“Our research team is continuing to analyze and write up a great deal of data from this larger project,” said Barry Wagner, who is professor of psychology at the Catholic University of America.
Two as yet unpublished studies look at whether suicidal youths are “scapegoated” in families and also at negative family communication and parent-child relationships as risk factors for suicidal behaviors.
The scapegoating study indicates not only that suicidal adolescents perceive more negative parental treatment than their siblings but also that parents report having treated the suicidal child more negatively as well.
“Importantly, the suicidal adolescents’ perceptions of negative differential treatment by fathers—but not by mothers—were associated with greater suicidal ideation at baseline and were predictive of heightened suicidal ideation across an 18-month period following the index suicide attempt,” Wagner said.
Wagner and his team observed mother-adolescent and father-adolescent interactions when discussing a topic identified by family members as highly conflictual.
“The results showed that parents of suicide attempters interacted with their adolescents in much the same way as the parents of psychiatric controls,” Wagner said. But, “the suicidal adolescents displayed significantly more emotional invalidation toward their mothers than did the control adolescents. A similar finding for fathers closely approached significance.”
Shaffer was asked which treatment approaches are effective in preventing reattempts.
“There are various approaches (eg, Beck’s cognitive therapy, Linehan’s dialectical behavior therapy, mindfulness- based cognitive therapy) that have all been found to be effective with adults in preventing suicide attempts,” he said. “Elements of these treatments have been or are being adapted for adolescents. However, there is relatively little research on their efficacy and effectiveness with adolescents."
As to whether SSRI antidepressants prevent or provoke suicide, Shaffer said that careful examination of both epidemiological and autopsy studies shows that very few adolescents commit suicide while complying with SSRI treatment. In general, most morbidity associated with SSRI exposure takes the form of expressions of suicidality, such as reporting ideation or attempts to others.
Regardless of treatment approach, Shaffer cautioned, no youth should be discharged from care before identifying and removing, where possible, potential dangers such as firearms and without establishing a “plan for safety.” That plan—what a teen might do if he or she again feels an urge to commit suicide—should include a list of emergency contact numbers for a clinician, a responsible adult, and others.
“Other aspects of treatment should deal with decreasing the teen’s wish to commit suicide by addressing the reasons for engaging in the behavior (eg, avoidance, escape from their distress),” Shaffer said. “For example, there is evidence . . . that people make suicide attempts when they see no other optons available to deal with their problems. Strengthening teenagers’ skills for and increasing their ability to come up with alternative solutions to problems may go a long way toward preventing another attempt.”