Associations Between Suicidal High School Students’ Help-Seeking and Their Attitudes and Perceptions of Social Environment
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.
KeywordsYouth suicide Help-seeking Prevention Youth–adult relationships Attitudes Social support
- 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
- 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.
- 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
- 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
- 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.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- LoMurray, M. (2005). Sources of strength facilitators guide: Suicide prevention peer gatekeeper training. Bismarck, ND: The North Dakota Suicide Prevention Project.Google Scholar
- 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
- 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
- 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
- SAS. (2008). SAS, Version 9.2. Cary, NC: SAS Institute Inc.Google Scholar
- 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
- 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
- Valente, T. W. (2010). Social networks and health: Models, methods, and applications. New York: Oxford University press USA.Google Scholar
- 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.
- WWAMI Rural Health Research Center (2004). 2004 ZIP RUCA Code files. http://depts.washington.edu/uwruca/ruca-download.php, Accessed March 13, 2012.
- 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
- 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
- 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
- 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