–5.99 0.015 Caregiver CBCL Suicidal Ideation 2.46 1.2–5.03 0.038 Self-injurious Behavior Child YSR Self-injurious behavior 4.91 1.66–14.53 0.015 Caregiver CBCL Self-injurious behavior 1.21 0.52–2.84 0.839 Note. SITB = Self-injurious thoughts and behaviors; CDI = Children’s Depression Inventory; CBCL = Child Behavior Checklist; YSR = Youth Self Report; CI = Confidence Interval. Table 7 Adolescent Behavioral Health Outcomes Behavioral Health outcome Source Scale/Item Regression Coefficient 95% CI Adjusted p-Value Internalizing Problems Child YSR Internalizing 0.08 -0.11–0.26 0.757 Caregiver CBCL Internalizing 0.00 -0.13–0.14 0.950 Externalizing Problems Child YSR Externalizing 0.05 -0.13–0.23 0.839 Caregiver CBCL Externalizing -0.12 -0.24–0.00 0.117 PTS Symptoms Child TSCC PTSD Scale 0.02 -0.16–0.21 0.906 Alcohol Use Child YRBS, CRAFFT, Add Health OR = 0.88 0.46–1.66 0.839 Note. CBCL = Child Behavior Checklist; YSR = Youth Self Report; PTS = posttraumatic stress; TSCC = Trauma Symptom Checklist for Children; PTSD = Posttraumatic Stress Disorder; YRBS = Youth Risk Behavior Survey; Add Health = National Longitudinal Survey of Adolescent Health; OR = Odds Ratio. Alcohol use was a binary variable while the other outcomes in this table were all continuous. As shown in Table 6 , 7 –11-year-olds with SI were two times more likely to experience adolescent SI than 7–11-year-olds without SI (ORs 2.46–2.92, 95% CIs 1.20–5.99) across all measures, even after balancing the two groups on other key variables with propensity score weighting and controlling for key covariates. No meaningful differences in the magnitudes of this effect when comparing between informants or measures were found. For self-injurious behavior, there were deviating results among informants. Seven- to eleven-year-olds reporting SI had nearly five times greater odds than those without SI to report self-injurious behavior in adolescence (OR = 4.91, 95% CI = 1.66–14.53), however, there was no observable effect when examining caregiver report (OR = 1.21, 95% CI = 0.52–2.84). Table 6 About Here SI at ages 7–11 did not significantly predict adolescent internalizing, externalizing, PTS, and alcohol use outcomes (Table 7 ). Figure 1 helps to illustrate and summarize all regression models. Table 7 About Here Figure 1 About Here Discussion This longitudinal study examined the relationship between childhood (ages 7–11) SI and adolescent (ages 12–15) mental health outcomes among high risk, CWS involved youth. We found that SI at ages 7–11 years predicted over two times greater odd of SI in adolescence but, in contrast, self-injurious behavior outcomes differed based upon informant. When examining self-injurious behaviors by youth report, SI at ages 7–11 years was associated with a quadrupling of odds for adolescent self-injurious behavior. However, there was no significant association with caregiver-reported adolescent self-injury. This informant discrepancy is consistent with previous research showing that rates of self-injurious behaviors (including suicide attempts) are higher when measured with youth self-report compared to caregiver report (D. C. DeVille et al., 2020 ; Jones et al., 2019 ). These informant discrepancies are important to understand, and may themselves predict adverse outcomes for adolescents (compared to outcomes for those with smaller youth-caregiver discrepancies) (Ferdinand et al., 2004 ). Caregivers may not always be aware of youth self-injurious behaviors as adolescents are much more likely to disclose self-injury to peers than to adults (Simone & Hamza, 2020 ). In CWS-involved families, some caregivers may be temporary (e.g., foster parents or extended family) and may not know the child well enough to identify intentional self-injury (vs. accidental). The caregivers in our sample—who have in many cases recently been investigated for allegations of child maltreatment—also may be reluctant to report self-injurious behaviors due to experiences of shame and guilt (Curtis et al., 2018 ) and worries that the injury will trigger another child welfare investigation (Cao et al., 2019). While more research is required to further examine these findings, it may be beneficial to also educate caregivers on how to have conversations with their youth about SITBs so intervention can occur early changing trajectories of risk. It is interesting that the informant discrepancy found for self-injurious behavior did not emerge for suicidal thoughts. This is inconsistent with other research where caregivers were less likely to report child SI compared to the child themselves using the same measures used in this study (i.e., the CBCL and YSR) (D. C. DeVille et al., 2020 ). More research is certainly needed to better understand these findings, and qualitative approaches that directly gather in-depth accounts from youth and caregivers may have potential value. Counter to our expectations, when we examined multiple other, non-SITB adolescent behavioral health dimensions, no significant differences between those with and without SI in their younger years were found—regardless of whether the adolescent or caregiver was the informant. While it is possible that there are differences in other SITB-related outcomes that we did not measure (e.g., risky behavior, psychosis), our finding implies that childhood SI is most strongly predictive of adolescent SITB and less predictive of other forms of adolescent psychopathology, after accounting for the influence of other pre-existing risk factors like child maltreatment and childhood mental health concerns. Our study had many methodological strengths, including the application of propensity score weights and adjustment for confounders in our regression models. This means that the identified associations are unlikely to be explained by group differences on the observed covariates used in the weights. Other key strengths include the study’s longitudinal design and the availability of multi-informant data. However, there are some limitations that should be considered. First, these data – while arguably the best available to study this topic– are relatively old, coming from studies conducted in the 1990s and 2000s. The experiences of youth – including their mental health and suicide risk – in current days may not be fully captured by data collected from prior generations. For instance, the evolution of technology including social media and artificial intelligence have transformed the ways that youth communicate with one another and seek help for mental health concerns (Benvenuti et al., 2023 ; Pretorius et al., 2019 ). Second, our inferences requires assumptions that unobserved confounders are not likely to impact our findings, which is an assumption that was not formally tested. Also, potential mechanisms of change, or mediators and moderators, were not examined for this study. Future research should investigate those key mechanisms, such as whether receipt of mental health care and other forms of support impact the extent to which childhood SI affects adolescent wellbeing. Finally, this dataset did not contain self-reported measures of self-injurious behavior for children under 11 years old. It is not clear whether those behaviors would show similar associations with adolescent outcomes as found for this study for SI. Conclusion Children in the CWS with SI face substantially elevated risk for adolescent SITB. However, they are not at heightened risk for other behavioral health concerns (e.g., internalizing problems) in adolescents relative to children in the CWS who have similar baseline mental health symptoms and demographic characteristics. Our findings underscore the value of caregivers, caseworkers and other caring adults talking to CWS-involved children about their potential suicidal thoughts as early as elementary school. CWS-involved children may experience multiple transitions in caregivers and school settings, which can hinder the building of trusting relationships necessary for recognizing risk. For children who remain with their primary caretakers, there may be hesitancy to identify and report mental health concerns due to fear of increased system involvement. System-level barriers within CWS, such as high caseloads, may further complicate the identification and treatment of at-risk youth. Additionally, cultural considerations and historical relationships with healthcare systems may impede help-seeking behaviors. Consequently, those most in need of support face substantial barriers in identification, connection to services, and treatment engagement. Strengthening suicide prevention efforts for these vulnerable youth should be a high priority for policy makers, practitioners, child welfare caseworkers, schools and caregivers. Declarations Conflicts of Interest : The authors have no conflicts of interest to disclose. Author Contribution L.A. and A.H.S. secured funding for the work and conceptualized the study. L.A., and A.S. wrote the main manuscript text and A.H.S. revised the text. E.O., B.A.G., and G.W.H. conducted the analyses, prepared tables and figures, and wrote the analysis sections of the manuscript. All authors reviewed the manuscript. Acknowledgement We are grateful for the wise and helpful advice of Andrea Hussong, Ph.D., and Andres De Los Reyes, Ph.D. in the conceptualization of the paper and analysis. Data Availability The restricted NSCAW data that support the findings of this study are available from National Data Archive on Child Abuse and Neglect (NDACAN), but restrictions apply to the availability of these data, which were used under license for the current study and so are not publicly available. The data are, however, available upon request and with the permission of NDACAN. References Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA School-Age Forms & Profiles . University of Vermont, Research Center for Children, Youth, & Families. Anderson, H. D. (2011). Suicide ideation, depressive symptoms, and out-of-home placement among youth in the U.S. child welfare system. 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Children and Youth Services Review , 82 , 122-129. https://doi.org/10.1016/j.childyouth.2017.09.020 Ferdinand, R. F., van der Ende, J., & Verhulst, F. C. (2004). Parent-adolescent disagreement regarding psychopathology in adolescents from the general population as a risk factor for adverse outcome. Journal of abnormal psychology , 113 (2), 198. Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., Musacchio, K. M., Jaroszewski, A. C., Chang, B. P., & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychol Bull , 143 (2), 187-232. https://doi.org/10.1037/bul0000084 Fulginiti, A., He, A. S., & Negriff, S. (2018). Suicidal because I don't feel connected or vice versa? A longitudinal study of suicidal ideation and connectedness among child welfare youth. Child Abuse Negl , 86 , 278-289. https://doi.org/10.1016/j.chiabu.2018.10.010 Green, M. J., Hindmarsh, G., Kariuki, M., Laurens, K. R., Neil, A. L., Katz, I., Chilvers, M., Harris, F., & Carr, V. J. (2020). Mental disorders in children known to child protection services during early childhood. Med J Aust , 212 (1), 22-28. https://doi.org/10.5694/mja2.50392 Harris, K. M., Florey, F., Tabor, J., Bearman, P. S., Jones, J., & Udry, J. (2003). The national longitudinal study of adolescent health: Research design [www document]. URL: http://www . cpc. unc. edu/Projects/addhealth/design . Hassler, G. W., Ayer, L., Sheftall, A. H., Griffin, B. A., & Ohana, E. (2025). Age-Based Trends in Suicidal Ideation Among Child Welfare System-Involved Youth. Child Maltreat , 10775595241311260. https://doi.org/10.1177/10775595241311260 Horowitz, L. M., Kahn, G., & Wilcox, H. C. (2021). The Urgent Need to Recognize and Reduce Risk of Suicide for Children in the Welfare System. Pediatrics , 147 (4). https://doi.org/10.1542/peds.2020-043471 Horwitz, S. M., Hurlburt, M. S., Heneghan, A., Zhang, J. J., Rolls-Reutz, J., Fisher, E., Landsverk, J., & Stein, R. E. K. (2012). Mental Health Problems in Young Children Investigated by U.S. Child Welfare Agencies. Journal of the American Academy of Child and Adolescent Psychiatry , 51 (6), 572-581. https://doi.org/10.1016/j.jaac.2012.03.006 Jones, J. D., Boyd, R. C., Calkins, M. E., Ahmed, A., Moore, T. M., Barzilay, R., Benton, T. D., & Gur, R. E. (2019). Parent-adolescent agreement about adolescents’ suicidal thoughts. Pediatrics , 143 (2). Kaplow, J. B., & Widom, C. S. (2007). Age of onset of child maltreatment predicts long-term mental health outcomes. J Abnorm Psychol , 116 (1), 176-187. https://doi.org/10.1037/0021-843X.116.1.176 Knight, D., Hensley, V. R., & Waters, B. (1988). Validation of the Children's Depression Scale and the Children's Depression Inventory in a prepubertal sample. J Child Psychol Psychiatry , 29 (6), 853-863. https://doi.org/10.1111/j.1469-7610.1988.tb00758.x Knight, J. R., Sherritt, L., Shrier, L. A., Harris, S. K., & Chang, G. (2002). Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Arch Pediatr Adolesc Med , 156 (6), 607-614. https://doi.org/10.1001/archpedi.156.6.607 Kovacs, M. (1992). Children’s Depression Inventory . Multi-Health Systems, Inc. Liu, R. T., Walsh, R. F. L., Sheehan, A. E., Cheek, S. M., & Sanzari, C. M. (2022). Prevalence and Correlates of Suicide and Nonsuicidal Self-injury in Children: A Systematic Review and Meta-analysis. JAMA Psychiatry , 79 (7), 718-726. https://doi.org/10.1001/jamapsychiatry.2022.1256 Pasek, J., & Pasek, M. J. (2018). Package ‘anesrake’. The comprehensive R archive network , 1-13. Pretorius, C., Chambers, D., & Coyle, D. (2019). Young people’s online help-seeking and mental health difficulties: Systematic narrative review. Journal of medical Internet research , 21 (11), e13873. Ridgeway, G., McCaffrey, D. F., Morral, A. R., Cefalu, M., Burgette, L. F., Pane, J. D., & Griffin, B. A. (2022). Toolkit for Weighting and Analysis of Nonequivalent Groups: A Tutorial for the R TWANG Package . RAND Corporation. https://doi.org/10.7249/TL-A570-5 Sheftall, A. H., Vakil, F., Armstrong, S. E., Rausch, J. R., Feng, X., Kerns, K. A., Brent, D. A., & Bridge, J. A. (2021). Clinical risk factors, emotional reactivity/regulation and suicidal ideation in elementary school-aged children. Journal of Psychiatric Research , 138 , 360-365. https://doi.org/10.1016/j.jpsychires.2021.04.021 Simone, A. C., & Hamza, C. A. (2020). Examining the disclosure of nonsuicidal self-injury to informal and formal sources: A review of the literature. Clinical Psychology Review , 82 , 101907. https://doi.org/https://doi.org/10.1016/j.cpr.2020.101907 Additional Declarations No competing interests reported. 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Bridge et al., \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e; Bridge et al., \u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e; Liu et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). Children in the Child Welfare System (CWS) are especially vulnerable to SITB and face a range of adversities that elevate risk for suicide, such as unstable home environments, lack of access to quality mental health care, and exposure to child maltreatment (Conn et al., \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e; Horwitz et al., \u003cspan class=\"CitationRef\"\u003e2012\u003c/span\u003e). Approximately one quarter of youth in the CWS report suicidal ideation (SI), compared to 11% of those not in the CWS (Anderson, \u003cspan class=\"CitationRef\"\u003e2011\u003c/span\u003e; Evans et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e) and experts emphasize that there is an \u0026ldquo;urgent need to recognize and reduce risk for suicide in the [CWS]\u0026rdquo; (Horowitz et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eEven more concerning is the age of the youth experiencing SITBs in the CWS. Younger children in the CWS may be thinking about suicide even more than older youth: one recent study found that across all racial/ethnic groups, 7- to 10-year-old CWS-involved males and females reported higher rates of SI (~\u0026thinsp;26%) than any other demographic group of youth, except for 15\u0026ndash;16 year old females (~\u0026thinsp;27%) (Hassler et al., \u003cspan class=\"CitationRef\"\u003e2025\u003c/span\u003e). However, while the high level of SITB risk among young CWS-involved youth is well established, there is little known about whether preteen SITB could be an early indicator of more severe or specific types of behavioral health problems in adolescence. These problems include continued SITB, posttraumatic stress (PTS), internalizing problems (e.g., depression and anxiety symptoms), externalizing problems (e.g., aggressive behavior, conduct problems), and alcohol use.\u003c/p\u003e\n\u003cp\u003eRecent research has shown associations between preteen SITB and later outcomes. For instance, one study found that preteen SI predicted poor academic outcomes among CWS-involved youth, after controlling for preteen mental health problems (Anderson et al., \u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e). Another indicated that preteen SITB is also indicative of emotion regulation difficulties (Sheftall et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e) which predicted more severe and co-occurring behavioral health symptoms beyond the impact of maltreatment and other CWS-related adversities (Cloitre et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e). Further, prior SITB is a well-documented risk factor for later SITB (Franklin et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e) \u0026mdash;suggesting preteen SITB may indeed predict worse outcomes. However, experiences related to CWS involvement (e.g., familial disruption and maltreatment) can influence later behavioral health outcomes as well (Conn et al., \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e; Green et al., \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e; Kaplow \u0026amp; Widom, \u003cspan class=\"CitationRef\"\u003e2007\u003c/span\u003e). Longitudinal research that considers the complexity of risk factors present in CWS involved youth is needed so we can determine how preteen SITB impacts adolescent outcomes in this high-risk population of youth. This type of study can inform future research and practice about the importance of preteen SITB as a risk factor for adverse outcomes relative to other well-documented factors like child maltreatment.\u003c/p\u003e\n\u003cp\u003eThe current study integrates data from two longitudinal, nationally representative datasets to examine how self-reported SI in the preteen years (ages 7\u0026ndash;11) predicts early adolescent behavioral health (ages 12\u0026ndash;15). We applied propensity score weighting techniques to ensure that preteens with and without SI were otherwise similar, prior to examining group differences in later (ages 12\u0026ndash;15) behavioral health as reported by both caregivers and youth themselves. This is important as clear and established discrepancies between self- and caregiver reports of youth behavioral health in multiple domains exist, with each perspective providing valuable information about youth wellbeing (De Los Reyes et al., \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e; De Los Reyes et al., \u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e). We hypothesized children with SITB would have a significantly higher risk for all measured behavioral health outcomes in adolescence, and youth would self-report more SITB than caregivers, consistent with prior literature (Danielle C DeVille et al., \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e; Jones et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe (Blinded IRB for review) determined this study to be exempt from human subjects review due to the use of secondary, de-identified data.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003ch3\u003eData Sources\u003c/h3\u003e\u003cp\u003eWe combined data from the National Survey of Child and Adolescent Well-Being (NSCAW) I \u0026amp; II (Dowd et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Dowd et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) for this study. Complete information about the NSCAW datasets can be found at the National Data Archive on Child Abuse and Neglect (NDACAN) website (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ndacan.acf.hhs.gov\u003c/span\u003e\u003cspan address=\"https://www.ndacan.acf.hhs.gov\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eNSCAW-I\u003c/span\u003e included 5,501 children ages birth to 14 and their families who were investigated for child abuse or neglect in the United States (U.S.) between October 1999 and December 2000 by Child Protective Services (CPS). Face-to-face interviews with children, caregivers, and child welfare caseworkers were conducted 2–6 months after the investigation was closed (baseline) and at three follow-up timepoints: 18 months (N = 4,470), 36 months (N = 4,511), and 59–96 months (N = 4,134). \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eNSCAW-II\u003c/span\u003e included 5,872 U.S. children aged birth to 17.5 years who had contact with the CWS from 2008–2009 and whose investigations were closed during this period. Children, caregivers, and caseworkers were interviewed face-to-face at three timepoints: baseline (March 2008-September 2009), and approximately 18- and 36-months following baseline. Both NSCAW-I and -II included cases that did and did not receive CWS services and followed children for the full study period regardless of whether they remained in the CWS. Additional information about the design and weighting for NSCAW-I and II are published (Dowd et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Dowd et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Weights from NSCAW-I and II aim to provide a national representative sample of children in the child welfare system.\u003c/p\u003e\u003cp\u003e\u003cem\u003eSample for the Current Study.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThis study focused on the influence of childhood SI on adolescent outcomes. All children with at least one study visit between ages 7–11 years and 12–15 years (N = 1,929) were included. Any children missing all SI observations between the 7–11 age range were omitted, leaving a final sample of N = 1,641. This subset of the eligible children did not differ substantively from the full population along any relevant covariates (See Supplemental Table\u0026nbsp;1). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the demographic characteristics of the sample.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSample Characteristics (N = 1,641)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDataset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNSCAW-I\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,230 (75%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNSCAW-II\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e411 (25%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e807 (49%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e834 (51%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRace \u0026amp; Ethnicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlack, non-Hispanic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e515 (31%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHispanic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e310 (19%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther/Unknown Race\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e107 (7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite, non-Hispanic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e709 (43%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaltreatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeglect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e596 (36%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e313 (19%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e356 (22%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSexual\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e231 (14%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e145 (8.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003eNote. NSCAW = National Survey of Child and Adolescent Wellbeing.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eNSCAW-I and -II were weighted to slightly different populations. Thus individual-level weights from the NSCAW I dataset were adjusted so that the weighted NSCAW I population statistics matched those from NSCAW II on race/ethnicity, sex, age distribution, Wave 1 SI, and type of alleged maltreatment using the raking procedure described in DeBell and Krosnick (DeBell \u0026amp; Krosnick, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) as implemented in the “anesrake” R package (Pasek \u0026amp; Pasek, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e About Here\u003c/p\u003e\u003ch2\u003eMeasures\u003c/h2\u003e\u003ch2\u003eIndependent Variable: Child Suicidal Ideation (SI)\u003c/h2\u003e\u003cp\u003eAt ages 7–11, SI was measured using item 9 from the Children’s Depression Inventory (CDI) (Kovacs, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e1992\u003c/span\u003e), a reliable and valid child depression scale (Doerfler et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e1988\u003c/span\u003e; Knight et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e1988\u003c/span\u003e). The SI item from the CDI has been used in prior studies (Anderson, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Fulginiti et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and serves as our primary independent variable of interest. This item was initially coded such that 1= “no ideation,” 2= “ideation but no desire to commit suicide,” and 3= “ideation with desire to commit suicide in the past 2 weeks.” Because very few (\u0026lt; 1%) of responses indicated a score of 3 (ideation with a desire to die by suicide), ideation was recoded as 0 = no ideation (originally option 1) and 1 = ideation (originally option 2 or 3). Children with multiple waves of data between ages 7–11 years were coded as SI = 1 if they expressed SI at any time at any wave in this age range.\u003c/p\u003e\u003ch3\u003eDependent Variables: Early Adolescent Behavioral Health\u003c/h3\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the study’s adolescent (ages 12–15) outcome measures.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eStudy outcome measures\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstruct\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSource\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eScale/Item\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eItem Text\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eItem Responses*\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSuicidal Ideation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCDI Item 9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePick out the sentences that describe you best in the past two weeks.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eI do not think about killing myself\u003c/p\u003e\u003cp\u003e\u003cb\u003eI think about killing myself, but I would not do it\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eI want to kill myself\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYSR Item 91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eI think about killing myself\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003enot true\u003c/p\u003e\u003cp\u003e\u003cb\u003esomewhat or sometimes true\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003every true or often true\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCBCL Item 91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTalks about killing self\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSelf-injury\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYSR Item 18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eI deliberately try to hurt or kill myself\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003enot true\u003c/p\u003e\u003cp\u003e\u003cb\u003esomewhat or sometimes true\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003every true or often true\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCBCL Item 18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDeliberately harms self or attempts suicide\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eInternalizing Behaviors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYSR Internalizing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"5\" nameend=\"c5\" namest=\"c4\" rowspan=\"6\"\u003e\u003cp\u003e\u003cem\u003eThese are scales with multiple items. See below for more information.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCBCL Internalizing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eExternalizing Behaviors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYSR Externalizing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCBCL Externalizing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTS Symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTSCC PTSD Scale\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlcohol Use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYRBS, CRAFFT, Add Health\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote. * Responses in bold are considered positive for ideation or self-injury. CDI = Children’s Depression Inventory; CBCL = Child Behavior Checklist; PTS = posttraumatic stress; YSR = Youth Self Report; TSCC = Trauma Symptom Checklist for Children; PTSD = Posttraumatic Stress Disorder; YRBS = Youth Risk Behavior Survey; Add Health = National Longitudinal Survey of Adolescent Health.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e About Here\u003c/p\u003e\u003ch3\u003eInternalizing and Externalizing Behaviors\u003c/h3\u003e\u003cp\u003eThe Child Behavior Checklist (CBCL/6–18) (Achenbach \u0026amp; Rescorla, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2001\u003c/span\u003e) is a caregiver-reported measure of children’s psychopathology for children aged 6–18. Caregivers rated each item on a 3-point scale (0 = not true, 1 = somewhat or sometimes true, and 2 = very true or often true) based on the prior six months. The \u003cb\u003einternalizing\u003c/b\u003e broadband scale is a measure of internalizing problems such as anxiety and depression, containing 33 items. The \u003cb\u003eexternalizing\u003c/b\u003e scale includes 34 items related to children’s externalizing behaviors such as aggression, rule breaking and hyperactivity. In this study, the raw internalizing (Cronbach’s a = 0.89) and externalizing (Cronbach’s a = 0.93) scale scores were used. The CBCL internalizing and externalizing scores at childhood were controlled for when examining adolescent scores. For cases where the CBCL was administered more than once in the 7–11-year age range or 12-15-year age range, an average of the scores were used.\u003c/p\u003e\u003cp\u003eThe Youth Self Report (YSR/11–18) (Achenbach \u0026amp; Rescorla, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2001\u003c/span\u003e) is the youth version of the CBCL/6–18 with youth self-reporting on their own psychopathology and is used for ages 11–18. Youth rated each item on a 3-point scale (0 = not true, 1 = somewhat or sometimes true, and 2 = very true or often true) based on the prior six months. The \u003cb\u003einternalizing\u003c/b\u003e broadband scale measures internalizing problems with 33 items and the \u003cb\u003eexternalizing\u003c/b\u003e scale includes 34 items. In this study, the raw internalizing (Cronbach’s a = 0.89) and externalizing (Cronbach’s a = 0.88) scale scores were used. As with the CBCL internalizing and externalizing scores, all responses in the 12-15-year-old period were averaged when multiple scores were present.\u003c/p\u003e\u003ch3\u003eSelf-Injurious Thoughts and Behaviors\u003c/h3\u003e\u003cp\u003eCaregiver-reported \u003cb\u003esuicidal ideation\u003c/b\u003e (suicidal thoughts) was defined as caregiver endorsement of a 1 or 2 on CBCL/6–18 item 91 “talks about killing self” and dichotomized as 0 = no and 1 = yes. \u003cb\u003eSelf-injurious behavior\u003c/b\u003e was defined as caregiver endorsement of a 1 or 2 on CBCL/6–18 item 18: “deliberately harms self or attempts suicide” and dichotomized as 0 = no and 1 = yes. Any instance of a positive score for ideation or self-injurious behaviors during adolescence, 12–15 years, was positive for ideation or self-injury, respectively.\u003c/p\u003e\u003cp\u003eAdolescent self-reported \u003cb\u003esuicidal ideation\u003c/b\u003e was measured in two ways: the same CDI item used to measure child SI; and youth endorsement of a 1 or 2 on YSR/11–18 item 91 “talks about killing self.” These were then dichotomized such that 0 = no and 1 = yes. \u003cb\u003eSelf-injurious behavior\u003c/b\u003e was defined as a 1 or 2 on YSR/11–18 item 18: “deliberately harms self or attempts suicide” and dichotomized as 0 = no and 1 = yes. Any endorsement during the 12-15-year-old period was a positive for the outcome.\u003c/p\u003e\u003ch2\u003ePosttraumatic Stress\u003c/h2\u003e\u003cp\u003eAdolescent-reported \u003cb\u003eposttraumatic stress symptoms\u003c/b\u003e were measured with the Trauma Symptom Checklist for Children (TSCC) PTSD scale (Briere, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1996\u003c/span\u003e). The PTSD score is a sum of 10 items. Youth rate how often they experience PTSD symptoms on a four-point Likert scale from 0 = never to 3 = almost all of the time (Cronbach’s a = 0.84). Scores were averaged when there were multiple TSCCs administered during the 12-15-year-old period.\u003c/p\u003e\u003ch3\u003eAlcohol Use\u003c/h3\u003e\u003cp\u003eQuestions derived from the Youth Risk Behavior Survey (YRBS) (Eaton et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2006\u003c/span\u003e), CRAFFT (Knight et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2002\u003c/span\u003e), and National Longitudinal Study of Adolescent Health (Add Health) (Harris et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2003\u003c/span\u003e) were used to measure \u003cb\u003ealcohol use\u003c/b\u003e in youth ages 11 + years. For NSCAW-I, youth were asked, “In your whole life, on how many days did you drink an alcoholic beverage including beer, wine, wine coolers, and liquor? Please do not include any sips you may have had from another person’s drink.” A follow-up question was asked of those who did not indicate “I have never done this.” The follow-up question was, “In the last 30 days, on how many days did you drink an alcoholic beverage?” Response options to the follow-up question included: “1 day” up to “20 days or more” and “I have not done this in the past 30 days.”\u003c/p\u003e\u003cp\u003eFrom NSCAW-II, three related questions were used: “During your life, on how many days have you had at least one drink of alcohol?” followed by, “How old were you when you had your first drink of alcohol other than a few sips?” and then, “During the past 30 days, on how many days did you have at least one drink of alcohol?” All three questions had a “0 days” or “I have never had a drink of alcohol other than a few sips” option and the subsequent question would only be asked if something other than a non-use option was chosen.\u003c/p\u003e\u003cp\u003eFor both NSCAW-I and NSCAW-II, children who reached the question related to the last 30 days and answered they had used any alcohol were coded positive for recent alcohol use. Children who indicated no alcohol use on either the final 30-day question or any of the previous questions were coded as having no alcohol use. All other children we coded as missing.\u003c/p\u003e\u003ch3\u003eCovariates and Confounders\u003c/h3\u003e\u003cp\u003eAdditional variables the analysis (propensity score weighting and/or regressions) included: CBCL internalizing and externalizing scores during 7–11 age range, the most serious form of maltreatment, dataset (NSCAW-I vs. NSCAW-II), age, sex, race, ethnicity, and the number of waves in the 7–11 and 12–15 age ranges. The CBCL internalizing and externalizing scores were averaged for any children with multiple CBCLs during the 7–11 range. The most serious form of maltreatment was identified by caseworkers and coded into the following categories: neglect, physical abuse, sexual abuse, and other abuse. All demographic variables were assigned by NSCAW based on a combination of caseworker, caregiver, and child self-reports (Dowd et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Dowd et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). The number of waves in the 7–11 and 12–15 periods were simply the number of waves of data collected for each child in each period.\u003c/p\u003e\u003cp\u003e\u003cem\u003eMissing data.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eA total of 1,929 children were present in NSCAW-I and NSCAW-II with at least one wave of data during both the child (age 7–11) and adolescent (age 12–15) age range. Of these, 1,641 (85%) have at least one non-missing SI observation during the 7–11 age range. We compared the weighted characteristics of the full dataset (N = 1,929) against those in the subset dataset (N = 1,641) and determined there were no significant differences between the two, indicating no selective non-response (see Supplementary Table\u0026nbsp;1). As such, no adjustments were made for non-response formally.\u003c/p\u003e\u003cp\u003eItem-level missingness in the remaining data is generally sparse. There was one child with missing race and ethnicity information, which was merged with the “Other” race category to avoid dropping the case. Similarly, there were 145 children missing the most severe form of maltreatment. Given the relatively large number, a “Missing” category for maltreatment was added to the regressions. No other demographic variables had any missingness. The mental health variables generally had low item-level missingness, with the highest number being for the 12–15 age range alcohol use (6.2%) and lowest being for the 7–11 age range CBCL scores (0.2%). Given the low rate of unaddressed item non-response, a complete case analysis was appropriate for each outcome.\u003c/p\u003e\u003ch2\u003eAnalysis\u003c/h2\u003e\u003ch2\u003ePropensity Score Weighting\u003c/h2\u003e\u003cp\u003eIn this study, propensity-score weighting was used to ensure better comparability between participants with and without SI at age 7–11. Potential confounders in the propensity score model were the number of waves with non-missing CDI item 9 during the 7–11 age range, maltreatment type, race and ethnicity, sex, and age at wave 1. The number of waves in the 7–11 age range was important to control for as child reported SI at any wave within this age was considered positive for SI status. Children with more waves have more opportunities to endorse SI and are more likely to code positive for SI. Including this variable in the propensity score model corrects for this effect in the regression models. We estimated the propensity score weights using generalized boosted models (GBM) via the Toolkit for Weighting and Analysis of Nonequivalent Groups (TWANG) package (Ridgeway et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) and controlling for the survey weights. The comparability (e.g., balance) of the two groups before and after weighting using effect size (ES) differences as well as Kolmogorov-Smirnoff (KS) statistics using a threshold of 0.1 to determine if balance was achieved was completed.\u003c/p\u003e\u003ch2\u003eRegression models\u003c/h2\u003e\u003cp\u003eThe effect of our exposure (SI at ages 7–11) on several outcomes (SITB, internalizing and externalizing problems, PTS, and alcohol use at ages 12–15) using doubly robust propensity-score weighted regression analyses for each outcome was conducted. Linear and logistic regression for continuous and dichotomous outcomes, respectively, was used to estimate the impact of childhood SI on adolescent outcomes with propensity score weighting to adjust for baseline differences between 7–11-year-olds with and without SI. All continuous outcomes were log + 1-transformed and standardized to normalize the distributions and permit comparisons across analyses. Control variables included 7–11-year-old CBCL internalizing and externalizing scores, race and ethnicity, sex, maltreatment type, age (during the 12–15 age range) and an interaction between sex and age. The interaction was included as previous work in this population suggests different trajectories of SI among females and males during this age period (Hassler et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Given the relatively large number of models, p-values were adjusted using the Benjamini-Hochberg procedure to control the false discovery rate (Benjamini \u0026amp; Hochberg, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e1995\u003c/span\u003e).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the survey-weighted mental health variables during the 7\u0026ndash;11 age range.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIdeation and CBCL scores during 7\u0026ndash;11 age range.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;1,641\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCDI Ideation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRaw CBCL Internalizing Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.0 (7.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRaw CBCL Externalizing Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.8 (9.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNote. Results are weighted using survey weights. CDI\u0026thinsp;=\u0026thinsp;Children\u0026rsquo;s Depression Inventory; CBCL\u0026thinsp;=\u0026thinsp;Child Behavior Checklist. \u003csup\u003e1\u003c/sup\u003e%; Mean (SD).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e About Here\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows balance information for our sample before and after propensity score weighting. As shown, the groups differed substantially on CBCL internalizing and externalizing scores, age, dataset, and number of waves in the 7\u0026ndash;11 age range prior to propensity score adjustment with ES differences ranging from 0.155 to 0.392. After weighting, all differences were minimal, and the groups were highly similar on all key control covariates used to estimate the weights (all ES differences\u0026thinsp;\u0026lt;\u0026thinsp;0.1).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBalance Table\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eSurvey Weighted\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003ePropensity Score Weighted\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCharacteristic\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eNo Ideation (7\u0026ndash;11)\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eIdeation (7\u0026ndash;11)\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eES Diff.\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eNo Ideation (7\u0026ndash;11)\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eIdeation (7\u0026ndash;11)\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eES Diff.\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCBCL Internalizing Score\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.2 (6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.5 (7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.331\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.0 (7.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.5 (7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.068\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCBCL Externalizing Score\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.6 (9.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.9 (10.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.338\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.1 (9.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.9 (10.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.078\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRace \u0026amp; Ethnicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlack, non-Hispanic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e28%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e29%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHispanic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e21%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.051\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther/Unknown Race\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.037\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite, non-Hispanic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e48%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e46%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.052\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge at Earliest Wave\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.7 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.1 (1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.392\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.1 (1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.1 (1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.036\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e53%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e55%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.029\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e47%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e45%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.029\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaltreatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeglect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e41%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e43%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.046\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e26%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSexual\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.096\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDataset\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNSCAW-I\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.163\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e77%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e77%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNSCAW-II\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.163\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of Waves (7\u0026ndash;11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.314\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e55%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e56%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.020\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e21%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eNote. CBCL\u0026thinsp;=\u0026thinsp;Child Behavior Checklist; NSCAW\u0026thinsp;=\u0026thinsp;National Survey of Child and Adolescent Wellbeing; ES\u0026thinsp;=\u0026thinsp;Effect Size; Diff\u0026thinsp;=\u0026thinsp;Difference.\u003c/p\u003e\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eMean (SD); %\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eDifference on effect size scale. Cohen's d for continuous variables and Cohen's h for categorical variables.\u003c/p\u003e\u003cp\u003e\u003csup\u003e3\u003c/sup\u003eReported statistics are on original scale, but propensity score matching was on log-scale. Effect size differences on log-scale for propensity score weighted analyses were 0.042 and 0.057 for internalizing and externalizing scales, respectively.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e About Here\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows the descriptive characteristics of all outcome variables using both the survey and propensity score weights, broken down by whether there was any ideation during the 7\u0026ndash;11 age range.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMental health outcomes during the 12\u0026ndash;15-year-old age range\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eSurvey Weighted\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003ePropensity Score Weighted\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eOverall\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eNo Ideation (7\u0026ndash;11)\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eIdeation (7\u0026ndash;11)\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eOverall\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eNo Ideation (7\u0026ndash;11)\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eIdeation (7\u0026ndash;11)\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuicidal Ideation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCDI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYSR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCBCL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-Injurious Behavior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYSR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCBCL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlcohol Use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInternalizing Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYSR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.4 (7.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.7 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.7 (8.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.1 (7.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.3 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10.7 (8.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCBCL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.6 (7.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.9 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.0 (7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.6 (7.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.2 (7.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9.0 (7.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExternalizing Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYSR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.4 (8.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.7 (7.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.5 (8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.0 (8.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12.5 (7.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13.5 (8.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCBCL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.4 (10.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.7 (9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.7 (11.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.6 (10.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13.6 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13.7 (11.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTSCC PTSD Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.5 (5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.3 (4.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.0 (5.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.8 (5.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.6 (4.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.0 (5.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eNote. CDI\u0026thinsp;=\u0026thinsp;Children\u0026rsquo;s Depression Inventory; CBCL\u0026thinsp;=\u0026thinsp;Child Behavior Checklist; YSR\u0026thinsp;=\u0026thinsp;Youth Self Report; TSCC\u0026thinsp;=\u0026thinsp;Trauma Symptom Checklist; PTSD\u0026thinsp;=\u0026thinsp;Posttraumatic Stress Disorder; \u003csup\u003e1\u003c/sup\u003e%; Mean (SD)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e About Here\u003c/p\u003e\u003cp\u003eTables\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e and \u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e include the final regression results for the effects of 7\u0026ndash;11-year-old ideation on each adolescent outcome with p-values adjusted for multiple testing. See SI Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e for full regression results with unadjusted p-values.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAdolescent SITB Outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSITB Outcome\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSource\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eScale/Item\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOdds Ratio\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAdjusted p-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSuicidal Ideation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCDI Suicidal Ideation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.56\u0026ndash;4.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYSR Suicidal Ideation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.42\u0026ndash;5.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCBCL Suicidal Ideation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.2\u0026ndash;5.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.038\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSelf-injurious Behavior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYSR Self-injurious behavior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.66\u0026ndash;14.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCBCL Self-injurious behavior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.52\u0026ndash;2.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.839\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote. SITB\u0026thinsp;=\u0026thinsp;Self-injurious thoughts and behaviors; CDI\u0026thinsp;=\u0026thinsp;Children\u0026rsquo;s Depression Inventory; CBCL\u0026thinsp;=\u0026thinsp;Child Behavior Checklist; YSR\u0026thinsp;=\u0026thinsp;Youth Self Report; CI\u0026thinsp;=\u0026thinsp;Confidence Interval.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAdolescent Behavioral Health Outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBehavioral Health outcome\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSource\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eScale/Item\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRegression Coefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAdjusted p-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eInternalizing Problems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYSR Internalizing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.11\u0026ndash;0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.757\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCBCL Internalizing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.13\u0026ndash;0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.950\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eExternalizing Problems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYSR Externalizing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.13\u0026ndash;0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.839\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCaregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCBCL Externalizing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.24\u0026ndash;0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.117\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTS Symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTSCC PTSD Scale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.16\u0026ndash;0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.906\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlcohol Use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYRBS, CRAFFT, Add Health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR\u0026thinsp;=\u0026thinsp;0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.46\u0026ndash;1.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.839\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote. CBCL\u0026thinsp;=\u0026thinsp;Child Behavior Checklist; YSR\u0026thinsp;=\u0026thinsp;Youth Self Report; PTS\u0026thinsp;=\u0026thinsp;posttraumatic stress; TSCC\u0026thinsp;=\u0026thinsp;Trauma Symptom Checklist for Children; PTSD\u0026thinsp;=\u0026thinsp;Posttraumatic Stress Disorder; YRBS\u0026thinsp;=\u0026thinsp;Youth Risk Behavior Survey; Add Health\u0026thinsp;=\u0026thinsp;National Longitudinal Survey of Adolescent Health; OR\u0026thinsp;=\u0026thinsp;Odds Ratio. Alcohol use was a binary variable while the other outcomes in this table were all continuous.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, \u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e\u0026ndash;11-year-olds with SI were two times more likely to experience adolescent SI than 7\u0026ndash;11-year-olds without SI (ORs 2.46\u0026ndash;2.92, 95% CIs 1.20\u0026ndash;5.99) across all measures, even after balancing the two groups on other key variables with propensity score weighting and controlling for key covariates. No meaningful differences in the magnitudes of this effect when comparing between informants or measures were found.\u003c/p\u003e\u003cp\u003eFor self-injurious behavior, there were deviating results among informants. Seven- to eleven-year-olds reporting SI had nearly five times greater odds than those without SI to report self-injurious behavior in adolescence (OR\u0026thinsp;=\u0026thinsp;4.91, 95% CI\u0026thinsp;=\u0026thinsp;1.66\u0026ndash;14.53), however, there was no observable effect when examining caregiver report (OR\u0026thinsp;=\u0026thinsp;1.21, 95% CI\u0026thinsp;=\u0026thinsp;0.52\u0026ndash;2.84).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e About Here\u003c/p\u003e\u003cp\u003eSI at ages 7\u0026ndash;11 did not significantly predict adolescent internalizing, externalizing, PTS, and alcohol use outcomes (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e helps to illustrate and summarize all regression models.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e About Here\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e About Here\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis longitudinal study examined the relationship between childhood (ages 7\u0026ndash;11) SI and adolescent (ages 12\u0026ndash;15) mental health outcomes among high risk, CWS involved youth. We found that SI at ages 7\u0026ndash;11 years predicted over two times greater odd of SI in adolescence but, in contrast, self-injurious behavior outcomes differed based upon informant. When examining self-injurious behaviors by youth report, SI at ages 7\u0026ndash;11 years was associated with a quadrupling of odds for adolescent self-injurious behavior. However, there was no significant association with caregiver-reported adolescent self-injury. This informant discrepancy is consistent with previous research showing that rates of self-injurious behaviors (including suicide attempts) are higher when measured with youth self-report compared to caregiver report (D. C. DeVille et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Jones et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). These informant discrepancies are important to understand, and may themselves predict adverse outcomes for adolescents (compared to outcomes for those with smaller youth-caregiver discrepancies) (Ferdinand et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2004\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCaregivers may not always be aware of youth self-injurious behaviors as adolescents are much more likely to disclose self-injury to peers than to adults (Simone \u0026amp; Hamza, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In CWS-involved families, some caregivers may be temporary (e.g., foster parents or extended family) and may not know the child well enough to identify intentional self-injury (vs. accidental). The caregivers in our sample\u0026mdash;who have in many cases recently been investigated for allegations of child maltreatment\u0026mdash;also may be reluctant to report self-injurious behaviors due to experiences of shame and guilt (Curtis et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and worries that the injury will trigger another child welfare investigation (Cao et al., 2019). While more research is required to further examine these findings, it may be beneficial to also educate caregivers on how to have conversations with their youth about SITBs so intervention can occur early changing trajectories of risk.\u003c/p\u003e\u003cp\u003eIt is interesting that the informant discrepancy found for self-injurious behavior did not emerge for suicidal thoughts. This is inconsistent with other research where caregivers were less likely to report child SI compared to the child themselves using the same measures used in this study (i.e., the CBCL and YSR) (D. C. DeVille et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). More research is certainly needed to better understand these findings, and qualitative approaches that directly gather in-depth accounts from youth and caregivers may have potential value.\u003c/p\u003e\u003cp\u003eCounter to our expectations, when we examined multiple other, non-SITB adolescent behavioral health dimensions, no significant differences between those with and without SI in their younger years were found\u0026mdash;regardless of whether the adolescent or caregiver was the informant. While it is possible that there are differences in other SITB-related outcomes that we did not measure (e.g., risky behavior, psychosis), our finding implies that childhood SI is most strongly predictive of adolescent SITB and less predictive of other forms of adolescent psychopathology, after accounting for the influence of other pre-existing risk factors like child maltreatment and childhood mental health concerns.\u003c/p\u003e\u003cp\u003eOur study had many methodological strengths, including the application of propensity score weights and adjustment for confounders in our regression models. This means that the identified associations are unlikely to be explained by group differences on the observed covariates used in the weights. Other key strengths include the study\u0026rsquo;s longitudinal design and the availability of multi-informant data. However, there are some limitations that should be considered. First, these data \u0026ndash; while arguably the best available to study this topic\u0026ndash; are relatively old, coming from studies conducted in the 1990s and 2000s. The experiences of youth \u0026ndash; including their mental health and suicide risk \u0026ndash; in current days may not be fully captured by data collected from prior generations. For instance, the evolution of technology including social media and artificial intelligence have transformed the ways that youth communicate with one another and seek help for mental health concerns (Benvenuti et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Pretorius et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Second, our inferences requires assumptions that unobserved confounders are not likely to impact our findings, which is an assumption that was not formally tested. Also, potential mechanisms of change, or mediators and moderators, were not examined for this study. Future research should investigate those key mechanisms, such as whether receipt of mental health care and other forms of support impact the extent to which childhood SI affects adolescent wellbeing. Finally, this dataset did not contain self-reported measures of self-injurious behavior for children under 11 years old. It is not clear whether those behaviors would show similar associations with adolescent outcomes as found for this study for SI.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eChildren in the CWS with SI face substantially elevated risk for adolescent SITB. However, they are not at heightened risk for other behavioral health concerns (e.g., internalizing problems) in adolescents relative to children in the CWS who have similar baseline mental health symptoms and demographic characteristics. Our findings underscore the value of caregivers, caseworkers and other caring adults talking to CWS-involved children about their potential suicidal thoughts as early as elementary school. CWS-involved children may experience multiple transitions in caregivers and school settings, which can hinder the building of trusting relationships necessary for recognizing risk. For children who remain with their primary caretakers, there may be hesitancy to identify and report mental health concerns due to fear of increased system involvement. System-level barriers within CWS, such as high caseloads, may further complicate the identification and treatment of at-risk youth. Additionally, cultural considerations and historical relationships with healthcare systems may impede help-seeking behaviors. Consequently, those most in need of support face substantial barriers in identification, connection to services, and treatment engagement. Strengthening suicide prevention efforts for these vulnerable youth should be a high priority for policy makers, practitioners, child welfare caseworkers, schools and caregivers.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eConflicts of Interest\u003c/span\u003e:\u003c/h2\u003e\u003cp\u003eThe authors have no conflicts of interest to disclose.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eL.A. and A.H.S. secured funding for the work and conceptualized the study. L.A., and A.S. wrote the main manuscript text and A.H.S. revised the text. E.O., B.A.G., and G.W.H. conducted the analyses, prepared tables and figures, and wrote the analysis sections of the manuscript. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe are grateful for the wise and helpful advice of Andrea Hussong, Ph.D., and Andres De Los Reyes, Ph.D. in the conceptualization of the paper and analysis.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe restricted NSCAW data that support the findings of this study are available from National Data Archive on Child Abuse and Neglect (NDACAN), but restrictions apply to the availability of these data, which were used under license for the current study and so are not publicly available. The data are, however, available upon request and with the permission of NDACAN.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAchenbach, T. M., \u0026amp; Rescorla, L. A. (2001). \u003cem\u003eManual for the ASEBA School-Age Forms \u0026amp; Profiles\u003c/em\u003e. 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Examining the disclosure of nonsuicidal self-injury to informal and formal sources: A review of the literature. \u003cem\u003eClinical Psychology Review\u003c/em\u003e,\u003cem\u003e 82\u003c/em\u003e, 101907. https://doi.org/https://doi.org/10.1016/j.cpr.2020.101907 \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"child-psychiatry-and-human-development","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"chud","sideBox":"Learn more about [Child Psychiatry \u0026 Human Development](http://link.springer.com/journal/10578)","snPcode":"10578","submissionUrl":"https://submission.nature.com/new-submission/10578/3","title":"Child Psychiatry \u0026 Human Development","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"suicide, child maltreatment, mental health, alcohol","lastPublishedDoi":"10.21203/rs.3.rs-8059053/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8059053/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWe examined whether child welfare\u0026ndash;involved children aged 7\u0026ndash;11 with suicidal ideation (SI) experience worse adolescent behavioral health compared to peers without SI. Using longitudinal data from the National Survey of Child and Adolescent Wellbeing I and II (N\u0026thinsp;=\u0026thinsp;1,641), propensity score weighting balanced baseline characteristics. We compared groups on adolescent outcomes (ages 12\u0026ndash;15) from youth and caregiver reports. Children with SI at ages 7\u0026ndash;11 had twice the odds of adolescent SI and four times the odds of self-reported self-injury, though caregiver reports did not confirm the latter. No significant differences emerged for other behavioral health outcomes. Thus, child welfare\u0026ndash;involved youth showing SI early face elevated risk for persistent SI and self-injury, even after controlling for maltreatment and prior symptoms. These findings highlight the need for early identification and monitoring of SI, and for further research on underlying mechanisms and replication.\u003c/p\u003e","manuscriptTitle":"Adolescent Behavioral Health Outcomes of Child Welfare Involved Youth with and without Childhood Suicidal Ideation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-23 11:35:53","doi":"10.21203/rs.3.rs-8059053/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-23T09:57:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-22T17:53:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65842022564522574131547633181956044218","date":"2025-12-13T09:46:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-05T19:18:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"57777196346134957795627374204987437586","date":"2025-11-11T17:51:46+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-11T17:04:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-09T23:51:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-08T07:55:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"Child Psychiatry \u0026 Human Development","date":"2025-11-07T16:41:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"child-psychiatry-and-human-development","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"chud","sideBox":"Learn more about [Child Psychiatry \u0026 Human Development](http://link.springer.com/journal/10578)","snPcode":"10578","submissionUrl":"https://submission.nature.com/new-submission/10578/3","title":"Child Psychiatry \u0026 Human Development","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"54239759-8fec-4bf8-9e47-13e82bc194fa","owner":[],"postedDate":"November 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-04T15:39:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-23 11:35:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8059053","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8059053","identity":"rs-8059053","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}