Suicide Report Concordance Among Adolescents and Parents: Implications for Screening and Practice

Background and Purpose: In the U.S., approximately 18% of adolescents report seriously considering suicide within the previous year, 15% report having made a plan, and 9% report making an attempt. Current prevention and treatment programs rely heavily on youth suicide risk screening in order to address suicide in this population, and the majority of these screening protocols rely solely on youth self-report to assess suicidality. It may be beneficial to utilize parents as additional informants in suicide risk screening protocols, as parents of adolescents with externalizing symptomatology have been found to be more likely to report suicidality than their children. The aims of this study were to 1.) compare parent-adolescent suicide report concordance among adolescents with internalizing versus externalizing symptomatology and 2.) examine whether internalizing and externalizing adolescents were more or less likely than their parents to report suicidality.  

Methods: A secondary analysis was completed using data from a clinical subsample of adolescents (n = 64) recruited for a separate study. Adolescents were classified as having “externalizing” or “internalizing” symptomatology based on their t-scores on the internalizing and externalizing subscales of the Child Behavior Checklist (CBCL). To measure suicide report concordance, an item from the CBCL asking parents about their child’s suicidal talk was compared to an item from the Children’s Depression Inventory (CDI-2) asking adolescents about their suicidal thoughts. A one-sided z-test for proportions was used to compare parent-adolescent suicide report concordance. Two-sided z-tests for proportions were used to compare the proportions of adolescents and parents reporting suicidal ideation for discordant pairs in each subset.

Results: No statistically significant differences were found between reports of suicidality among the internalizing and externalizing subsets of adolescents, nor were adolescents more likely than parents to report suicidal thoughts. There were higher rates of suicide report concordance among adolescents in the externalizing subset (73.0%) compared to the internalizing subset (59.3%), but this difference was not statistically significant. Among the discordant pairs in the subset of externalizing adolescents, more parents reported suicidality (60%) than adolescents (40%), but this difference was also not statistically significant. Among the discordant pairs of the subset of internalizing adolescents, significantly more adolescents (72.7%) reported suicidal thoughts than parents (26.3%; p < .05).

Conclusions and Implications: These findings support other research showing that parents of internalizing youth are often unaware that their children are experiencing suicidal thoughts. While the results regarding externalizing adolescents were not statistically significant, they were in the hypothesized directions, with higher proportions of parents reporting suicidality than adolescents. Because of the small sample, there may have been limited power to detect results. Therefore, replication of these findings with a larger sample may be warranted.  While these findings did not provide direct support for the inclusion of parents in suicide risk screening protocols, they do support the importance of educating parents about how to recognize and inquire about suicidal ideation among youth with primarily internalizing symptomatology. Future adolescent suicide prevention and treatment efforts should be cognizant of the importance of including parents in their protocols.