Family Support and Mental Health Service Use Among Suicidal Adolescents

Background and Purpose: While multiple evidence-based treatments have been shown to ameliorate suicidal ideation and behaviors among adolescents, fewer than 30% of suicidal youth report having contact with a mental health provider within the past year. While family members often serve as informal supports for youth and can help connect them with services, suicidal youth are also more likely to experience neglect, abuse, and dysfunction within their families. This study investigated whether levels of perceived family support were related to the likelihood that suicidal adolescents would utilize mental health services and, secondly, whether this relationship was mediated by symptom severity. It was hypothesized that, if higher levels of parental support were related to a lower likelihood of mental health service use, that this relationship would be mediated by the severity of symptoms reported.

Methods: Using a prospective design, bivariate and mediational analyses were conducted using data from the first two waves of data from the National Longitudinal Study of Adolescent Health. Two different models were tested using two different proxies for symptom severity at Wave I: scores on the Center for Epidemiological Studies Depression Scale (CES-D) and whether or not a suicide attempt was reported. The relationship between scores on the parental connection subscale at Wave I, each measure of symptom severity at Wave I, and mental health service use (“receipt of emotional or psychological counseling”) at Wave II were tested. The sample included only those respondents who reported “seriously considering suicide” during the first year of data collection.

Results: 30.6% of the sample reported a suicide attempt during Wave I and 78.3% reported no mental health service use at Wave II. Higher parental connection scores were consistently associated with a lower likelihood of mental health service use. Having attempted suicide and higher CES-D scores were associated with a higher likelihood of mental health service use. In Model 1, there was strong evidence that the presence of a suicide attempt mediated the relationship between parental connection and mental health service use. For Model 2, however, once CES-D scores and parental connection were concurrently entered into the model, parental connection scores became non-significant. Additional tests showed that depression did not mediate the relationship between parental connection and mental health service use.

Conclusion and Implications: Despite the fact that suicidal adolescents are at high risk for suicide attempts, few of them have contact with mental health providers. Parental support appears to be highly protective, at least for suicide attempts. The continued development of family-based interventions for this population would be extremely beneficial.  Additionally, different types of symptomatology (depression versus suicidal behavior) appear to have different relationships to both parental connection and mental health service use. Future research should continue to investigate the relationships between different types of symptomatology, family dynamics, and mental health service use in this population.