PROJECT ABSTRACT Suicide risk is increasing in preteens, 8-12 years old. Although research is limited, it is estimated that 15% of preteens in community samples and 43% in clinical samples have thought about suicide, and 3% in community and 18% in clinical samples of preteens have attempted suicide. Further, the suicide death rate among preteens has more than tripled over the past 15 years, disproportionally affecting youth of color (who make up ~1/3rd of the youth in our current work). Alarmingly, other than prevalence rates, we know very little about suicide risk in preteens. Specifically, we have limited understanding of key risk factors related to suicidal thoughts and behaviors in this age group. Our knowledge of suicide risk has been limited by the paucity of developmentally appropriate tools to assess suicidal thoughts, and relevant risk factors, in preteens. Critically, we know that suicide risk fluctuates over time (i.e., day-to-day) in both adults and adolescents. As such, it is critical not only to develop assessments of lifetime suicidal thoughts and behaviors appropriate for preteens, but also to develop tools to examine how risk fluctuates over time, particularly during high-risk periods. The overall objective of this proposal is to address these critical gaps in knowledge by adapting and validating a time-varying measure of suicide risk for preteens, based on our established measure of suicide risk used with teens in our current multi-site R01. Aim 1 adapts our team’s existing measure of suicide risk used with 12- 18 year-olds into a developmentally and culturally appropriate measure of suicide risk for preteens. This aim will be achieved by a two-stage approach consisting of expert input (stage 1), and interviews with 15 preteen and caregiver dyads (stage 2), recruited from three diverse sites (Rutgers, Old Dominion University, Massachusetts General Hospital). Feedback will be obtained about the assessment of suicidal thoughts, suicidal behaviors, and candidate risk factors for preteens. For the current application, we strategically targeted time-varying and potentially modifiable risk factors to optimize translational potential. Aim 2 uses the measure from Aim 1 to establish phenotypes of suicide risk among preteens consisting of self-reported risk, as well as objectively measured factors like sleep disturbance, acquired from a wrist worn biosensor. We will address this aim by conducting a 28-day intensive longitudinal monitoring study with multiple informants—preteens, who have just been discharged from acute psychiatric care settings, and one caregiver (n=150 dyads). Aim 3 examines, in the same preteen sample as Aim 2, how these phenotypes predict risk for suicidal thoughts, suicidal behaviors, and other suicide-related events (e.g., rehospitalizations) across a 6-month follow-up.

PROJECT NARRATIVE Suicide risk is increasing in preteens, 8-12 years old: in clinical samples (e.g., inpatient psychiatry), more than 40% have seriously considered suicide and nearly 20% have attempted suicide. Our knowledge of suicide risk has been limited by the paucity of developmentally appropriate tools to assess suicidal thoughts, and relevant risk factors, in preteens. The goal of this study is to adapt a developmentally and culturally appropriate measures of suicide risk for preteens (via community-engaged research) and to examine different phenotypes (i.e., presentations) of suicide risk among 150 at-risk preteens following discharge from acute psychiatric care settings.