Suicidal ideation and planning in adolescents: Temporal trends (2006-2022) and intersectional inequalities.

PURPOSE: To analyze temporal trends in suicidal ideation and planning among adolescents from 2006 to 2022, and to assess the association between intersectional inequalities and these outcomes. METHODS: A repeated cross-sectional study was conducted using data from four nationally representative epidemiological surveys (2006, 2011, 2016, and 2022), comprising 21,019 high school students aged 14-19 years. The Jeopardy Index was used to quantify cumulative social disadvantage based on sex, race/ethnicity, and maternal education. Suicidal ideation and planning were the primary outcomes, each categorized dichotomously, and analyzed using survey-weighted logistic regression models. RESULTS: Suicidal behaviors increased significantly over the study period: ideation rose from 11.2% to 26.7%, and planning from 7.8% to 22.1%, with the most pronounced increase between 2016 and 2022. Among adolescent females, ideation reached 35.3% and planning 30.3%, compared to 16.2% and 12.1% among males. Each one-unit increase in the Jeopardy Index was associated with a 6% increase in the odds of suicidal ideation (OR = 1.06) and a 9% increase in the odds of suicidal planning (OR = 1.09). CONCLUSION: Social disparities do not operate in isolation. The cumulative burden of vulnerabilities, particularly the intersection of sex, race/ethnicity, and socioeconomic disadvantage, was associated with increased risk of suicidal ideation and planning. These findings underscore the need for intersectional approaches in mental health surveillance and targeted public health policies for vulnerable adolescent populations.