Abstract Studied mostly in developed countries, the increased prevalence of suicide among youth, worldwide, is a preventable public health concern. Guyana, a developing country in South America, has the highest rate of youth death by suicide. Based on the diathesis–stress model, this community-based study aimed to identify both psychiatric and biological factors associated with repeated suicide attempts among high-risk youth. Objective We measured psychiatric symptoms, childhood traumas, and cortisol to identify correlates with recurrent suicide attempts. Method Poisson regression tested the association between psychiatric symptoms, trauma, and cortisol levels on number of suicide attempts among 50 youths from three child welfare orphanages in Guyana. Sixty-six percent were female, and the average age was 14 years. DSM-5 symptom measure was administered and saliva samples collected. Results Fifty percent of the youth endorsed suicide attempt. Within this subsample, a minimum of one and maximum of five suicide attempts were self-reported. Participants’ number of suicide attempts was positively associated with number of past traumas, psychosis, and depression symptoms. Conclusion Suicide prevention screening among at-risk youth should target severity of psychosis and depression reports and number of traumatic life experiences.