Preventing Suicide Attempts in Diverse Groups of Adolescents: A System Dynamics Approach

Background and Purpose: Though the reduction of suicide-related deaths have been a national priority for over a decade (U.S. Department of Health and Human Services, 2001) and over $22 million dollars per year (National Institutes of Health, 2015) have been invested in the prevention of suicide, rates of suicide have not declined (CDC, 2012). In fact, these rates have increased for adolescents (Wasserman, Cheng, & Jiang, 2005), especially for those from various racial minority groups (Range et al., 1999). This study uses computer simulation modeling to expand current social work research on suicide during adolescence for racial minority groups and answers the following research questions:

1. Is the interpersonal theory of suicide adequate in predicting suicide attempts for adolescents across development?

2. How do suicide attempts differ for adolescents from various racial and ethnic backgrounds?

Methods: Joiner’s (2005) interpersonal theory of suicide (IPTS) and a cultural model of suicide (Chu, Goldblum, Floyd, & Bongar, 2010) were used to build a system dynamics model of suicidality for adolescents who identified as either Latino, Black, White, Asian, or Native American. Race was used as a proxy for the experiences and/or values that may be held by various racial groups, rather than an indicator of biological difference. Weighted data from four waves of the National Longitudinal Survey of Adolescent to Adult Health (Add Health) (N=~9,500) informed the suicidal behaviors adolescents from the age of 12 into their 30s. System dynamics models were formulated to mathematically simulate a model of suicide based in IPTS. Modifications to the theory are made and tested for accuracy in predicting suicide attempts using the Theil Inequality Statistic.

Findings: The system dynamics model of the interpersonal theory of suicide was not adequate in predicting suicide attempts for both the general population and by racial subgroups. However, a modified version of the model, the developmental systems model of the interpersonal theory of suicide, was sensitive and helpful in predicting suicide attempts across early adolescence and into young adulthood. Using this model to simulate policies on suicide attempts indicate that shortening the duration of depression by improving access to treatment was more effective at reducing suicide attempts across adolescence than simply restricting one’s capability to die by suicide.

Conclusion and Implications: There are two major findings from this study. First, the most utilized theory of suicide, Joiner’s (2005) Interpersonal Theory of Suicide, was not adequate in predicting a developmental trajectory of suicide attempts from early adolescence (age 12) to early adulthood (age 30). The model, however, when modified with the plausible balancing feedback loops that occur after an attempt (e.g., counseling or intervention), could generally reproduce trends in suicide attempts for the general population. When tested for applicability to racial subgroups (e.g., Latino, White, Black, Asian, and Native American), the developmental model of IPTS did not accurately predict trends in suicide attempts. This study suggests there are processes, values, and/or experiences in suicidality that may differ for adolescents from various racial groups. Disentangling these differences is necessary for future research and prevention.