Emotion Regulation Difficulties, Youth–Adult Relationships, and Suicide Attempts Among High School Students in Underserved Communities
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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.
KeywordsYouth suicide Suicide prevention Emotion regulation Youth–adult relationships Youth–adult communication Underserved populations Suicide attempts
The authors wish to thank Caitlyn Eberle and Jane Fitzgerald for their help collecting data and preparing tables for this manuscript and William Morrison for proofreading our final drafts. We gratefully acknowledge support from the National Institute of Mental Health (R01MH091452, K24MH066252); the University of Rochester CTSA award number KL2 RR024136 from the National Center for Research Resources and the National Center for Advancing Translational Sciences of the National Institutes of Health; New York State-Office of Mental Health; and the Locker Family Fund. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or any of our other funders.
A.P. conceived of the study, conducted most analyses, and drafted the manuscript. P.W. led the trial from which data are generated and participated at all stages of study design, analysis, interpretation, and manuscript preparation. M.P. helped to recruit schools, coordinated the study, and supervised data collection, entry, and cleaning. K.S-C managed data, conducted preliminary analysis, and assisted with analytic interpretation. D.G. assisted interpretation of findings and helped to draft the manuscript. Y.X. reviewed analyses and assisted in interpretation. M.G. contributed to the study design and manuscript preparation. All authors read and approved the final manuscript.
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