Journal of Youth and Adolescence

, Volume 41, Issue 10, pp 1312–1324 | Cite as

Associations Between Suicidal High School Students’ Help-Seeking and Their Attitudes and Perceptions of Social Environment

  • Anthony R. Pisani
  • Karen Schmeelk-Cone
  • Douglas Gunzler
  • Mariya Petrova
  • David B. Goldston
  • Xin Tu
  • Peter A. Wyman
Empirical Research

Abstract

Suicide is a leading cause of death among adolescents, many of whom fail to disclose suicide concerns to adults who might help. This study examined patterns and predictors of help-seeking behavior among adolescents who seriously considered suicide in the past year. 2,737 students (50.9 % female, 46.9 % male; racial distribution 79.5 % Caucasian, 11.9 % Hispanic/Latino, and 3.6 % Black/African-American) from 12 high schools in rural/underserviced communities were surveyed to assess serious suicide ideation (SI) in the past year, disclosure of SI to adults and peers, attempts to get help, attitudes about help-seeking, perceptions of school engagement, and coping support. Help-seeking was defined as both disclosing SI to an adult and perceiving oneself as seeking help. The relationship between adolescents’ help-seeking disclosure and (1) help-seeking attitudes and (2) perceptions of social resources was examined among suicidal help-seeking youth, suicidal non-help-seeking youth, and non-suicidal youth. Of the 381 (14 %) students reporting SI, only 23 % told an adult, 29 % sought adult help, and 15 % did both. Suicidal help-seekers were similar to non-suicidal peers on all measures of help-seeking attitudes and social environment perceptions. Positive attitudes about help-seeking from adults at school, perceptions that adults would respond to suicide concerns, willingness to overcome peer secrecy requests, and greater coping support and engagement with the school were associated with students’ increased disclosure of SI and help-seeking. This study supports prevention strategies that change student norms, attitudes and social environments to promote help-seeking among adolescents with SI. Promising intervention targets include increasing students’ perceptions of the availability and capability of adults to help them, and strengthening students’ understanding of how existing resources can help them cope.

Keywords

Youth suicide Help-seeking Prevention Youth–adult relationships Attitudes Social support 

Notes

Acknowledgments

The authors wish to thank Emily Hurley for her help in preparing this manuscript. We gratefully acknowledge support from the Center for Mental Health Services, SAMHSA (SM-05-019), New York State-Office of Mental Health, Locker Family Fund, National Institute of Mental Health (T32MH20061 and K24 MH066252), and the University of Rochester CTSA award KL2 RR024136 from the National Center for Research Resources and the National Center for Advancing Translational Sciences of the National Institutes of Health.

References

  1. Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10.PubMedCrossRefGoogle Scholar
  2. Angold, A., Costello, E. J., Messer, S., Pickles, A., Winder, F., & Silver, D. (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5, 237–249.Google Scholar
  3. Apter, A. (2001). Relationship between self-disclosure and serious suicidal behavior. Comprehensive Psychiatry, 42(1), 70–75. doi:10.1053/comp.2001.19748.PubMedCrossRefGoogle Scholar
  4. Aseltine, R. H., Jr, & DeMartino, R. (2004). An outcome evaluation of the SOS suicide prevention program. American Journal of Public Health, 94(3), 446–451.PubMedCrossRefGoogle Scholar
  5. Biddle, L., Gunnell, D., Sharp, D., & Donovan, J. (2004). Factors influencing help seeking in mentally distressed young adults: A cross-sectional survey. British Journal of General Practice, 54(501), 248–253.PubMedGoogle Scholar
  6. Boldero, J., & Fallon, B. (1995). Adolescent help-seeking: What do they get help for and from whom? Journal of Adolescence, 18(2), 193–209.CrossRefGoogle Scholar
  7. Boyd, C., Hayes, L., Nurse, S., Aisbett, D., Francis, K., Newnham, K., et al. (2011). Preferences and intention of rural adolescents toward seeking help for mental health problems. Rural and Remote Health, 11, 1582. http://1.usa.gov/HQvj8s.
  8. Brener, N. D., Krug, E. G., & Simon, T. R. (2000). Trends in suicide ideation and suicidal behavior among high school students in the United States, 1991–1997. Suicide and Life-Threatening Behavior, 30(4), 304–312.PubMedGoogle Scholar
  9. Brener, N. D., Kann, L., McManus, T., Kinchen, S. A., Sundberg, E. C., & Ross, J. G. (2002). Reliability of the 1999 youth risk behavior survey questionnaire. [Evaluation Study]. The Journal of Adolescent Health: Offificial Publication of the Society for Adolescent Medicine, 31(4), 336–342.Google Scholar
  10. Brent, D. A., Perper, J. A., Moritz, G., Allman, C., Friend, A., Roth, C., et al. (1993). Psychiatric risk factors for adolescent suicide: A case-control study. Journal of the American Academy of Child and Adolescent Psychiatry, 32(3), 521–529. doi:10.1097/00004583-199305000-00006.PubMedCrossRefGoogle Scholar
  11. Breslow, N., & Clayton, D. (1993). Approximate inference in generalized linear mixed models. Journal of the American Statistical Association, 88(421), 9–25.CrossRefGoogle Scholar
  12. Bridge, J. A., Goldstein, T. R., & Brent, D. A. (2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry, 47(3–4), 372–394. doi:10.1111/j.1469-7610.2006.01615.x.Google Scholar
  13. Bringewatt, E. H., & Gershoff, E. T. (2010). Falling through the cracks: Gaps and barriers in the mental health system for America’s disadvantaged children. Children and Youth Services Review, 32(10), 1291–1299. Elsevier Ltd. doi:10.1016/j.childyouth.2010.04.021.
  14. Brown, C. H., Wyman, P. A., Brinales, J. M., & Gibbons, R. D. (2007). The role of randomized trials in testing interventions for the prevention of youth suicide. International Review of Psychiatry, 19(6), 617–631. doi:10.1080/09540260701797779.Google Scholar
  15. Carlton, P. A., & Deane, F. P. (2000). Impact of attitudes and suicidal ideation on adolescents’ intentions to seek professional psychological help. Journal of Adolescence, 23(1), 35–45. doi:10.1006/jado.1999.0299.PubMedCrossRefGoogle Scholar
  16. Casey, B., Jones, R., Levita, L., Libby, V., Pattwell, S., Ruberry, E., et al. (2010). The storm and stress of adolescence: Insights from human imaging and mouse genetics. Developmental Psychobiology, 52(3), 225–235.PubMedGoogle Scholar
  17. Chaudoir, S. R., & Fisher, J. D. (2010). The disclosure processes model: understanding disclosure decision making and postdisclosure outcomes among people living with a concealable stigmatized identity. Psychological Bulletin, 136(2), 236–256. doi:10.1037/a0018193.PubMedCrossRefGoogle Scholar
  18. Ciarrochi, J., Deane, F., Wilson, C., & Rickwood, D. (2002). Adolescents who need help the most are the least likely to seek it: The relationship between low emotional competence and low intention to seek help. British Journal of Guidance & Counselling, 30(2), 173–188.CrossRefGoogle Scholar
  19. Cohen, S. (2004). Social relationships and health. American Psychologist, 59(8), 676–684. doi:10.1037/0003-066X.59.8.676.PubMedCrossRefGoogle Scholar
  20. Cohen, P., & Hesselbart, C. S. (1993). Demographic factors in the use of children’s mental health services. American Journal of Public Health, 83(1), 49.PubMedCrossRefGoogle Scholar
  21. Costello, E. J., Pescosolido, B., Angold, A., & Burns, B. J. (1998). A family network-based model of access to child mental health services. In J. P. Morrissey (Ed.), Research in community and mental health: Social networks and mental illness (Vol. 9, pp. 165–190). Stamford, CT: JAI Press.Google Scholar
  22. Eaton, D. K., Kann, L., Kinchen, S., Shanklin, S., Ross, J., Hawkins, J., Harris, W. A., & Lowry, R. (2008). Youth risk behavior surveillance—United States, 2007. MMWR Recommendations and Reports, 57(SS-4), 1–131.Google Scholar
  23. Eaton, D. K., Lowry, R., Brener, N. D., Galuska, D. A., & Crosby, A. E. (2005). Associations of body mass index and perceived weight with suicide ideation and suicide attempts among US high school students. Archives of Pediatric and Adolescent Medicine, 159(6), 513–519. doi:10.1001/archpedi.159.6.513.CrossRefGoogle Scholar
  24. Epstein, R., Duberstein, P., Feldman, M., Rochlen, A., Bell, R., Kravitz, R., et al. (2010). “I Didn’t Know What Was Wrong:” How People with Undiagnosed Depression Recognize, Name and Explain Their Distress. Journal of General Internal Medicine, 25(9), 954–961. doi:10.1007/s11606-010-1367-0.PubMedCrossRefGoogle Scholar
  25. Freedenthal, S. (2010). Adolescent help-seeking and the Yellow ribbon suicide prevention program: An evaluation. Suicide and Life-Threatening Behavior, 40(6), 628–639.PubMedCrossRefGoogle Scholar
  26. Goldston, D. B., Daniel, S. S., Erkanli, A., Reboussin, B. A., Mayfield, A., Frazier, P. H., et al. (2009). Psychiatric diagnoses as contemporaneous risk factors for suicide attempts among adolescents and young adults: Developmental changes. Journal of Consulting and Clinical Psychology, 77(2), 281–290. doi:10.1037/a0014732.PubMedCrossRefGoogle Scholar
  27. Gould, M. S., Greenberg, T., Velting, D. M., & Shaffer, D. (2003). Youth suicide risk and preventive interventions: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 42(4), 386–405.PubMedCrossRefGoogle Scholar
  28. Gould, M. S., Velting, D., Kleinman, M., Lucas, C., Thomas, J. G., & Chung, M. (2004). Teenagers’ attitudes about coping strategies and help-seeking behavior for suicidality. Journal of the American Academy of Child and Adolescent Psychiatry, 43(9), 1124–1133. doi:10.1097/01.chi.0000132811.06547.31.PubMedCrossRefGoogle Scholar
  29. Grunbaum, J. A., Kann, L., Kinchen, S., Ross, J., Hawkins, J., Lowry, R., et al. (2004). Youth risk behavior surveillance—United States, 2003. MMWR Surveillance Summaries, 53, 1–96.Google Scholar
  30. Hirsch, J. K. (2006). A review of the literature on rural suicide. Crisis, 27(4), 189–199.PubMedCrossRefGoogle Scholar
  31. Insel, B. J., & Gould, M. S. (2008). Impact of modeling on adolescent suicidal behavior. Psychiatric Clinics of North America, 31(2), 293–316. doi:10.1016/j.psc.2008.01.007.PubMedCrossRefGoogle Scholar
  32. Institute of Medicine Committee on the Prevention of Mental Disorders and Substance Abuse Among Children Youth and Young Adults (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: National Academies Press.Google Scholar
  33. Jacobson, C. M., Marrocco, F., Kleinman, M., & Gould, M. S. (2011). Restrictive emotionality, depressive symptoms, and suicidal thoughts and behaviors among high school students. Journal of Youth and Adolescence, 40, 656–665.PubMedCrossRefGoogle Scholar
  34. Kerr, D., Owen, L., Pears, K., & Capaldi, D. (2008). Prevalence of suicidal ideation among boys and men assessed annually from ages 9 to 29 years. Suicide and Life-Threatening Behavior, 38(4), 390.PubMedCrossRefGoogle Scholar
  35. Kessler, R. C., Avenevoli, S., & Ries Merikangas, K. (2001). Mood disorders in children and adolescents: An epidemiologic perspective. Biological Psychiatry, 49(12), 1002–1014.PubMedCrossRefGoogle Scholar
  36. Klaus, N., Mobilio, A., & King, C. (2009). Parent–Adolescent agreement concerning Adolescents’ suicidal thoughts and behaviors. Journal of Clinical Child & Adolescent Psychology, 38(2), 245–255.CrossRefGoogle Scholar
  37. Lerner, R. M., Eye, A., Lerner, J. V., Lewin-Bizan, S., & Bowers, E. P. (2010). Special issue introduction: The meaning and measurement of thriving: A view of the issues. Journal of Youth and Adolescence, 39(7), 707–719. doi:10.1007/s10964-010-9531-8.PubMedCrossRefGoogle Scholar
  38. Lindsey, M., Korr, W., Broitman, M., Bone, L., Green, A., & Leaf, P. (2006). Help-seeking behaviors and depression among African American adolescent boys. Social Work, 51(1), 49–58.PubMedCrossRefGoogle Scholar
  39. Logan, D. E., & King, C. A. (2001). Parental facilitation of adolescent mental health services utilization: A conceptual and empirical review. Clinical Psychology: Science and Practice, 8(3), 319–333. doi:10.1093/clipsy/8.3.319.CrossRefGoogle Scholar
  40. Logan, D., & King, C. (2002). Parental identification of depression and mental health service use among depressed adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 41(3), 296.PubMedCrossRefGoogle Scholar
  41. LoMurray, M. (2005). Sources of strength facilitators guide: Suicide prevention peer gatekeeper training. Bismarck, ND: The North Dakota Suicide Prevention Project.Google Scholar
  42. Maggs, J., Schulenberg, J., & Hurrelmann, K. (1997). Developmental transitions during adolescence: Health promotion implications. In J. Schulenberg, J. Maggs, & K. Hurrelmann (Eds.), Health risks and developmental transitions during adolescence (pp. 522–546). Cambridge: Cambridge Univ Press.Google Scholar
  43. McCarty, C. A., Russo, J., Grossman, D. C., Katon, W., Rockhill, C., McCauley, E., et al. (2011). Adolescents with suicidal ideation: Health care use and functioning. Academic Pediatrics, 11(5), 422–426. doi:10.1016/j.acap.2011.01.004.PubMedCrossRefGoogle Scholar
  44. Messer, S. C., Angold, A., Costello, E. J., Loeber, R., Van Kammen, W., & Stouthamer-Loeber, M. (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents: Factor composition and structure across development. International Journal of Methods in Psychiatric Research, 5, 251–262.Google Scholar
  45. Muehlenkamp, J. J., Walsh, B. W., & McDade, M. (2009). Preventing non-suicidal self-injury in adolescents: The signs of self-injury program. Journal of Youth and Adolescence, 39(3), 306–314. doi:10.1007/s10964-009-9450-8.PubMedCrossRefGoogle Scholar
  46. O’Donnell, L., Stueve, A., Wardlaw, D., & O’Donnell, C. (2003). Adolescent suicidality and adult support: The reach for health study of urban youth. American Journal of Health Behavior, 27(6), 633–644.PubMedCrossRefGoogle Scholar
  47. Olafsdottir, S., & Pescosolido, B. A. (2009). Drawing the line: The cultural cartography of utilization recommendations for mental health problems. Journal of Health and Social Behavior, 50(2), 228–244.Google Scholar
  48. Perez, V. W. (2005). The relationship between seriously considering, planning, and attempting suicide in the youth risk behavior survey. Suicide and Life-Threatening Behavior, 35(1), 35–49. doi:10.1521/suli.35.1.35.59267.PubMedCrossRefGoogle Scholar
  49. Pescosolido, B. (1992). Beyond rational choice: The social dynamics of how people seek help. American Journal of Sociology, 97, 1096–1138.CrossRefGoogle Scholar
  50. Rao, C. (1973). Linear statistical inference and it’s applications (2nd ed.). New York: Wiley & Company.CrossRefGoogle Scholar
  51. Rickwood, D. J., Deane, F. P., & Wilson, C. J. (2007). When and how do young people seek professional help for mental health problems? Medical Journal of Australia, 187(7 suppl), S35–S39.PubMedGoogle Scholar
  52. Rughani, J., Deane, F. P., & Wilson, C. J. (2011). Rural adolescents’ help-seeking intentions for emotional problems: The influence of perceived benefits and stoicism. Australian Journal of Rural Health, 19(2), 64–69. doi:10.1111/j.1440-1584.2011.01185.x.PubMedCrossRefGoogle Scholar
  53. SAS. (2008). SAS, Version 9.2. Cary, NC: SAS Institute Inc.Google Scholar
  54. Saunders, S. M., Resnick, M. D., Hoberman, H. M., & Blum, R. W. (1994). Formal help-seeking behavior of adolescents identifying themselves as having mental health problems. Journal of the American Academy of Child and Adolescent Psychiatry, 33(5), 718–728. doi:10.1097/00004583-199406000-00013.PubMedCrossRefGoogle Scholar
  55. Schmeelk-Cone, K., Pisani, A. R., Petrova, M., & Wyman, P. A. (2012). Three scales assessing high school students’ attitudes and perceived norms about seeking adult help for distress and suicide concerns. Suicide and Life Threatening Behavior, 42(2), 157–172. doi:10.1111/j.1943-278X.2011.00079.x.CrossRefGoogle Scholar
  56. Seiffge-Krenke, I., & Klessinger, N. (2000). Long-term effects of avoidant coping on adolescents’ depressive symptoms. Journal of Youth and Adolescence, 29(6), 617–630.CrossRefGoogle Scholar
  57. Sen, B. (2004). Adolescent propensity for depressed mood and help seeking: Race and gender differences. Journal of Mental Health Policy and Economics, 7(3), 133–145.PubMedGoogle Scholar
  58. Shaffer, D., Gould, M. S., Fisher, P., Trautman, P., et al. (1996). Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 53(4), 339–348.PubMedCrossRefGoogle Scholar
  59. Shaughnessy, L., Doshi, S. R., & Jones, S. E. (2004). Attempted suicide and associated health risk behaviors among Native American high school students. Journal of School Health, 74(5), 177–182.PubMedCrossRefGoogle Scholar
  60. Stiffman, A. R., Pescosolido, B., & Cabassa, L. J. (2004). Building a model to understand youth service access: The gateway provider model. Mental Health Services Research, 6(4), 189–198.PubMedCrossRefGoogle Scholar
  61. Swahn, M. H., & Bossarte, R. M. (2007). Gender, early alcohol use, and suicide ideation and attempts: Findings from the 2005 youth risk behavior survey. Journal of Adolescent Health, 41(2), 175–181. doi:10.1016/j.jadohealth.2007.03.003.Google Scholar
  62. Valente, T. W. (2010). Social networks and health: Models, methods, and applications. New York: Oxford University press USA.Google Scholar
  63. Whitlock, J. (2007). The role of adults, public space, and power in adolescent community connectedness. Journal of Community Psychology, 35(4), 499–518.CrossRefGoogle Scholar
  64. Wilson, C. J., & Deane, F. P. (2010). Brief report: Need for autonomy and other perceived barriers relating to adolescents’ intentions to seek professional mental health care. Journal of Adolescence, 1-5, doi:10.1016/j.adolescence.2010.06.011.
  65. Wilson, C. J., Deane, F. P., Marshall, K. L., & Dalley, A. (2010). Adolescents’ suicidal thinking and reluctance to consult general medical practitioners. Journal of Youth and Adolescence, 39(4), 343–356. doi:10.1007/s10964-009-9436-6.PubMedCrossRefGoogle Scholar
  66. Wilson, C. J., Rickwood, D., & Deane, F. P. (2007). Depressive symptoms and help-seeking intentions in young people. Clinical Psychologist, 11(3), 98–107. doi:10.1080/13284200701870954.CrossRefGoogle Scholar
  67. Wu, P., Katic, B., Liu, X., Fan, B., & Fuller, C. (2010). Mental health service use among suicidal adolescents: Findings from a us national community survey. Psychiatric Services, 61(1), 17.PubMedCrossRefGoogle Scholar
  68. WWAMI Rural Health Research Center (2004). 2004 ZIP RUCA Code files. http://depts.washington.edu/uwruca/ruca-download.php, Accessed March 13, 2012.
  69. Wyman, P. A., Brown, C. H., Inman, J., Cross, W., Schmeelk-Cone, K., Guo, J., et al. (2008). Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff. Journal of Consulting and Clinical Psychology, 76(1), 104–115. doi:10.1037/0022-006X.76.1.104.PubMedCrossRefGoogle Scholar
  70. Wyman, P. A., Brown, C. H., LoMurray, M., Schmeelk-Cone, K., Petrova, M., Yu, Q., et al. (2010). An outcome evaluation of the sources of strength suicide prevention program delivered by adolescent peer leaders in high schools. American Journal of Public Health, 100(9), 1653–1661.PubMedCrossRefGoogle Scholar
  71. Xu, J., Kochaneck, K., Murphy, S., & Tejada-Vera, B. (2010). Deaths: Final data for 2007. National Vital Statistics Reports, 58(19), 1–73.Google Scholar
  72. Yakunina, E. S., Rogers, J. R., Waehler, C. A., & Werth, J. L., Jr. (2010). College students’ intentions to seek help for suicidal ideation: Accounting for the help-negation effect. Suicide & life-threatening behavior, 40(5), 438–450. doi:10.1521/suli.2010.40.5.438.CrossRefGoogle Scholar
  73. Zhang, H., Lu, N., Feng, C., Thurston, S., Xia, Y., & Tu, X. (2011). On fitting generalized linear mixed-effects models for binary responses using different statistical packages. Statistics in Medicine, 30(20), 2562–2572.Google Scholar
  74. Zullig, K. J., Pun, S., Patton, J. M., & Ubbes, V. A. (2006). Reliability of the 2005 middle school youth risk behavior survey. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 39(6), 856–860.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Anthony R. Pisani
    • 2
    • 3
    • 1
  • Karen Schmeelk-Cone
    • 2
  • Douglas Gunzler
    • 4
  • Mariya Petrova
    • 2
  • David B. Goldston
    • 5
  • Xin Tu
    • 2
    • 6
  • Peter A. Wyman
    • 2
  1. 1.Department of PsychiatrySchool of Medicine and Dentistry, University of Rochester Medical CenterRochesterUSA
  2. 2.Department of PsychiatryUniversity of RochesterRochesterUSA
  3. 3.Department of PediatricsUniversity of RochesterRochesterUSA
  4. 4.Center for Health Care Research & Policy, MetroHealth Medical Center, School of MedicineCase Western Reserve UniversityClevelandUSA
  5. 5.Department of Psychiatry & Behavioral SciencesDuke University School of MedicineDurhamUSA
  6. 6.Department of Biostatistics and Computational BiologyUniversity of RochesterRochesterUSA

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