Suicide is a major public health concern claiming over 44,000 lives annually and ranking within the top 10 causes of death for the general population and the 2nd leading cause of death for those aged 15-24 years of age (though there is variation in this when examining causes by racial groups). In the United States, this represented 5,723 deaths in 2016 among those aged 15-24. Even more adolescents attempt suicide. The national average of attempt to death is 25 attempts for every 1 death by suicide. For those aged 15-24 there are an estimated 100 attempts to every death. This represents over 570,000 suicide attempts for every one death of those aged 15-24. Given these numbers, efforts to better understand the relationship between risk and protective factors and suicidal thoughts and behaviours among adolescents and young adults can be life-saving.
Recent models of suicide propose the importance of social connection (or lack thereof) in the development of suicidal behaviour. The role of social connection is an old idea in the field of suicidology. Durkheim in 1897 proposed a sociological model of suicidal behaviour and postulated the role of social integration in national suicide rates. According to Durkheim, lack of social integration or too much social integration could lead to elevated suicide rates. This view focused on suicide at a macro-level and researchers working from Durkheim’s model have examined national suicide rates in relation to marital status, religiosity, and other proxy measures of social integration. Interested in suicidal thoughts and behaviours from a psychological perspective, the Interpersonal-Psychological Theory of Suicide (IPTS) proposes that suicide results from the co-occurrence of three risk factors:
- thwarted belongingness,
- perceived burdensomeness,
- the acquired capability for suicide.
Most applicable to the present study is the concept of thwarted belongingness which is the perception of lowered social connection, a sense of general loneliness, and that others do not care about you.
In our recent work, we examine the impact of adolescents’ overall social connection as well as specific forms (family and school) on the occurrence of suicidal thoughts and behaviours. We also wished to explore the transition from suicidal thoughts to suicidal behaviours, an important transition with prevention and treatment applications. Our study, using the National Longitudinal Study of Adolescent to Adult Health (ADD Health), examined the impact of changes in social connection and its corresponding relationship to suicidal thoughts and behaviours over a 1-year period. Wave 1 of the study was collected during the 1994-1995 school year and Wave 2 was collected in 1996. At Wave 1 participants ranged from 12 to 21 years of age, with an average age of 16.04 and more than half were females (51.6%). Those interested in a more in-depth review of the sampling procedures and ethical guidelines used can find them at the University of Michigan’s data sharing website. Those expressing suicidal thoughts represented 12.6% and 10.8% of the participants in Wave 1 and 2 respectively, and suicidal behaviours were reported in 3.5% and 4.0% respectively.
While it is important to identify those at risk for suicidal thoughts, steps to identify those making the transition from thoughts to behaviour are vitally important. As such, two models were tested in our study with our connectedness measures. First, we examined the prediction of suicidal thoughts among the full public use sample (N = 4,753) and found our model was predictive of suicidal thoughts. Findings supported the role of overall social connection (e.g., general loneliness, feelings that people disliked you) and parental connection (e.g., felt close to mother, felt close to father) as protective factors against suicidal thoughts. Increases in overall social connection and parental connection were both independently predictive of lowered likelihood of reporting suicidal thoughts. Additionally, and as has been supported in previous research, past suicidal thoughts were the strongest predictor of future suicidal thoughts. Gender differences were also found, with female adolescents almost twice as likely to report suicidal thoughts as male adolescents.
In the second model, we focused on the prediction of suicidal behaviours from the sub-sample of those who reported on suicide attempts (N = 230). Once more, our full model was significant at predicting suicidal behaviours. Findings supported the role of school connectedness as a protective factor against reporting suicide attempt behaviours. School connectedness was a scale which included questions which assessed information such as if students felt like they were a part of their school or felt close to the people at their school. Increases in school connectedness were associated with lowered likelihood of reporting suicide attempts. Past suicidal behaviour was also predictive of suicide attempt at Wave 2, a finding that has been supported by past research.
There are a number of limitations to consider when examining the present findings. Given the close proximity of the two waves of data (only a single year) we cannot make conclusions about long-term effects of our predictors on suicide risk later in life. Finally, our connection variables are computed by subtracting the scores at one timepoint from another to assess change but may not reflect yearlong changes in connectivity. Despite these limitations, the present study adds to our understanding of the development of suicidal thoughts and behaviours. Given these findings, and other findings in the field, the role of social connectedness in alleviating suicide risk is compelling.
This is a summary of the paper published in CAMH – Gunn JF, Goldstein SE, Gager CT. (2018). A longitudinal examination of social connectedness and suicidal thoughts and behaviors among adolescents. Child and Adolescent Mental Health, 23(4), 341-350. doi: 10.1111/camh.12281
- Future research is needed to further explore what role social connectedness plays in adolescent suicidal thoughts and behaviours, with an emphasis on the different forms of social connectedness (i.e., parental connectedness, school connectedness, and peer connectedness).
- The findings also serve the practical function of providing for prevention. The link between social connectedness and suicidal thoughts and behaviours can easily be targeted within a school setting for the developmental ages examined.
- School programs that emphasise interpersonal relationship development and connecting adolescents can aid in lowering the risk of these populations.
- There are many factors contributing to the development of adolescent suicidal thought and behaviours. Some of these (such as past suicidal behaviour, genetic vulnerabilities) would be hard or potentially impossible to target. Social connectedness, however, is one factor that could be more easily targeted.
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