Association between unintentional injuries and suicidal ideation of children and adolescents: a longitudinal study.

PURPOSE: This study aims to investigate the prospective association between unintentional injuries and subsequent suicidal ideation among children and adolescents.

METHODS

This study is a two-wave longitudinal school-based cohort derived from repeated surveys administered in Anhui, China, in November 2023 (Wave 1) and April 2025 (Wave 2). As grade 12 students in Wave 1 would graduate by July 2024 and thus be unavailable for follow-up, we included only students in grades 5-11 from Wave 1. We identified 24,522 students who participated in both waves, yielding a follow-up rate of 84.18% (47.08% female).

RESULTS

Among 12 types of unintentional injuries, after adjustment for socio-demographic characteristics and Wave 1 suicidal ideation, all 12 types were significantly associated with Wave 2 suicidal ideation, with adjusted odds ratios ranging from 1.31 to 1.65; all associations remained significant after Benjamini-Hochberg FDR correction (q < 0.05). The strongest associations were observed for explosion injuries (OR = 1.65, 95% CI = 1.27-2.13, q < 0.001), injuries from sharp objects (OR = 1.62, 95% CI = 1.50-1.75, q < 0.001), and poisoning (OR = 1.54, 95% CI = 1.19-1.99, q = 0.001), while the weakest, though still significant, was for Swallow a foreign object (OR = 1.31, 95% CI = 1.21-1.42, q < 0.001). Formal interaction tests indicated that only 3 of the 12 injury types (fall injuries, explosion injuries, and electric-current exposure) showed statistically significant gender × injury interactions, suggesting that the overall pattern of associations is largely consistent across sexes.

CONCLUSION

Previous unintentional injuries are associated with an increased likelihood of subsequent suicidal ideation. Given the consistent pattern of associations and the absence of a clearly dominant injury category, broadly framed injury-prevention and early-identification strategies may be warranted, rather than prioritization of any single injury type.