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

Abstract

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.

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References

  1. Ackard, D., Neumark-Sztainer, D., Story, M., & Perry, C. (2006). Parent-child connectedness and behavioral and emotional health among adolescents. American Journal of Preventive Medicine, 30(1), 59–66.

    PubMed  Article  Google Scholar 

  2. Ahrens, K. R., DuBois, D. L., Richardson, L. P., Fan, M. Y., & Lozano, P. (2008). Youth in foster care with adult mentors during adolescence have improved adult outcomes. Pediatrics, 121(2), e246–e252. doi:10.1542/peds.2007-0508.

    PubMed  Article  Google Scholar 

  3. Angold, A., Costello, E. J., Messer, S., Pickles, A., Winder, F., & Silver, D. (1996). 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 

  4. Aseltine, R., Jr, & DeMartino, R. (2004). An outcome evaluation of the SOS suicide prevention program. American Journal of Public Health, 94(3), 446.

    PubMed  Article  Google Scholar 

  5. Bagge, C. L., Glenn, C. R., & Lee, H.-J. (2012). Quantifying the impact of recent negative life events on suicide attempts. Journal of Abnormal Psychology. doi:10.1037/a0030371.

  6. Barber, B. K., Stolz, H. E., Olsen, J. A., Collins, W. A., & Burchinal, M. (2005). Parental support, psychological control, and behavioral control: Assessing relevance across time, culture, and method. Monographs of the Society for Research in Child Development.

  7. Bariola, E., Hughes, E. K., & Gullone, E. (2011). Relationships between parent and child emotion regulation strategy use: A brief report. Journal of Child and Family Studies, 21(3), 443–448. doi:10.1007/s10826-011-9497-5.

    Article  Google Scholar 

  8. Barnes, H., & Olson, D. (1982). Parent adolescent communication scale. In D. Olson, H. McCubbin, H. Barnes, M. Larsen, M. Muxen, & M. Wilson (Eds.), Family inventories: Inventories used in a national survey of families across the family life cycle (pp. 33–48). St. Paul: Family Social Science, University of Minnesota.

    Google Scholar 

  9. Baumeister, R. (1990). Suicide as escape from self. Psychological Review, 97(1), 90–113. doi:10.1037/0033-295X.97.1.90.

    PubMed  Article  Google Scholar 

  10. Bean, R. A., Barber, B. K., & Crane, D. R. (2006). Parental support, behavioral control, and psychological control among African American youth: The relationships to academic grades, delinquency, and depression. Journal of Family Issues, 27(10), 1335–1355.

    Google Scholar 

  11. Beauchaine, T. P., Gatzke-Kopp, L., & Mead, H. K. (2007). Polyvagal theory and developmental psychopathology: Emotion dysregulation and conduct problems from preschool to adolescence. Biological Psychology, 74(2), 174–184. doi:10.1016/j.biopsycho.2005.08.008.

    PubMed  Article  Google Scholar 

  12. Biglan, A., Flay, B. R., Embry, D. D., & Sandler, I. N. (2012). The critical role of nurturing environments for promoting human well-being. American Psychologist, 67(4), 257–271. doi:10.1037/a0026796.

    PubMed  Article  Google Scholar 

  13. Borowsky, I. W., Ireland, M., & Resnick, M. D. (2001). Adolescent suicide attempts: Risks and protectors. Pediatrics, 107(3), 485–493.

    PubMed  Article  Google Scholar 

  14. Boutelle, K., Eisenberg, M. E., Gregory, M. L., & Neumark-Sztainer, D. (2009). The reciprocal relationship between parent–child connectedness and adolescent emotional functioning over 5 years. Journal of Psychosomatic Research, 66(4), 309–316. doi:10.1016/j.jpsychores.2008.10.019.

    PubMed  Article  Google Scholar 

  15. Braveman, P., & Barclay, C. (2009). Health disparities beginning in childhood: A life-course perspective. Pediatrics, 124(Suppl 3), S163–S175. doi:10.1542/peds.2009-1100D.

    PubMed  Article  Google Scholar 

  16. 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. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 31(4), 336–342.

    Article  Google Scholar 

  17. 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.

    PubMed  Google Scholar 

  18. 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. doi:10.1016/j.childyouth.2010.04.021.

    Article  Google Scholar 

  19. 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.

    PubMed  Article  Google Scholar 

  20. Call, K. T., & Mortimer, J. (2001). Arenas for comfort in adolescence: A study of adjustment in context. Mahwah, NJ: Lawrence Erlbaum.

  21. Cameron, A., & Trivedi, P. (2009). Microeconomics using stata. College Station, TX: Stata Press.

    Google Scholar 

  22. Carthy, T., Horesh, N., Apter, A., Edge, M. D., & Gross, J. J. (2010). Emotional reactivity and cognitive regulation in anxious children. Behaviour Research and Therapy, 48(5), 384–393. doi:10.1016/j.brat.2009.12.013.

    PubMed  Article  Google Scholar 

  23. Centers for Disease Control, Prevention. (2010). Youth risk behavior surveillance—United States, 2009. Morbidity and Mortality Weekly Report, 59(SS-5), 1–142.

    Google Scholar 

  24. Centers for Disease Control and Prevention. (2012). Trends in suicide rates among persons ages 10 years and older, by sex, United States, 1991–2009. Web-based injury statistics query and reporting system (WISQARS) fatal injury reports. Retrieved March 9, 2012, from http://www.cdc.gov/injury/wisqars/index.html.

  25. Cha, C. B., & Nock, M. K. (2009). Emotional intelligence is a protective factor for suicidal behavior. JAAC, 48(4), 422–430. doi:10.1097/CHI.0b013e3181984f44.

    Google Scholar 

  26. 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.

    PubMed  Article  Google Scholar 

  27. Cole, P., Martin, S., & Dennis, T. (2004). Emotion regulation as a scientific construct: Methodological challenges and directions for child development research. Child Development, 75(2), 317–333.

    PubMed  Article  Google Scholar 

  28. 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 

  29. Daniels, A., Taylor, S. C., Post, S., Pilsner, A. M., Hunt, Y. M., & Auguston, E. (2012). Tech to treat: The smokefree teen approach to cessation. Paper presented at the National Conference on Health Communication Marketing and Media, Atlanta, GA.

  30. Dour, H. J., Cha, C. B., & Nock, M. K. (2011). Evidence for an emotion-cognition interaction in the statistical prediction of suicide attempts. Behaviour Research and Therapy, 49(4), 294–298. doi:10.1016/j.brat.2011.01.010.

    PubMed  Article  Google Scholar 

  31. DuBois, D. L., & Silverthorn, N. (2005). Natural mentoring relationships and adolescent health: Evidence from a national study. American Journal of Public Health, 95(3), 518. doi:10.2105/AJPH.2003.031476.

    PubMed  Article  Google Scholar 

  32. Eaton, D., Kann, L., Kinchen, S., Shanklin, S., Ross, J., Hawkins, J., et al. (2010). Youth risk behavior surveillance—United States, 2009. MMWR. Surveillance summaries: Morbidity and mortality weekly report. Surveillance summaries/CDC, 59(5), 1.

    Google Scholar 

  33. Fales, C. L., Barch, D. M., Rundle, M. M., Mintun, M. A., Snyder, A. Z., Cohen, J. D., et al. (2008). Altered emotional interference processing in affective and cognitive-control brain circuitry in major depression. Biological Psychiatry, 63(4), 377–384.

    PubMed  Article  Google Scholar 

  34. Fingerman, K., Miller, L., Birditt, K., & Zarit, S. (2009). Giving to the good and the needy: Parental support of grown children. Journal of Marriage and the Family, 71(5), 1220–1233. doi:10.1111/j.1741-3737.2009.00665.x.

    PubMed  Article  Google Scholar 

  35. Forbes, E. E., & Dahl, R. E. (2005). Neural systems of positive affect: Relevance to understanding child and adolescent depression? Development and Psychopathology, 17(3), 827–850. doi:10.1017/S095457940505039X.

    PubMed  Article  Google Scholar 

  36. Garnefski, N., & Kraaij, V. (2006). Relationships between cognitive emotion regulation strategies and depressive symptoms: A comparative study of five specific samples. Personality and Individual Differences, 40(8), 1659–1669.

    Article  Google Scholar 

  37. Ge, X., Natsuaki, M. N., Neiderhiser, J. M., & Reiss, D. (2009). The longitudinal effects of stressful life events on adolescent depression are buffered by parent–child closeness. Development and Psychopathology, 21(02), 621. doi:10.1017/S0954579409000339.

    PubMed  Article  Google Scholar 

  38. Goldin, P. R., Manber, T., Hakimi, S., Canli, T., & Gross, J. J. (2009). Neural bases of social anxiety disorder: Emotional reactivity and cognitive regulation during social and physical threat. Archives of General Psychiatry, 66(2), 170–180. doi:10.1001/archgenpsychiatry.2008.525.

    PubMed  Article  Google Scholar 

  39. 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.

    PubMed  Article  Google Scholar 

  40. Goldston, D., Reboussin, B., & Daniel, S. (2006). Predictors of suicide attempts: State and trait components. Journal of Abnormal Psychology, 115(4), 842.

    PubMed  Article  Google Scholar 

  41. Gould, M. S., Fisher, P., Parides, M., Flory, M., & Shaffer, D. (1996). Psychosocial risk factors of child and adolescent completed suicide. Archives of General Psychiatry, 53(12), 1155–1162.

    PubMed  Article  Google Scholar 

  42. 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.

    PubMed  Article  Google Scholar 

  43. Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. doi:10.1023/B:JOBA.0000007455.08539.94.

    Article  Google Scholar 

  44. Gratz, K. L., Rosenthal, M. Z., Tull, M. T., Lejuez, C. W., & Gunderson, J. G. (2006). An experimental investigation of emotion dysregulation in borderline personality disorder. Journal of Abnormal Psychology, 115(4), 850–855. doi:10.1037/0021-843X.115.4.850.

    PubMed  Article  Google Scholar 

  45. Greenberg, M. T., Weissberg, R. P., O’Brien, M. U., Zins, J. E., Fredericks, L., Resnik, H., et al. (2003). Enhancing school-based prevention and youth development through coordinated social, emotional, and academic learning. American Psychologist, 58(6–7), 466–474. doi:10.1037/0003-066X.58.6-7.466.

    PubMed  Article  Google Scholar 

  46. Hinshaw, S. P. (2002). Process, mechanism, and explanation related to externalizing behavior in developmental psychopathology. Journal of Abnormal Child Psychology: An official publication of the International Society for Research in Child and Adolescent Psychopathology, 30(5), 431–446. doi:10.1023/A:1019808712868.

    Google Scholar 

  47. Hunter, E. C., Katz, L. F., Shortt, J. W., Davis, B., Leve, C., Allen, N. B., et al. (2010). How do I feel about feelings? Emotion socialization in families of depressed and healthy adolescents. Journal of Youth and Adolescence, 40(4), 428–441. doi:10.1007/s10964-010-9545-2.

    PubMed  Article  Google Scholar 

  48. Jacobson, C. M., Marrocco, F., Kleinman, M., & Gould, M. S. (2010). Restrictive emotionality, depressive symptoms, and suicidal thoughts and behaviors among high school students. Journal of Youth and Adolescence, 1–10. doi: 10.1007/s10964-010-9573-y.

  49. Kaminski, J. W., Puddy, R. W., Hall, D. M., Cashman, S. Y., Crosby, A. E., & Ortega, L. A. G. (2009). The relative influence of different domains of social connectedness on self-directed violence in adolescence. Journal of Youth and Adolescence, 39(5), 460–473. doi:10.1007/s10964-009-9472-2.

    PubMed  Article  Google Scholar 

  50. Kessler, R. C., & Merikangas, K. R. (2004). The national comorbidity survey replication (NCS-R): Background and aims. International Journal of Methods in Psychiatric Research, 13(2), 60–68. doi:10.1002/mpr.166.

    PubMed  Article  Google Scholar 

  51. Khurana, A., & Romer, D. (2012). Modeling the distinct pathways of influence of coping strategies on youth suicidal ideation: A national longitudinal study. Prevention Science, 1–11. doi:10.1007/s11121-012-0292-3.

  52. Kidd, S., Henrich, C. C., Brookmeyer, K. A., Davidson, L., King, R. A., & Shahar, G. (2006). The social context of adolescent suicide attempts: Interactive effects of parent, peer, and school social relations. Suicide and Life Threatening Behavior, 36(4), 386–395.

    PubMed  Article  Google Scholar 

  53. King, C. A., Klaus, N., Kramer, A., Venkataraman, S., Quinlan, P., & Gillespie, B. (2009). The youth-nominated support team–version ii for suicidal adolescents: A randomized controlled intervention trial. Journal of Consulting and Clinical Psychology, 77(5), 880–893. doi:10.1037/a0016552.

    PubMed  Article  Google Scholar 

  54. Kuntsche, E., Knibbe, R., Engels, R., & Gmel, G. (2007). Drinking motives as mediators of the link between alcohol expectancies and alcohol use among adolescents. Journal of Studies on Alcohol and Drugs, 68(1), 76–85.

    PubMed  Google Scholar 

  55. Levine, D., McCright, J., Dobkin, L., Woodruff, A., & Klausner, J. (2008). Sexinfo: A sexual health text messaging service for San Francisco youth. American Journal of Public Health, 98(3), 393–395. doi:10.2105/AJPH.2007.110767.

    PubMed  Article  Google Scholar 

  56. Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.

    Google Scholar 

  57. 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.

    Article  Google Scholar 

  58. LoMurray, M. (2005). Sources of strength facilitators guide: Suicide prevention peer gatekeeper training. Bismarck, ND: The North Dakota Suicide Prevention Project.

    Google Scholar 

  59. Lyson, T. A. (2002). What does a school mean to a community? Assessing the social and economic benefits of schools to rural villages in New York. Journal of Research in Rural Education, 17(3), 131–137.

    Google Scholar 

  60. Marmot, M., Friel, S., Bell, R., Houweling, T.A., Taylor, S., on behalf of the Commission on Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. The Lancet, 372(9650), 1661–1669. doi:10.1016/S0140-6736(08)61690-6.

    Google Scholar 

  61. Mcneely, C. A., & Barber, B. K. (2010). How do parents make adolescents feel loved? Perspectives on supportive parenting from adolescents in 12 cultures. Journal of Adolescent Research, 25(4), 601–631. doi:10.1177/0743558409357235.

    Article  Google Scholar 

  62. McNeely, C., & Falci, C. (2004). School connectedness and the transition into and out of health-risk behavior among adolescents: A comparison of social belonging and teacher support. The Journal of School Health, 74(7), 284–292.

    PubMed  Article  Google Scholar 

  63. Merikangas, K. R., Avenevoli, S., Costello, E. J., Koretz, D., & Kessler, R. C. (2009). National comorbidity survey replication adolescent supplement (NCS-A): I. Background and measures. Journal of the American Academy of Child and Adolescent Psychiatry, 48(4), 367–379. doi:10.1097/CHI.0b013e31819996f1.

    PubMed  Article  Google Scholar 

  64. Messer, S., Angold, A., Costello, E., 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 

  65. Miller, A. L., Rathus, J. H., & Linehan, M. M. (2007). Dialectical behavior therapy with suicidal adolescents. New York, NY: Guilford Press.

    Google Scholar 

  66. Morris, A. S., Silk, J. S., Steinberg, L., Myers, S. S., & Robinson, L. R. (2007). The role of the family context in the development of emotion regulation. Social Development (Oxford, England), 16(2), 361–388. doi:10.1111/j.1467-9507.2007.00389.x.

    Google Scholar 

  67. Neumann, A., Van Lier, P. A. C., Gratz, K. L., & Koot, H. M. (2010). Multidimensional assessment of emotion regulation difficulties in adolescents using the difficulties in emotion regulation scale. Assessment, 17(1), 138–149. doi:10.1177/1073191109349579.

    PubMed  Article  Google Scholar 

  68. Nock, M. K. (2012). Future directions for the study of suicide and self-injury. Journal of Clinical Child & Adolescent Psychology, 41(2), 255–259. doi:10.1080/15374416.2012.652001.

    Article  Google Scholar 

  69. Pedersen, S., Seidman, E., Yoshikawa, H., Rivera, A. C., Allen, L., & Aber, J. L. (2005). Contextual competence: Multiple manifestations among urban adolescents. American Journal of Community Psychology, 35(1–2), 65–82. doi:10.1007/s10464-005-1890-z.

    PubMed  Article  Google Scholar 

  70. Pisani, A. R., Schmeelk-Cone, K., Gunzler, D., Petrova, M., Goldston, D. B., Tu, X., et al. (2012). Associations between suicidal high school students’ help-seeking and their attitudes and perceptions of social environment. Journal of Youth and Adolescence, 41(10), 1312–1324. doi:10.1007/s10964-012-9766-7.

    PubMed  Article  Google Scholar 

  71. Rajappa, K., Gallagher, M., & Miranda, R. (2011). Emotion dysregulation and vulnerability to suicidal ideation and attempts. Cognitive Therapy and Research,. doi:10.1007/s10608-011-9419-2.

    Google Scholar 

  72. Rathus, J. H., & Miller, A. L. (2002). Dialectical behavior therapy adapted for suicidal adolescents. Suicide and Life Threatening Behavior, 32(2), 146–157. doi:10.1521/suli.32.2.146.24399.

    PubMed  Article  Google Scholar 

  73. Resnick, M. D., Bearman, P. S., Blum, R. W., Bauman, K. E., Harris, K. M., Jones, J., et al. (1997). Protecting adolescents from harm. Findings from the national longitudinal study on adolescent health. JAMA, the Journal of the American Medical Association, 278(10), 823–832.

    Article  Google Scholar 

  74. 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.

    PubMed  Article  Google Scholar 

  75. Shneidman, E. S. (1996). The suicidal mind. New York, NY: Oxford University Press.

    Google Scholar 

  76. Silk, J., Steinberg, L., & Morris, A. (2003). Adolescents’ emotion regulation in daily life: Links to depressive symptoms and problem behavior. Child Development, 74(6), 1869–1880.

    PubMed  Article  Google Scholar 

  77. Simons, J. S., & Gaher, R. M. (2005). The distress tolerance scale: Development and validation of a self-report measure. Motivation and Emotion, 29(2), 83–102. doi:10.1007/s11031-005-7955-3.

    Article  Google Scholar 

  78. StataCorp. (2011). Stata statistical software: Release 12. College Station, TX: StataCorp LP.

    Google Scholar 

  79. Suicide Prevention Resource Center and Suicide Prevention Action Network USA. (2010). Charting the future of suicide prevention: A 2010 progress review of the national strategy and recommendations for the decade ahead. Retrieved December 4, 2012, from http://www.sprc.org/library_resources/items/charting-future-suicide-prevention-2010-progress-review-national-strategy-an.

  80. Thompson, R. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59(2), 25–52.

    PubMed  Article  Google Scholar 

  81. Thompson, E., Eggert, L., Randell, B., & Pike, K. (2001). Evaluation of indicated suicide risk prevention approaches for potential high school dropouts. American Journal of Public Health, 91(5), 742.

    PubMed  Article  Google Scholar 

  82. U.S. Department of Health and Human Services (HHS) Office of the Surgeon General and National Action Alliance for Suicide Prevention. (2012). 2012 national strategy for suicide prevention: Goals and objectives for action. Washington, DC: HSS.

    Google Scholar 

  83. U.S. Dept. of Health and Human Services. (2001). National strategy for suicide prevention: Goals and objectives for action. Retrieved February 10, 2009, from http://mentalhealth.samhsa.gov/publications/allpubs/SMA01-3517/.

  84. Weinberg, A., & Klonsky, E. D. (2009). Measurement of emotion dysregulation in adolescents. Psychological Assessment, 21(4), 616–621. doi:10.1037/a0016669.

    PubMed  Article  Google Scholar 

  85. Williams, J. M. G., & Pollock, L. R. (2008). The pschology of suicidal behaviour. In K. Hawton & K. van Heeringen (Eds.), The international handbook of suicide and attempted suicide. John Wiley & Sons, West Sussex, England. doi:10.1002/9780470698976.ch5.

  86. Wolchik, S. A., Sandler, I. N., Millsap, R. E., Plummer, B. A., Greene, S. M., Anderson, E. R., et al. (2002). Six-year follow-up of preventive interventions for children of divorce. JAMA, the Journal of the American Medical Association, 288(15), 1874–1881.

    Article  Google Scholar 

  87. WWAMI Rural Health Research Center. (2004). 2004 zip ruca code files. Retrieved March 13, 2012, from http://depts.washington.edu/uwruca/ruca-download.php.

  88. 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.

    PubMed  Article  Google Scholar 

  89. 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.

    PubMed  Article  Google Scholar 

  90. Wyman, P. A., Gaudieri, P. A., Schmeelk-Cone, K., Cross, W., Brown, C. H., Sworts, L., et al. (2009). Emotional triggers and psychopathology associated with suicidal ideation in urban children with elevated aggressive-disruptive behavior. Journal of Abnormal Child Psychology, 37(7), 917–928. doi:10.1007/s10802-009-9330-4.

    PubMed  Article  Google Scholar 

  91. Zimmerman, M. A., Bingenheimer, J. B., & Notaro, P. C. (2002). Natural mentors and adolescent resiliency: A study with urban youth. American Journal of Community Psychology, 30(2), 221–243.

    PubMed  Article  Google Scholar 

  92. 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.

    Article  Google Scholar 

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Acknowledgments

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.

Author contributions

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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Correspondence to Anthony R. Pisani.

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Pisani, A.R., Wyman, P.A., Petrova, M. et al. Emotion Regulation Difficulties, Youth–Adult Relationships, and Suicide Attempts Among High School Students in Underserved Communities. J Youth Adolescence 42, 807–820 (2013). https://doi.org/10.1007/s10964-012-9884-2

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Keywords

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