Risk factors for adolescent suicidal behavior: loss, insufficient familial support, and hopelessness

Adolescence, Winter, 1993 by Christopher D. Morano, Ron A. Cisler, John Lemerond

The precipitous increase in the adolescent suicide rate over the past three decades has been well documented (Berger & Thompson, 1991; Den Houter, 1981). This rapid rise has led to much research aimed at determining high-risk groups and predictors (Adcock, Nagy, & Simpson, 1991; Gispert, Wheeler, March, & Davis, 1985). Many variables, notably depression (Robbins & Allesi, 1985) and gender (Kosky, Silburn, & Zubrick, 1986), have been found to differentiate adolescent suicide attempters from nonattempters.

However, many seemingly key variables associated with adult suicide attempts have not been explored adequately with adolescents; three such variables are hopelessness, loss, and social support. For example, Beck and his colleagues (Beck, Brown & Steer, 1989) found that hopelessness was the best predictor of adult serious suicide attempts, but to date it has not been reliably linked to adolescent attempts. Another predictor of adult suicide attempts that has not been firmly established with adolescents is loss of a significant other (Slater & Depue, 1981). Finally, a third plausibly related variable, though not fully explored, is social support. This present study investigated the relationship between hopelessness, loss, social support, and inpatient psychiatric adolescent serious suicide attempts.

Though depression has long been considered the hallmark sign of risk for youths, the relationship is neither simple nor linear (Carlson & Cantwell, 1982). Not all severely depressed adults or adolescents requiring hospitalization resort to suicide, and many who attempt, and complete, suicide were not previously diagnosed as globally depressed (Kazdin, French, Unis, Esvelt-Dawson, & Sherick, 1983). Indeed, Beck and others (Beck, Steer, Kovacs, & Garrison, 1985; Cole, 1988; Emery, Steer, & Beck, 1981; Schotte & Clum, 1987) have shown that hopelessness, one facet of depression, is a better predictor of suicide intent among adults than is global depression. In terms of adolescent suicide, however, further study on this hopelessness-suicide intent relationship is needed because existing evidence is based on studies which (1) used weak measures of suicidal intention (Rotheram-Borus & Trautman, 1988; Topol & Resnikoff, 1982), and (2) asked about hospitalized subjects' current state of hopelessness rather than about their perceived sense of hopelessness before their suicide attempt (Spirito, Williams, Stark, & Hart, 1988).

Loss is another event which may precede adult and child/adolescent suicide attempts. Loss of someone who provides emotional, informational, and/or material support has been shown to leave adults seriously vulnerable to suicide (Conroy & Smith, 1983; Hart & Williams, 1987; Wasserman, 1988). Also, divorce, separation, and chronic family discord, but not the death of a parent, were related to suicide attempts in children and adolescents (Crook & Raskin, 1975). This latter study, however, did not differentiate children from adolescents. Taken together there is some reason to believe that the loss of a significant other could be a precursor to adolescent suicide attempts.

Relatedly, much research has explored the role of social support in general adolescent health (Blyth, Hill, & Thiel, 1982; Boyce, 1985; Buruda, Vaux, & Schill, 1984; Clark & Clissold, 1982). However, only two studies report a relationship between social support and adolescent suicidal behavior, one of which suffers from methodological problems (Dubow, Kausch, Blum, Reed, & Bush, 1989) and the other has not been published (Reynolds & Waltz, 1986). Dubow and others (1989) found that suicidal ideation and suicide attempts were associated with low family support. However, the findings were based only on anonymous self-report; no independent verification of important variables was assessed, such as whether a subject had actually made an attempt. Further, no distinction was made between serious and nonserious attempts. Reynolds and Waltz (1986) presented nonpublished data, derived from a nonclinical sample, that linked lack of social support and increased risk of suicide in adolescence. Overall, the dearth of research in this area is particularly compelling when one considers that adolescence is an especially tumultuous time when individuals are arguably more sensitive to social systems and support.

Some studies suggest that family support is a particularly crucial part of overall social support with respect to adolescent health (Boyce, 1985; Clark & Clissold, 1982). Boyce (1985) concluded that mutual, interactive social support is evident in the child's earliest experiences with the family, and that this interaction is critical to the maintenance and normal development of the child. Clark and Clissold (1982) examined the general adaptation of adolescent boys, and found that support from family and friends was the most powerful predictor of healthy adjustment in this population. Neither of these studies, however, examined the effects of varying degrees of family support on adolescent suicidal behavior.