Does It Make a Difference Where You Get It? Social Support and Suicide Attempts Among Youth Experiencing Homelessness

Background/ Purpose:Youth experiencing homelessness (YEH) are at elevated risk for suicide. Social support is central to many suicide prevention strategies but the extent to which it confers protection for YEH is largely unknown. This is a critical oversight because YEH are embedded in complex social networks where they may be forced to rely on people who engage in behaviors that can undermine the protective effects of their social support (e.g., abusive parents). The present study examined the impact of social support from three different sources (family, home-based peers, and street-based peers) on suicide attempt. In doing so, this study sought to determine the utility of prevention programming that seeks to enhance support across relationships as well as within certain relationships among YEH.

Methods:Data were collected from 1046 YEH at three drop-in centers that serve YEH. Participants completed a survey about their individual characteristics (i.e., suicide attempt in last year) and a social network interview about their relationships (i.e., type of relationship with each person in their network and whether each person provided them with emotional support). Multivariable logistic regression was used to examine the main effect of social support from family, street-based peers, and home-based peers on suicide attempt. Two-step hierarchical regression models were then used to test whether social support from each source moderated the relationship between well-established risk factors (i.e., depression, trauma, substance use) and suicide attempt. 

Results:Overall, 11.5% of YEH had attempted suicide in the past year. The main effect analysis revealed a significant negative association between home-based friend support and suicide attempt (OR: 0.83, 95% CI [0.72, 0.96]). Interaction analyses revealed that home-based friend support moderated the relationship between depression and suicide attempt (OR: 1.01, 95% CI [1.01, 1.03]) and street-based support moderated the relationship between trauma and suicide attempt (OR=1.08, 95% CI [1.02-1.15]). No main effect or moderation effects were observed for family support.

Conclusion/Implications: Social support is often promoted as a universal protective factor but we found that support from different people had different effects on suicide attempt risk among YEH. YEH who receive social support from home-based peers were observed to be at lower risk for suicide attempt, implying that suicide prevention efforts should seek to strengthen and funnel support delivery through those relationships. This may be particularly true for YEH experiencing higher levels of depression. Finding that support from street-based peers amplifies risk among YEH who experience higher levels of trauma suggests that seeking support from certain people may be discouraged under certain circumstances. Notably, family support was not shown to be associated with suicide risk. For many YEH, family members may be a source of conflict, abuse, and neglect that precipitates homelessness, thus nullifying the positive aspects of familial support. Overall, our pattern of results may help to guide more efficient support-based suicide prevention programming for YEH.