The value of adult relationships in preventing youth suicide attempts 

Associate Professor Lynne Fullerton, PhD, University of New Mexico Health Sciences Center, examines the results of a recent study exploring the link between positive adult relationships and the impact on youth suicide attempt resilience

Suicide is the third leading killer of teens in the U.S., after unintentional injury (including drug overdose) and homicide, and suicide death rates have increased in this age group relatively steadily for 20 years (1). In 2019, the Center for Disease Control and Prevention’s (CDC) biennial Youth Risk Behavior Survey (YRBS) indicated that in the previous year, suicide was attempted by 8.9% of high school (HS) students. However, the percentage varied widely by race and ethnicity: American Indian or Alaska Native (AI/AN) 25.5%; Asian 7.7%; Black or African American (AfAmer) 11.8%; Hispanic or Latino (Hisp) 8.9%, White 7.9%, and multiple races 12.9% (2).

Work in New Mexico

New Mexico (NM) is among the U.S. states with the highest overall suicide death rates; in 2020, it was fourth highest at 24.1/100,000 (3). The NM version of the YRBS is the Youth Risk and Resiliency Survey (YRRS). The 2019 results indicate that our youth suicide attempt rate (9.5%) is higher than the U.S. rate. Previous studies of NM YRRS data showed in bivariable analyses that positive relationships with adults from the home, community, and school and same-age friendships were associated with lower rates of past-year youth suicide attempts (4-7).

What was the purpose of the study?

Past research suggests that positive relationships at home between adults and adolescents impact suicide attempt resilience more than other positive relationships. However, not all teens have parents or adults at home or even a home to go to. Moreover, homelessness is a risk factor for adolescent suicidal behaviours (8). Therefore, the current study aims to answer the logical follow-up question: What relationships are essential when those most likely to protect teens from suicide do not exist in a meaningful way?

The YRRS database is a representative sample of NM HS students. In addition to the CDC questions, the NM YRRS includes questions about relationships believed to confer resilience against risk-taking. These are phrased as statements with four levels of the agreement provided as response options. There are seven questions about adult relationships and two about relationships with friends. (9-10)

“Suicide is the third leading killer of teens in the U.S., after unintentional injury (including drug overdose) and homicide, and suicide death rates have increased in this age group reasonably steadily for 20 years”

We constructed race/ethnicity-specific models of past-year suicide attempts (yes/no) using multiple logistic regression for the current paper. We began with all possible protective relationships in the model. We also included public school grades (A’s, B’s, C’s, etc.) to measure relationships with school adults. For the first model, we had variables related to relationships with adults at home to confirm earlier findings. Odds ratios and 95% confidence intervals were used as a statistical significance threshold.

Results: Protective relationships that matter most

In model 1, five variables stood out for Hispanic and NHW adolescents, four for AIAN teens, and two for African Americans (AfAmer) (Table). For every group except Anglos, having an adult at home who believes in their success ranked as the most protective type of relationship of those tested.

For teens with parents, guardians, or other adults at home, positive communication about their potential for success is associated with a significantly reduced risk of a suicide attempt. Almost equal in weight was the effect of having a parent or guardian know where the teen is and who they are with.

Model 1 also shows that adults outside the home make a difference in suicide prevention for all teens. Adults in the community and at school confer essential benefits when they listen, demonstrate that they believe that kids will be successful, and give acclaim when they see students doing a good job.

Model 2 results: How do we help other adolescents?

Model 2 shows that when parents are absent, the effect of adults outside the home becomes more powerful. All adults who interact with children have the privilege and responsibility to make a difference in suicide prevention. Teens who feel noticed, heard, believed in, and appreciated are less likely to attempt suicide.

Positive adult relationships decrease the likelihood of suicide attempts

These results provide good news.

Each increasing level of positive adult relationships is associated with a decreased likelihood of past-year suicide attempts. Adults do not have to be heroic, just present. Every adult who chooses to make a young person feel as though they matter in a positive way—keep doing it. It matters.

References

1. WISQARSTM Fatal Injury Data. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Accessed
2. Centers for Disease Control and Prevention (CDC). 2019 High School Youth Risk Behavior Survey Data. Available at http://yrbs-explorer.services.cdc.gov/. Accessed on [2022-10-02].
3. Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Mortality 2018-2020 on CDC WONDER Online Database, released in 2021. Data are from the Multiple Cause of Death Files, 2018-2020, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Available at http://wonder.cdc.gov/ucd-icd10-expanded.html. Accessed on 2022-10-02.
4. C. FitzGerald, L. Fullerton, D. Green, M. Hall, L. Penaloza. The Association between Positive Relationships with Adults and Suicide-Attempt Resiliency in American Indian Youth in New Mexico. J Amer Indian and Alaska Native Mental Hlth Res 2017; 24(2):40-53.
5. M. Hall, L. Fullerton, C. FitzGerald, D. Green. Suicide risk and resiliency factors among Hispanic teens in New Mexico: Schools can make a difference. Journal of School Health 2018; 88(3):227-36.
6. Fullerton L, FitzGerald C, Hall M, Green D, DeBruyn L. Adult relationships are associated with past year suicide attempt prevalence among American Indian, Hispanic, and Anglo youth in New Mexico. Family Community Health 2019; 42(3):171-9.
7. Hall M, Fullerton L, Green D, FitzGerald C. Positive relationships with adults and resilience to suicide attempt among New Mexico Hispanic adolescent. International Journal of Environmental Research and Public Health 2021; 18:10430.
8. Institute for Children, Poverty & Homelessness. Suicide and depression among homeless high school students. Available at https://www.icphusa.org/reports/suicide-and-depression-among-homeless-high-school-students/#key-findings. #key-findings. Accessed on 2022-10-02.
9. New Mexico Department of Health. New Mexico Youth Risk & Resiliency Survey. 2019 High School Questionnaire https://youthrisk.org/data-collection/questionnaires/2019-high-school-questionnaire-english/. Accessed on 2022-10-02.
10. Underwood JM, Brener N, Thornton J, Harris WA, Bryan LN, Shanklin SL, Deputy N, Roberts AM, Queen B, Chyen D, Whittle L, Lim C, Yamakawa Y, Leon-Nguyen M, Kilmer G, Smith-Grant J, Demissie Z, Jones SE, Clayton H, Dittus P. Overview and Methods for the Youth Risk Behavior Surveillance System – United States, 2019. MMWR Suppl. 2020 Aug 21;69(1):1-10. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440204/. Accessed on 2022-10-02.

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