Have We Been Looking in the Wrong Direction? the Effect of Suicidal Crises on Future Social Connectedness Among Child-Welfare-Engaged Youth

Background/Purpose: Suicide is a major public health problem among youth involved with the child welfare system. Social connectedness rests at the core of many suicide prevention approaches. However, research has almost exclusively focused on how social connectedness affects future suicidal crises and all but ignored the impact of suicidal crises on subsequent perceptions of social connectedness. This is highly concerning given the pervasive stigmatization of people who experience suicidal crises and the stress placed on social networks in the aftermath of such crises—both of which can seriously compromise connectedness. This oversight is especially worrisome for child-welfare-involved youth who already face immense challenges to social stability and fear social alienation due to their child welfare status. Although our study tested traditional assumptions that social connectedness predicts later suicide risk, our main study hypotheses were that the presence of suicidal ideation at baseline would predict lower perceptions of connectedness in three social domains (i.e., caregiver, peers, and school) 18 months later.

Methods: The current study used baseline and 18-month follow-up data from 995 youth who participated in the National Survey of Child and Adolescent Well-Being (NSCAW II)—a nationally representative study of children and families investigated by a child welfare agency conducted from 2008 to 2011. A cross-lagged path model was used for the analysis of the relationships between suicidal ideation and social connectedness over time. A multi-group path analysis was also conducted to examine whether gender moderated the main effects from Time 1 to Time 2 variables. A wide range of sociodemographic and mental health variables (e.g., PTSD; depression; substance use) were controlled for in the analysis.

Results: Consistent with our hypotheses, the path analysis found significant main effects of suicidal ideation at Time 1 on peer connectedness (β= -.17, p<.01) and caregiver connectedness (β= -.12, p<.05) at Time 2. There was no main effect of suicidal ideation at Time 1 on school connectedness at Time 2 (β= -.05, ns). Contrary to traditional assumptions, there was no main effect of any of the connectedness variables at Time 1 on suicidal ideation at Time 2. The multi-group path analyses did not reveal any moderating effect of gender on the relationships between suicidal ideation and connectedness variables.

Conclusions/Implications: Screening child-welfare-engaged youth for suicidal ideation is important for managing immediate risk but our findings suggest that such ideation also foreshadows disconnectedness from their primary caregiver and peers in the future. Child welfare practitioners (like all clinical practitioners) who work with suicidal youth are naturally most concerned about preventing suicidal behavior but our results point to the relevance of conducting assessments and designing pilot programming that targets caregiver and peer connectedness in the aftermath of suicidal crises. For example, there are a great many stigma-reduction approaches that can be adapted to the child welfare context to target suicide-related stigma. The value in doing so lies beyond suicide prevention and extends to the robust body of evidence showing that social connectedness rivals other social determinants in impacting future health and premature mortality.