Abstract
BACKGROUND: Pediatric suicide is a critical global public health issue. Discovering protective factors which can effectively block the progression from suicidal ideation (SI) to suicidal plan (SP) and suicidal attempt (SA) is essential for prevention. This study examined the role of resilience in preventing the transition of suicidal indicators among children and adolescents. METHODS: A case-control study nested within a two-wave longitudinal survey was conducted in Yunnan province, China, involving 5,924 children and adolescents. Self-administered questionnaires were used to collect relevant information from the participants. Resilience was evaluated by using the Resilience Scale for Chinese Adolescents (RSCA), suicidal indicators (SI, SP, SA) were measured by the Modified Suicidal Behaviors Questionnaire-Revised (SBQ-R). Cases and controls were matched at a 1:3 ratio using propensity score matching. Univariate and multivariate logistic regression models were employed to examine the sequential associations between resilience and the suicidal indicators. RESULTS: The two-wave survey revealed high transition rates from SI to SP (18.5%), SI to SA (7.75%), and SP to SA (11.13%). A 10-point increase in baseline resilience score was significantly associated with a 14% odds reduction in SI to SP progression (OR = 0.86, 95% CI: 0.75-0.99) and an 18% odds reduction in SI to SA progression (OR = 0.82, 95% CI: 0.69-0.96). Stratified analysis showed that resilience was most protective among adolescents, females, and those with baseline mood disorders. For the specific dimensions of resilience, emotion regulation demonstrated a protective effect in SI-SP transition, but not in SI-SA transition. Besides, family support played a prominent role in protecting against the progression from SI to SP among adolescents, minority groups, and subjects with baseline anxiety. CONCLUSIONS: The major findings of our study can provide important longitudinal evidence in guiding the construction of resilience-based suicide prevention strategies among vulnerable juvenile suicidal ideators. CLINICAL TRIAL NUMBER: Not applicable.