Empirical Research

Journal of Youth and Adolescence

, Volume 42, Issue 6, pp 807-820

First online:

Emotion Regulation Difficulties, Youth–Adult Relationships, and Suicide Attempts Among High School Students in Underserved Communities

  • Anthony R. PisaniAffiliated withDepartment of Psychiatry, University of RochesterDepartment of Pediatrics, University of RochesterDepartment of Psychiatry, School of Medicine and Dentistry, University of Rochester Medical Center Email author 
  • , Peter A. WymanAffiliated withDepartment of Psychiatry, University of Rochester
  • , Mariya PetrovaAffiliated withDepartment of Psychiatry, University of Rochester
  • , Karen Schmeelk-ConeAffiliated withDepartment of Psychiatry, University of Rochester
  • , David B. GoldstonAffiliated withDepartment of Psychiatry and Behavioral Sciences, Duke University School of Medicine
  • , Yinglin XiaAffiliated withDepartment of Biostatistics and Computational Biology, University of Rochester
  • , Madelyn S. GouldAffiliated withDepartment of Psychiatry, Columbia University/New York State Psychiatric InstituteDepartment of Epidemiology, Columbia University/New York State Psychiatric Institute

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To develop and refine interventions to prevent youth suicide, knowledge is needed about specific processes that reduce risk at a population level. Using a cross-sectional design, the present study tested hypotheses regarding associations between self-reported suicide attempts, emotion regulation difficulties, and positive youth–adult relationships among 7,978 high-school students (48.6 % male, 49.9 % female) in 30 high schools from predominantly rural, low-income communities. 683 students (8.6 %) reported a past-year suicide attempt. Emotion regulation difficulties and a lack of trusted adults at home and school were associated with increased risk for making a past-year suicide attempt, above and beyond the effects of depressive symptoms and demographic factors. The association between emotion regulation difficulties and suicide attempts was modestly lower among students who perceived themselves as having higher levels of trusted adults in the family, consistent with a protective effect. Having a trusted adult in the community (outside of school and family) was associated with fewer suicide attempts in models that controlled only for demographic covariates, but not when taking symptoms of depression into account. These findings point to adolescent emotion regulation and relationships with trusted adults as complementary targets for suicide prevention that merit further intervention studies. Reaching these targets in a broad population of adolescents will require new delivery systems and “option rich” (OR) intervention designs.


Youth suicide Suicide prevention Emotion regulation Youth–adult relationships Youth–adult communication Underserved populations Suicide attempts