Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Social Rejection and Suicidal Ideation and Attempts among Adolescents Following Hospitalization: a Prospective Study

  • 241 Accesses

Abstract

Despite research indicating that stressful life events are associated with subsequent suicidal ideation (SI) and behavior, there is a lack of clarity regarding whether specific types of life events are differentially related to SI and attempts. The current prospective study examines whether social rejection related life events are proximally related to SI and suicide attempts in a clinically acute sample of adolescents. Adolescents aged 12 to 18 (n = 219) were followed for 6 months after discharge from inpatient hospitalization. A contextual threat interview of stressful life events between index admission and 6-month follow-up was administered. Participants were also assessed for current SI and suicide attempts at baseline and 6-month follow-up. Results from a multiple linear regression model indicated a significant prospective association between number of social rejection stressors and SI, even after controlling for baseline depressive symptoms, SI at study entry, gender, age, and number of non-social rejections stressors. An Anderson-Gill recurrent events model was conducted to examine the relationship between SR stressors and suicide attempts. Results demonstrated that the 31 days following a major social rejection stressor were associated with heightened risk for prospective suicide attempts. However, social rejection stressors were not more strongly related to risk for suicide attempt than non-social rejection stressors. These findings help clarify the role of social rejection as a precipitant of suicidal crises and have potential to inform more accurate, targeted risk assessment.

This is a preview of subscription content, log in to check access.

References

  1. Andersen, P. K., & Gill, R. D. (1982). Cox ‘s regression model for counting processes: A large sample study. The Annals of Statistics, 10(4), 1100–1120.

  2. Breines, J. G., & Ayduk, O. (2015). Rejection sensitivity and vulnerability to self-directed hostile cognitions following rejection. Journal of Personality, 83(1), 1–13. https://doi.org/10.1111/jopy.12077.

  3. Brown, & Harris. (1978). Social origins of depression: A study of psychiatric disorder in women. London: Tavistock.

  4. Cha, C. B., Franz, P. J. M., Guzmán, E., Glenn, C. R., Kleiman, E. M., & Nock, M. K. (2017). Annual research review: Suicide among youth - epidemiology (potential), etiology, and treatment. Journal of Child Psychology and Psychiatry and Allied Disciplines., 59, 460–482. https://doi.org/10.1111/jcpp.12831.

  5. Chango, J. M., McElhaney, K. B., Allen, J. P., Schad, M. M., & Marston, E. (2012). Relational stressors and depressive symptoms in late adolescence: Rejection sensitivity as a vulnerability. Journal of Abnormal Child Psychology, 40(3), 369–379. https://doi.org/10.1007/s10802-011-9570-y.

  6. Chiodo, D., Crooks, C. V., Wolfe, D. A., McIsaac, C., Hughes, R., & Jaffe, P. G. (2012). Longitudinal prediction and concurrent functioning of adolescent girls demonstrating various profiles of dating violence and victimization. Prevention Science, 13(4), 350–359. https://doi.org/10.1007/s11121-011-0236-3.

  7. Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M. (2017). Suicide rates after discharge from psychiatric facilities: A systematic review and meta-analysis. JAMA Psychiatry, 74(7), 694–702. https://doi.org/10.1001/jamapsychiatry.2017.1044.

  8. Cooper, J., Appleby, L., & Amos, T. (2002). Life events preceding suicide by young people. Social Psychiatry and Psychiatric Epidemiology, 37(6), 271–275. https://doi.org/10.1007/s001270200019.

  9. Cruz, D., Narciso, I., Pereira, C., & Sampaio, D. (2015). Self-destructive symptomatic frames in clinical adolescents: Is the same different? Journal of Research on Adolescence, 25(3), 524–533. https://doi.org/10.1111/jora.12152.

  10. Czyz, E. K., King, C. A., & Nahum-Shani, I. (2018). Ecological assessment of daily suicidal thoughts and attempts among suicidal teens after psychiatric hospitalization: Lessons about feasibility and acceptability. Psychiatry Research, 267, 566-574. https://doi.org/10.1016/j.psychres.2018.06.031

  11. Daniel, S. S., Goldston, D. B., Erkanli, A., Heilbron, N., & Franklin, J. C. (2017). Prospective study of major loss life events and risk for suicidal thoughts and behaviors among adolescents and young adults. Suicide and Life-threatening Behavior, 47(4), 436–449. https://doi.org/10.1111/sltb.12305.

  12. Foster, T. (2011). Adverse life events proximal to adult suicide: A synthesis of findings from psychological autopsy studies. Archives of Suicide Research, 15(1), 1–15. https://doi.org/10.1080/13811118.2011.540213.

  13. Fotti, S. A., Katz, L. Y., Afifi, T. O., & Cox, B. J. (2006). The associations between peer and parental relationships and suicidal behaviours in early adolescents. Canadian Journal of Psychiatry, 51(11), 698–703.

  14. Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., Musacchio, K. M., Jaroszewski, A. C., Chang, B. P., & Nock, M. K. (2016). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187–232. https://doi.org/10.1037/bul0000084.

  15. Glenn, C. R., & Nock, M. K. (2014). Improving the short-term prediction of suicidal behavior. American Journal of Preventive Medicine, 47(3 SUPPL. 2), S176–S180. https://doi.org/10.1016/j.amepre.2014.06.004.

  16. Hammen, C. (2005). Stress and depression. Annual Review of Clinical Psychology, 1(1), 293–319. https://doi.org/10.1146/annurev.clinpsy.1.102803.143938.

  17. Hammen, C., & Brennan, P. A. (2001). Depressed adolescents of depressed and nondepressed mothers: Tests of an interpersonal impairment hypothesis. Journal of Consulting and Clinical Psychology, 69(2), 284–294. https://doi.org/10.1037//0022-006X.69.2.284.

  18. Heilbron, N., & Prinstein, M. J. (2010). Adolescent peer victimization, peer status, suicidal ideation, and nonsuicidal self-injury: Examining concurrent and longitudinal associations. Merrill-Palmer Quarterly, 56(3), 388–419. https://doi.org/10.1353/mpq.0.0049.

  19. Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.

  20. Kessler, R. C. (1997). The effects of stressful life events on depression. Annual Review of Psychology, 48(1), 191–214. https://doi.org/10.1146/annurev.psych.48.1.191.

  21. Kessler, R. C., Berglund, P., Borges, G., Nock, M., & Wang, P. S. (2015). Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990-1992 to 2001-2003. JAMA Psychiatry, 293(20), 2487–2495.

  22. Klimes-Dougan, B. P. D., Free, K. P. D., Ronsaville, D. P. D., Stilwell, J. M. S., Welsh, C. J. B. S., & Radke-Yarrow, M. P. D. (1999). Suicidal ideation and attempts: A longitudinal investigation of children of depressed and well mothers. Journal of the American Academy of Child & Adolescent Psychiatry, 38(6), 651–659. https://doi.org/10.1097/00004583-199906000-00011.

  23. Klonsky, D. E., & May, A. M. (2015). The three-step theory (3ST): A new theory of suicide rooted in the “ideation-to-action” framework. International Journal of Cognitive Therapy, 8(2), 114–129. https://doi.org/10.1521/ijct.2015.8.2.114.

  24. Liu, R. T., & Miller, I. (2014). Life events and suicidal ideation and behavior: A systematic review. Clinical Psychology Review, 34(3), 181–192. https://doi.org/10.1016/j.cpr.2014.01.006.

  25. Liu, R. T., Cheek, S. M., & Nestor, B. A. (2016). Non-suicidal self-injury and life stress: A systematic meta-analysis and theoretical elaboration. Clinical Psychology Review, 47, 1–14. https://doi.org/10.1016/j.cpr.2016.05.005.

  26. Ma, J., Batterham, P. J., Calear, A. L., & Han, J. (2016). A systematic review of the predictions of the interpersonal-psychological theory of suicidal behavior. Clinical Psychology Review, 46, 34–45. https://doi.org/10.1016/j.cpr.2016.04.008.

  27. Mackin, D. M., Perlman, G., Davila, J., Kotov, R., & Klein, D. N. (2017). Social support buffers the effect of interpersonal life stress on suicidal ideation and self-injury during adolescence. Psychological Medicine, 47(6), 1149–1161. https://doi.org/10.1017/S0033291716003275.

  28. Massing-Schaffer, M., Helms, S. W., Rudolph, K. D., George, M., Hastings, P. D., Giletta, M., … Hastings, P. D. (2018). Journal of Clinical Child & Adolescent Psychology, 0(0), 1–8. https://doi.org/10.1080/15374416.2018.1469093, Preliminary Associations among Relational Victimization, Targeted Rejection, and Suicidality in Adolescents: A Prospective Study, 48.

  29. Mayes, T. L., Bernstein, I. H., Haley, C. L., Kennard, B. D., & Emslie, G. J. (2010). Psychometric properties of the Children’s depression rating scale–revised in adolescents. Journal of Child and Adolescent Psychopharmacology, 20(6), 513–516. https://doi.org/10.1089/cap.2010.0063.

  30. Mcquaid, J. R., Monroe, S. M., Mcquaid, J. R., Monroe, S. M., Roberts, J. E., Kupfer, D. J., & Frank, E. (2000). A comparison of two life stress assessment approaches. Prospective prediction of treatment outcome in recurrent depression, 109(November 2016), 787–791. https://doi.org/10.1037//0021-843X.109.4.787.

  31. Meza, J. I., Owens, E. B., & Hinshaw, S. P. (2016). Response inhibition, peer preference and victimization, and self-harm: Longitudinal associations in young adult women with and without ADHD. Journal of Abnormal Child Psychology, 44(2), 323–334. https://doi.org/10.1007/s10802-015-0036-5.

  32. Monck, E., & Dobbs, R. (1985). Measuring life events in an adolescent population: Methodological issues and related findings. Psychological Medicine, 15(4), 841–850.

  33. Monroe, S. M. (2008). Modern approaches to conceptualizing and measuring human life stress. Annual Review of Clinical Psychology, 4(1), 33–52. https://doi.org/10.1146/annurev.clinpsy.4.022007.141207.

  34. Nock, M. K., Borges, G., Bromet, E. J., Alonso, J., Angermeyer, M., Beautrais, A., Bruffaerts, R., Chiu, W. T., de Girolamo, G., Gluzman, S., de Graaf, R., Gureje, O., Haro, J. M., Huang, Y., Karam, E., Kessler, R. C., Lepine, J. P., Levinson, D., Medina-Mora, M. E., Ono, Y., Posada-Villa, J., & Williams, D. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry, 192(2), 98–105. https://doi.org/10.1192/bjp.bp.107.040113.

  35. Paykel, E. S., Prusoff, B. A., & Myers, J. K. (1975). Suicide attempts and recent life events: A controlled comparison. Archives of General Psychiatry, 32, 327–333.

  36. Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., et al. (2011). The Columbia-suicide severity rating scale - initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168, 1266–1277. https://doi.org/10.1176/appi.ajp.2011.10111704.

  37. Poznanski, E. O., & Mokros, H. B. (1996). Children’s depression rating scale, revised (CDRS-R) manual. Los Angeles, CA: Western Psychological Services.

  38. Prinstein, M. J., Boergers, J., Spirito, A., Little, T. D., & Grapentine, W. L. (2000). Peer functioning, family dysfunction, and psychological symptoms in a risk factor model for adolescent inpatients’ suicidal ideation severity. Journal of Clinical Child Psychology, 29(3), 392–405. https://doi.org/10.1207/S15374424JCCP2903_10.

  39. Reynolds, W., & Mazza, J. J. (1999). Assessment of suicidal ideation in inner-city children and young adolescents: Reliability and validity of the suicidal ideation questionnaire-JR. School Psychology Review, 28(1), 17–30. https://doi.org/10.1086/250095.

  40. Ribeiro, J. D., Franklin, J. C., Fox, K. R., Bentley, K. H., Kleiman, E. M., Chang, B. P., & Nock, M. K. (2016). Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: A meta-analysis of longitudinal studies. Psychological Medicine, 46(2), 225–236. https://doi.org/10.1017/S0033291715001804.

  41. Ross, M. W., Clayer, J. R., & Campbell, R. L. (1983). Parental rearing patterns and suicidal thoughts. Acta Psychiatrica Scandinavica, 67(6), 429–433. https://doi.org/10.1111/j.1600-0447.1983.tb09723.x.

  42. Sebastian, C., Viding, E., Williams, K. D., & Blakemore, S. J. (2010). Social brain development and the affective consequences of ostracism in adolescence. Brain and Cognition, 72(1), 134–145. https://doi.org/10.1016/j.bandc.2009.06.008.

  43. Simons, A. D., Angell, K. L., Monroe, S. M., & Thase, M. E. (1993). Cognition and life stress in depression: Cognitive factors and the definition, rating, and generation of negative life events. Journal of Abnormal Psychology, 102(4), 584–591. https://doi.org/10.1037/0021-843X.102.4.584.

  44. Slavich, G. M., Thornton, T., Torres, L. D., Monroe, S. M., & Gotlib, I. H. (2009). Targeted rejection predicts hastened onset of major depression. Journal of Social and Clinical Psychology, 28(2), 223–243.

  45. Sobrinho, A. T., Campos, R. C., & Holden, R. R. (2016). Parental rejection, personality, and depression in the prediction of suicidality in a sample of nonclinical young adults. Psychoanalytic Psychology, 33(4), 554–570. https://doi.org/10.1037/pap0000051.

  46. Somerville, L. H. (2013). Special issue on the teenage brain: Sensitivity to social evaluation. Current Directions in Psychological Science, 22(2), 121–127. https://doi.org/10.1177/0963721413476512.

  47. Stone, D. M., Simon, T. R., Fowler, K. A., Kegler, S. R., Yuan, K., Holland, K. M., Ivey-Stephenson, A. Z., & Crosby, A. E. (2018). Vital signs: Trends in state suicide rates—United States, 1999–2016 and circumstances contributing to suicide—27 states, 2015. Morbidity and Mortality Weekly Report, 67(22), 617–624.

  48. Uliaszek, A. A., Zinbarg, R. E., Mineka, S., Craske, M. G., Griffith, J. W., Sutton, J. M., Epstein, A., & Hammen, C. (2012). A longitudinal examination of stress generation in depressive and anxiety disorders. Journal of Abnormal Psychology, 121(1), 4–15. https://doi.org/10.1037/a0025835.

  49. Van Orden, K., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600. https://doi.org/10.1037/a0018697.

  50. Van Orden, K. A., Cukrowicz, K. C., Witte, T. K., & Joiner, T. E. (2012). Thwarted belongingness and perceived burdensomeness: Construct validity and psychometric properties of the interpersonal needs questionnaire. Psychological Assessment, 24(1), 197–215. https://doi.org/10.1037/a0025358.

  51. Vrshek-Schallhorn, S., Stroud, C. B., Mineka, S., Hammen, C., Zinbarg, R. E., Wolitzky-Taylor, K., & Craske, M. G. (2015). Chronic and episodic interpersonal stress as statistically unique predictors of depression in two samples of emerging adults. Journal of Abnormal Psychology, 124(4), 918–932. https://doi.org/10.1037/abn0000088.

Download references

Funding

Preparation of this manuscript was supported by the American Foundation for Suicide Prevention and the National Institute of Mental Health under Award Numbers R01 MH101138 and R01 MH099703.

Author information

Correspondence to Shayna M. Cheek.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval and Informed Consent

All participants provided informed consent under an approved IRB study protocol.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Cheek, S.M., Goldston, D.B., Erkanli, A. et al. Social Rejection and Suicidal Ideation and Attempts among Adolescents Following Hospitalization: a Prospective Study. J Abnorm Child Psychol 48, 123–133 (2020). https://doi.org/10.1007/s10802-019-00580-z

Download citation

Keywords

  • Life stress
  • Social rejection
  • Adolescents
  • Suicidal ideation
  • Suicide attempts