Think Outside of the Maysi-2 Box and See Loneliness As a Red Flag

Background and Purpose: Suicide is the leading cause of death in juvenile justice facilities. In fact, each year approximately 11,000 juvenile offenders confined in juvenile justice facilities engage in suicidal behaviors. When compared to the general population, detained juvenile offenders are at a greater risk for and are more successful at suicide attempts. In response, facilities in 47 states use the mental health screening tool, the Massachusetts Youth Screening version 2 (MAYSI-2), to screen for suicide ideation. The MAYSI-2’s suicide ideation (SI) scale requires affirmative responses to at least two of five items designed to indicate whether in the past few months a youth had thoughts or intentions of self-harm or is currently at risk of a suicide attempt or gesture. The item “have you felt lonely too much of the time?” is used to identify feelings of loneliness. However, despite research showing that loneliness is one of the leading causes of suicide for adolescents, an affirmative response to the item is not weighed more heavily than the remaining four items. The aim of this study is to identify the prevalence of juvenile offenders endorsing the feeling lonely item alone and coupled with a second item on the SI scale.  

Methods: MAYSI-2 data were collected from all youth detained in a Midwestern juvenile detention facility between May 2006 and March 2010 for a total of 1,992 occasions. The sample (N=1,348) was 86% male; 79% Black, 17% White, and 4% Other; and ages 10-17. Chi-square analyses were conducted using SAS 9.2.

Results: On the overall SI scale, univariate analyses revealed n=1,542 (78%) responses to zero items, n=205 (10%) to one item, n=245 (12%) to two or more items, and n=415 (21%) felt lonely.  Chi-square analyses revealed n=84 felt lonely and had suicidal thoughts (χ²=150.41, p<.0001); n=91 felt lonely and wanted to hurt themselves (χ²=144.31, p<.0001); n=117 felt lonely and wished they were dead (χ²=168.11, p<.0001); and n=167 felt lonely and life was not worth living (χ²=194.92, p<.0001).

Conclusions and Implications: Not only is suicide a major public health concern, it is a tremendous issue for juvenile offenders and every effort should be made to identify suicide ideation. In this study, there were practical and statistically significant responses to items reflective of suicidal thoughts. By broadening how we identify those at risk, mental health practitioners can be more equipped to address suicidal thoughts, gestures, and attempts. Although it was not possible to explore the number of actual suicide gestures or attempts made by study participants, this study highlights the pervasiveness of feeling lonely.  Prior or current feelings of loneliness, separation from one’s normal environment, and being detained, might exacerbate a juvenile’s loneliness and ultimately their risk of suicide. These possibilities warrant concern and should be responded to; therefore, a new strategy should be used when identifying suicide ideation with the MAYSI-2. Instead of only noting when any two items are responded to affirmatively, addition al attention should be paid when a juvenile responds affirmatively to feeling lonely, coupled with another SI item.