Suicidal trajectories from early adolescence into young adulthood in a national sample  (2019)

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The impetus for this study rests on the need to understand how suicidal trajectories present from early adolescence into adulthood among a community-based, nationally representative sample. While longitudinal research among adolescent clinical samples has contributed to the literature, they often do not follow adolescents into adulthood and/or include particular higher-risk racial/ethnic groups. Clinical samples also include participants who have already disclosed their suicidal behaviors to professionals. Adolescents, especially particular racial/ethnic minorities, utilize mental health professionals and disclose to trusted adults less than non-Hispanic whites, which arguably heighten risk for suicidal behaviors. No study has tracked longitudinally, a representative sample of suicidal behaviors over the crucial developmental period of adolescence to young adulthood. This study contributes to the literature and aids in public health efforts, as these groups have not reported significant decreases in suicidal behavior in the past 25 years.

The study will focus on a salient protective mechanism: developmentally appropriate social relationships. We propose that the heterogeneity of suicidal trajectories will not only help explain suicidal behavior disparities, but will aid in tailoring prevention initiatives based upon the onset of symptomology. This proposed work will create profiles that reflect the variation of suicidal behaviors, based on four independent levels of suicidal risk (1) no suicidal behaviors, (2) suicidal ideation yet no attempts, (3) suicide attempts (4) suicide attempts resulting in medical treatment. This work will examine whether particular profiles not only describe how specific subgroups are at a heightened risk in early adolescence, but also elucidate why some might be chronically suicidal and while others might first present suicidal behaviors later in life.

The proposed study will use secondary analysis of the Add Health dataset to 1) describe the longitudinal patterns and progression of suicidal behaviors; 2) examine how social relationships and behavioral health are related to the escalation and de-escalation of suicidal behaviors, and 3) observe the heterogeneity of racial/ethnic and gender presentations in these suicidal behavior trajectories. Profiles will be identified through latent transition analysis. The proposed study will produce recommendations for how pediatricians and other health care providers, as well as educators, particularly in the context of gatekeeping and understanding suicidal risk factors, can support parents and other trusted adults in communicating effectively with their children about suicidal behaviors by (1) identifying which particular subgroups (race/ethnicity, gender and the intersectionality of these identities) are at the most need for upstream prevention messaging; and (2) targeting specific social relationships to capitalize on for help-seeking promotion during times of distress.