Connectedness and Suicidality: Implications for Prevention Among Child Welfare-Investigated Youth

Background:  Suicide is the third leading cause of death among youth. Youth investigated by child protective services (CPS) may be particularly vulnerable given the co-occurrence of various suicide risk factors, such as maltreatment and behavioral and mental health problems.  With suicidal ideation having been linked to suicidal behavior, it serves as a viable and recommended target for suicide prevention efforts. Although suicide theory and considerable evidence support the value of social connectedness in protecting against suicide, few studies have examined the relationship between social connectedness and suicidal ideation among CPS-investigated youth. Given that CPS-investigated youth may be at greater risk for being disconnected from caregivers, peers and schools than youth in the general population, an improved understanding of how connectedness to these different domains relates to suicidal ideation can inform targeted primary prevention efforts in this population.

Methods: This study used baseline data from the National Survey of Child and Adolescent Well-Being (NSCAW II) and consisted of a sub-sample of adolescent youth ages 11 to 17 (N=1054). Social connectedness domains were measured using modified versions of the Rochester Assessment (RAPS-SM)  (caregiver), Loneliness and Social Dissatisfaction Questionnaire (peer), and Drug Free Schools (school) scales. Suicidal ideation was measured by a composite variable consisting of two items, one from the Children's Depression Inventory (CDI) and another from the Youth Self-Report (YSR). Logistic regression analyses examined the relationship between various connectedness domains and suicidal ideation while controlling for other well-known risk factors (e.g. placement history and maltreatment allegation type, and behavioral and mental health status). Analyses were stratified by gender (males, n=471; females, n=583).

Results:  Among males, connectedness to primary caregiver (OR: 0.27, CI=0.10, 0.73) but not peers or school decreased the likelihood of suicidal ideation. Among females, connectedness to school (OR: 0.42, CI=0.19, 0.93) but not primary caregiver or peers decreased the likelihood of suicidal ideation. Interestingly, several CPS factors, including the substantiation of a case and the presence of child neglect as compared to physical abuse, were associated with an increased likelihood of suicidal ideation exclusively among males.  PTSD increased the likelihood of suicidal ideation across gender groups, while substance use disorder only increased the likelihood of suicidal ideation for males and depression only increased the likelihood of suicidal ideation for females.

Conclusions and Implications: The current work suggests that the protective value of connectedness is domain-specific and differs across gender groups.  For males, finding that connectedness to primary caregiver reduces the likelihood of suicidal ideation indicates that service professionals working with CPS-investigated males would be wise to promote this type of relationship building.  For females, finding that connectedness to school reduces the likelihood of suicidal ideation indicates that suicide prevention efforts targeting CPS-investigated females should assess and seek to bolster the formation and preservation of school ties.  Although existing research suggests that connectedness to peers is often considered to be of the utmost importance among adolescent youth, it appears that such connectedness may play a less pivotal role in suicide prevention among CPS-investigated youth.