Examining Adolescent Suicide Related Behaviors and Belonging: Empirical Evidence from the 2017 Youth Risk Behavior Survey

Background: Suicidal behaviors including suicidal thoughts and attempts continue to negatively impact the adolescent population. According to the Centers for Disease Control and Prevention, in 2017 suicide was the second leading cause of death for high school aged students (14-18) with suicide resulting in 2,052 deaths. School districts serve as a backdrop to implement suicide prevention education, identification, and interventions targeted to those at risk for suicide related behaviors. While school districts throughout the United States are implementing youth suicide awareness and prevention policies, little is known regarding the use of suicide theory in youth suicide awareness/prevention. The interpersonal theory of suicide proposes that the constructs of belonging and burdensomeness impact suicidal thoughts and the construct of capability is involved in the progression from suicidal desire to suicidal behavior. Utilizing one construct of the interpersonal theory of suicide, this study examines the association between belonging and suicide related behaviors in high school students in the United States.

Methods: The Youth Risk Behavior Survey is a nationally representative data set utilizing a multi-stage cluster sample design completed by high school students in the United States every two years beginning in 1991. This study utilized 2017 Youth Risk Behavior Survey data completed by 14,765 high school students in the United States. Suicide related behavior variables including suicidal ideation (1=Yes/0=No), suicide planning (1=Yes/0=No), and suicide attempts (1=Yes/0=No and number of suicide attempts) are the dependent variables while belonging, measured by sports team participation (1=Yes/0=No and number of sport teams), is the major independent variable. The control variables include grade in school, gender, ethnicity, and sexual orientation. Regression analyses are applied to use youths’ sports team participation to predict suicide related behaviors adjusting for socio-demographic characteristics. 

Results: In 2017, 18% of high school respondents reported seriously considering suicide, 14% made a suicide plan, 8% attempted suicide, and 4% attempted suicide more than one time in the past 12 months. 53% of respondents participated in sports teams in the past 12 months and 28% participated in more than one sports team. Regression results demonstrate that high school students who had participated in at least one sports team experienced less suicide behaviors (ideation, planning, and attempts). Specifically, the odds of experiencing suicidal thoughts and suicide planning for high school students with sports team participation are 25% less than the odds of their non-sport participating counterparts (aOR 0.75, 95% CI 0.67-0.84; p < 0.001). In addition, adolescents with sports team involvement experienced 3% less suicide attempts than their non-sport participating counterparts (p < 0.01).

Implications: The findings suggest that increased levels of belonging, indicated by sport team participation, are associated with decreased levels of suicide behaviors, supporting the interpersonal theory of suicide. Adolescent belonging should be considered when developing effective adolescent suicide awareness/prevention policies including identification of at-risk youth, providing interventions and clinical assessments to at-risk youth, and in providing prevention education to students/faculty/staff in the secondary education setting. Future studies measuring the construct of belonging with additional variables could serve to support and strengthen study results.