Pathways to Suicide Attempts Among High Schoolers: Findings from a Population-Based Study

Background and Purpose:

Suicide is the second leading cause of death in the U.S. for adolescents ages 14 to 18. Years of data from the Youth Risk Behavior Surveillance (YRBS) indicate high rates of suicidal consideration for this age group. Since not all who consider suicide will attempt suicide, despite decades of research, predicting the transition from suicidal consideration to suicidal action continues to elude. Guided by the Interpersonal Theory of Suicide, this study examined 18 risk factors associated with suicide consideration, planning, and attempts. Also, this study examined the path of suicide consideration to attempts via planning among high-school-aged adolescents.

Methods:

Data were drawn from the YRBS year 2019. The YRBS is a cross-sectional, school-based national survey conducted by the Centers for Disease Control and Prevention every two years to examine health-risk behaviors contributing to the leading causes of death and disability among U.S. adolescents. The study sample (n= 13,677) comprised high school students between 9^th and 12^th grades, majority White (50.37%) and female (50.9%). Multiple imputations chained equations were used for missing data (MICE). A path analysis was conducted in Mplus version 8.

Results:

Among study participants, 19.6% considered suicide, 16% planned suicide, and 10.1% attempted suicide more than once. Regarding risk factors, adolescents reported that 9.34% skipped school due to safety, 11.32% experienced forced sexual intercourse, 13.3% carried weapons, 22% engaged in fighting, and 36.7% experienced hopelessness. Path analysis showed that (a) risk factors had unique associations with suicide consideration, planning, and attempts, (b) suicide consideration (b = 0.337, p=.021) and suicide planning (b = 0.477, p=.025) had a direct association with suicide attempts, and (c) suicide planning had an indirect association between consideration and attempts (b = 0.244, p=.014). The goodness-of-fit test showed that the model fits data well (CFI=1.00, RMSEA<.001, and SRMR<.001).

Conclusion and Implications:

Study results emphasize that risk factors associated with suicide-risk behaviors among this adolescent population are heterogeneous and should not be addressed with “one size fits all” strategies. In addition, research findings provide empirical support for the mediating role of suicide planning on the association between suicide consideration and attempts in a national high school sample. Findings raise awareness of important pathways that may be distinct to this population and are key to accurate assessment, screening, and identification of risk factors in preventing suicidal behaviors among adolescents.