Risk Factors for Suicidal Ideation and Attempts Among Adolescents in Foster Care

Background and Purpose. Adolescents in the foster care system exhibit significant mental health difficulties, including anxiety, depression, and disruptive and posttraumatic stress disorders. However, few studies examined suicidal ideation and suicide attempts among this population. The purpose of the present study is to (1) examine the rates of suicidal ideation and attempts among youths aged 12-18 involved with the foster care system; and (2) evaluate the risk factors associated with both considering and attempting suicide.

Methods. Data and Samples: This study used a cross-sectional analysis of baseline data from the Multi-Site Evaluation of Foster Youth Programs. The sample consisted of 860 youths (56% females; 44% males) residing in several counties in California. The average age of the youth was 15.7 years. Measurement: Participants reported on whether they seriously considered suicide in the past year (i.e., suicide ideation), and whether they actually attempted suicide during this time period. Participants also reported on their demographics (age, race/ethnicity, sexual orientation), and a range of risk factors, such as prior victimization and involvement in delinquent behaviors. Data Analysis: First, we examined the frequency of suicidal ideation and attempts in the current sample, and identified subgroups of youth who exhibited the highest rates of these behaviors. Then, we conducted binary logistic regression analyses to identify the risk factors which presented the strongest contribution to suicidal ideation and attempts.

Results. About 7% of youths seriously considered suicide in the past year, and within those who considered suicide, more than 65% had attempted suicide. Females were more likely to consider and attempt suicide, while African-Americans were less likely to report both behaviors. A subgroup examination highlighted that sexual minority females were especially likely to report suicidal ideation and attempts (16% and 13% respectively). In logistic regression analyses, female gender emerged as a strong predictor of both considering (OR=2.93, p<.01) and attempting (OR=5.40, p<.01) suicide. A history of sexual abuse was also strongly associated with suicidal ideation and attempts (OR=2.41 and OR=3.06 respectively, p<.01). Finally, youths who reported any delinquent behaviors in the past year were substantially more likely to both consider (OR=3.14, p<.01) and attempt (OR=4.04, p<.01) suicide. Noteworthy, the impact of sexual orientation became non-significant once past-year delinquency was accounted for.

Conclusions and Implications: Findings from this study shed light on the prevalence of suicidal ideation and attempts among youths in the foster care system. Our findings indicate that once a youth seriously considers suicide, an actual attempt is highly likely. Youths with a history of sexual abuse and those who engage in delinquent behaviors are especially vulnerable for both considering and attempting suicide. Provision of targeted services to identify and address suicidal ideation among adolescents involved with the foster care system is sorely needed.