Health Care Resources, Family Supports, and Long-Term Mental Health Outcomes for Suicidal Adolescents

Background and Purpose: Suicide is currently the third leading cause of death for all individuals ages 15-24 and, in 2010, the estimated cost of deaths from suicide was $44 billion. Few studies have investigated the relationship between specific social and institutional resources and later suicide risk for suicidal youth. Using a theoretical framework that combines the Behavioral Model of Health Services Use and the Children’s Network Episode Model (C-NEM), this study investigated the relationship between three resources addressed under policy in the Patient Protection and Affordable Care Act (ACA) and depression and suicidality in a nationally representative sample of suicidal adolescents. This study examined whether type of insurance (public, private/other, or none), receipt of routine medical care, availability of school-based mental health treatment, and parental support during adolescence were related to levels of depression, suicidal ideation and suicide attempts during young adulthood. It was hypothesized that having routine medical care, school-based treatment, and higher levels of parental support would be protective against depression and suicidality in young adulthood.

Methods: Longitudinal bivariate and regression analyses were conducted using data from the National Longitudinal Study of Adolescent Health. The sample included only those respondents who reported “seriously considering suicide” during the first year of data collection. Primary predictors at Wave I included: type of insurance, receipt of a routine physical, availability of school-based counseling, and parental connection subscale scores. Demographic variables and two proxies for symptom severity at Wave I were entered as controls. Symptom severity was measured with scores from the Center for Epidemiological Studies Depression Scale (CES-D) and whether or not a suicide attempt had been made at Wave I. Outcome measures included scores on the CES-D, presence of suicidal ideation, and presence of a suicide attempt at Waves III and IV.

Results: This sample was at comparatively high risk for depression, suicidal ideation, and attempts during young adulthood, particularly those respondents who had made a suicide attempt at Wave I. Having public insurance was associated with significantly higher depression scores at Wave IV, even with demographic and symptom severity factors controlled. Higher levels of parental support were associated with lower levels of depression at Waves III and IV, but with all predictors in the model, this relationship only remained significant at Wave IV. Having had a physical at Wave I was associated with a higher risk of suicide attempt at Wave III and the availability of school-based treatment during Wave I was not associated with any of the outcomes.

Conclusion and Implications: Because suicidal adolescents are at high risk for depression and suicidality as they enter adulthood, prevention and intervention strategies for this population are crucial. Youth who are publically insured may be at particular risk for later negative outcomes, and may benefit from specific outreach and intervention programs. More research is needed to examine the relationship between routine medical care and long-term outcomes for this population. Additionally, more research on the long-term efficacy of specific types of school-based treatment protocols may be warranted.