A recent doctoral dissertation reveals that adverse childhood experiences, such as abuse and neglect, predisposes adolescents to suicidality. Girls had a higher risk of a suicidal event occurring during treatment, and suicidality risk screening at intake to behavioral and mental health services failed to predict a large number of suicidal events.
Adolescent suicide is a major public health concern in the United States. Extensive research has been conducted on suicidality (thoughts of suicide, suicide attempts, etc.) among the general adolescent population, but less is known about suicidality among adolescents who are at-risk, or have been exposed to adverse childhood experiences.
Adverse childhood experiences include things like domestic violence, abuse (physical, sexual, or emotional), neglect (physical or emotional), and chaotic home environment, and exposure to them makes at-risk adolescents more likely to experience suicidality.
“At-risk adolescents are also more likely to receive treatment for behavioral and mental health disorders in the community at clinics that are underfunded and understaffed. This is concerning given that at-risk adolescents have more severe behavioral and mental disorders symptoms and are challenging to treat, even at the most well-equipped clinics,” explains Doctoral Researcher Karen L. Celedonia from the University of Turku, Finland.
Using a blend of quantitative and qualitative research methods, she examined factors associated with and factors that predicted suicidality and suicidal events among at-risk adolescents receiving behavioral and mental health services in the community in the United States.
Her research also investigated qualities that contribute to a strong therapeutic alliance between at-risk adolescents receiving behavioral and mental health services and their therapists, as well as analyzed the use of wide-scale suicide risk detection systems embedded in social media platforms.
Many suicidal events occurred despite negative risk screening at intake
The research findings revealed that thoughts of suicide and suicide attempt among at-risk adolescents were double and triple that of the general adolescent population, respectively. Sexual abuse was a strong predictor of suicidality.
Average time to suicidal event after suicidality risk screen at intake to behavioral and mental health services was around 6 months, and adolescents who screened negative for suicidality risk at intake had a longer time until a suicidal event occurred.
Female gender was a predictor of a suicidal event occurring during treatment, and interestingly, almost half of the adolescents who presented with a suicidal event had screened negative for suicidality risk at intake.
“This could potentially be explained by the therapeutic alliance between adolescents and their therapists not being fully formed at intake, and therefore adolescents may not have felt comfortable disclosing a history of suicidal thoughts and behaviors,” says Celedonia.
Five qualities were identified by therapists providing behavioral and mental health services to at-risk adolescents as contributing to a strong therapeutic alliance between themselves and their at-risk adolescent clientele: ecosystemic approach; strong working alliance; professionalism; warmth and support; and open communication. Warmth and support was deemed the most important and most experienced quality by therapists.
Analysis of social media suicide risk detection systems revealed legal, ethical, and cultural concerns, to include the violation of the GDPR in Europe and HIPAA in the United States and the stigma attached to mental disorders, particularly in low- and middle-income countries.
The findings from Celedonia’s doctoral research may help other community-based behavioral and mental health care organizations improve detection and treatment of suicidality among at-risk adolescents.
“Based on the results, it would be advisable to implement routine suicidality risk screening after intake to behavioral and mental health services, regardless of how an adolescent screened at intake. Furthermore, given the high prevalence of suicidality among at-risk adolescents, using treatment approaches that specifically target suicidality as the main target of treatment may prove more effective at reducing suicidality symptoms, thereby preventing death by suicide,” says Celedonia.
Broader implications of the research include focusing efforts on the prevention of sexual abuse among children and adolescents, and providing more mental health support and resources to female adolescents.