Adolescent suicide risk: four psychosocial factors

Adolescence, Summer, 2004 by Philip A. Rutter, Andrew E. Behrendt

Suicide is a leading cause of death among those aged 15-24 (Berman & Jobes, 1995; Centers for Disease Control, 2002). Consequently, in the U.S., a National Health Objective (National Institute of Mental Health, 2001) urges researchers to focus on ways to decrease the adolescent suicide rate by more than 25% within the decade.

Adolescent suicide research has, by and large, focused on demographic risk factors (Brent, Baugher, & Bridge, 1999; Levy, Jurkovic, & Spirito, 1995). This approach provides descriptive data and correlates demographics with suicide risk. Numerous studies have examined the incidence of suicidal thoughts and suicide attempts by age, race, educational level, family background, religion, socioeconomic level, sexual orientation, and other demographic variables (D'Augelli, Hershberger, & Pilkington, 1996; Levy, Jurkovic, & Spirito, 1995). Such studies focused on who is at risk, but did not explain why certain youths may be at risk for suicide. For example, adolescents with substance abuse problems, psychiatric disorders, family disruption/stress, antisocial behavior, or family suicide history are said to be at greater risk for completing suicide. This does not explain the context of an adolescent's propensity for suicide, and is problematic in the formulation of effective intervention strategies (Grholt, Ekebrg, & Wichstrom, 2000).

This approach also suggests that adolescents of a certain demographic may be at higher risk for suicide, but focusing on demographics alone may lead to misidentifying those not at risk, as well as bypassing those who are actually at risk for suicidal behavior (Pfeffer, Klerman, Hurt, Lesser, Peskin, & Seifker, 1991). For example, D'Augelli and Hershberger (1995) suggested that gay, lesbian, and bisexual adolescents exhibit greater suicide risk than their heterosexual peers. However, Rutter (1998) found that sexual orientation alone did not impact suicide risk. Rutter and Soucar (2002) reported that adolescents who endorsed items citing the presence of social support from peers and family displayed less suicide risk, regardless of their sexual orientation.

The majority of suicides occur among Caucasian adolescents; consequently, most interventions are based on Caucasian adolescents' suicidal behavior. Yet, rates among Native American, Hispanic, and African American adolescents have increased dramatically in the past decade. Recent research suggests that racial and ethnic minority adolescents exhibit suicide risk differently, are unlikely to be assessed accurately, and are often overlooked as "at risk" (Canino & Roberts, 2001; Choquet, Kovess, & Poutignat, 1993; Scouller & Smith, 2002).

Blum, Beuhring, Shew, Bearinger, Sieving, and Resnick (2000) have suggested that researchers look within more proximal social contexts to understand what predisposes some adolescents to increased suicide risk. In keeping with the aforementioned National Health Objective (National Institute of Mental Health, 2001), examining the psychosocial correlates within a particular demographic group may be a more efficacious approach to predicting who is at highest risk for suicide. The purpose of the present study was to ascertain the salience of combining four psychosocial variables as potential predictors of suicide risk.

METHOD

Participants

A sample of one hundred adolescents, with an equal number of male and female participants, was recruited from a sexual minority support agency (n = 50) and an urban university (n = 50). Fifty-three percent of the participants were Caucasian, 25% African American, 6% Asian, 3% Hispanic, and 13% identified themselves as either biracial or Native American. Fourteen percent were 17 years old, 37% were 18 years old, and 49% were 19 years old. In terms of sexual orientation, 26% self-identified as homosexual, 24% as bisexual/questioning, and 50% as heterosexual. This was a nonclinical sample and participation was voluntary.

Procedure

The exploration of psychosocial factors in relation to suicide risk is by no means new. There is extensive literature on how certain individual factors can affect suicidal behavior. The current study explored adolescent suicide risk across multiple psychosocial factors (hopelessness, negative self-concept, hostility, and low social support). The instrument combined the Suicide Probability Scale (SPS; Zachary, Roid, Cull, & Gill, 1983), the Beck Hopelessness Scale (BHS; Beck, Brown & Steer, 1989), the Suicide Questionnaire (SQ; Meehan, Lamb, Saltzman, & O'Caroll, 1992), and a demographics form (Rutter, 1998).

The SPS is a reliable 36-item Likert-type self-report inventory focusing on hopelessness, hostility, suicidal ideation, and negative self-concept. The BHS is a psychometrically sound self-report measure that has 20 true-false statements to assess negative beliefs about the future. Scores range from 0 to 20, with higher scores indicating greater levels of hopelessness. The SQ was modified from its original form as an inpatient clinical interview. Reliability and validity have yet to be established, although the SQ has been reported to exhibit high face validity and to offer a nonthreatening method of assessing suicidal ideation, plans, and attempts (Muehrer, 1995). The demographics form contains questions about the adolescent's ethnicity, sexual orientation, and education level, as well as questions about the level of social support received from friends, family, and school staff.