Research That Matters (January 17 - 20, 2008)

The question of how suicidal behavior in others relates to young people's own suicidal thoughts or attempts is of particular import to American Indians, whose youth suicide rate is 3 times higher than average. Research has produced conflicting accounts of whether exposure to suicidal behavior is linked to suicidality in young people, although a national survey of American Indian adolescents recently found that suicidal behavior (attempts or completions) in friends and family related positively to reservation youth's suicide attempts. In order to inform suicide prevention efforts, this study sought to more precisely examine how specific types of exposure in a mixed sample of urban and reservation American Indian youth vary in their relationship to youth's reports of prior suicidality. Accordingly, the study had three aims: 1) determine rates of exposure to suicide attempts and suicides, separately, in family and peers; 2) investigate relationships of the various exposure types to youth's prior ideation and attempts; and 3) examine whether these relationships remained statistically significant when controlling for potential confounders. METHOD: This study surveyed 345 American Indian youth (ages 14-21; mean=18.56, SD=1.55) in a stratified random sample of American Indian youth in a southwestern state. The sample comprised 181 urban and 164 reservation youth in a southwestern state. Participants completed a lengthy personal interview, including the Diagnostic Interview Schedule's depression and substance use modules. Questions assessed youth's lifetime suicidal ideation, suicide attempt, and exposure to, separately, suicide attempts and completions of family and friends. Analyses included descriptive statistics (Aim 1); chi square and logistic regression with post-estimation tests for differences in odds ratios (Aim 2); and logistic regressions controlling for age, gender, location, depression symptoms, substance use (Aim 3). Regression diagnostics ruled out multicollinearity. RESULTS: In all, almost half the sample (48.1%) was exposed to some type of suicidal behavior, including 34.0% who lost a peer to suicide and 4.0% who reported a family suicide. Of youth reporting any exposure to suicidal behavior, 46.1% reported prior suicidal ideation and 26.4% reported an attempt, both statistically significant higher proportions than youth with no exposure to suicidal behavior (22.5% and 16.9%, respectively). However, the different types of exposure related differentially to youth's ideation and attempts. Exposure to family attempts related most strongly, followed by exposure to peer attempts. Although exposure to peer suicide was associated bivariately with youth's suicidal ideation, it lost significance in analyses controlling for potential confounders. Family suicide had no significant relationship with youth's ideation or attempts. IMPLICATIONS: It is commonly accepted that some type of intervention with survivors (i.e., “postvention”) should follow an adolescent or family suicide. This study's associations of exposure to suicide attempt with youth's suicidality suggest that a nonfatal suicide attempt also may warrant intervening with family members and peers. Additionally, prevention programs training peers of suicidal youth as gatekeepers may need to take into account the peers' own potential vulnerability to suicidal behavior. Finally, risk assessments should not only include questions about family suicide, but also about peer suicide and suicide attempts in family and peers.