Can Better Emotion Regulation Protect Against Suicidality in Traumatized Homeless Youth?
Background/Purpose: Homeless youth are characterized by high rates of early childhood trauma and street victimization and are at increased risk for posttraumatic stress disorder and suicidality. Previous research examining suicidality in homeless youth has focused largely on associations with psychopathology and substance use behavior as well as demographic variables such as gender and sexual orientation. The role of emotion regulation behaviors, which are response tendencies individuals use to manage emotions, has been not been investigated in this population despite the responsiveness of emotion regulation to intervention and evidence linking difficulties regulating emotion to increased risk for suicidal behavior in clinical samples. The purpose of this study was to understand the relationship between trauma experiences, PTSD, emotion regulation and suicidality among homeless youth.
Method: This project used data collected from 389 youth recruited at three drop in centers in the Los Angeles area as part of the NIMH funded YouthNet project. All responses were based on self-reports. Suicidality was operationalized as two dichotomous variables capturing suicidal ideation and at least 1 suicide attempt in the last year. Trauma experiences were dichotomized as presence or absence of trauma prior to and after homelessness. PTSD was a count variable of symptoms in the last two weeks (0-4). Emotion regulation was measured on the emotional control and awareness subscales of the Difficulties in Emotion Regulation Scale (6-30); higher scores mean better regulation. Multinomial logistic regression models were conducted to account for the effects of independent variables on suicidality.
Results: Nearly a fifth of youth reported suicidal ideation in the last year and 6.98% reported at least one attempt during that time. Heterosexual youth were less likely to report suicidal ideation but not suicide attempts. Trauma exposure prior to homelessness was a significant risk for both suicidal ideation (OR=5.95, 95% C.I. 2.41, 14.70) and attempts (OR=2.86, 95% C.I. 1.24, 6.56) as were PTSD symptoms (OR=1.33, 95% C.I. 1.09, 1.62; OR=1.55, 95% C.I. 1.23, 1.95). Emotional control was negatively associated with suicidal ideation and attempts (OR=.95, 95% C.I. .90, 1.00; OR=.93, 95% C.I. .88, .99) and emotional awareness with attempts (OR=.94, 95% C.I., .90, .99). An emotional awareness score one standard deviation above the mean was associated with a 25.24 decrease in the relative odds of a suicide attempt.
Discussion: This study has important implications for interventions targeting suicidality among homeless youth. Results suggest that emotion regulation skills may protect against the effects of early trauma and PTSD symptoms on suicidality. An ability to observe emotional content and exert control in emotionally challenging contexts may facilitate use of adaptive coping skills, such as problem solving and reappraisal, which are associated with better mental and behavioral health outcomes. Emotion regulation skills are highly amenable to improvement through intervention. Renewed focus on interventions which build regulatory skills in addition to those targeting risk behavior directly may represent an effective strategy for reducing homeless youth’s suicide risk.