Certain mental health risk factors can increase risk for suicide. During times of transition, such as when an adolescent shifts into emerging adulthood, risk factors for suicide such as depression, delinquency, impulsivity, and alcohol problems may relate to suicide risk. Teens who have some of these behaviors in early adolescence may not have them later. Most youth don’t show these risk factors.
Understanding the different ways that suicidal ideation and behavior may emerge over time can help with the identification and treatment of youth and young adults at risk for suicidal behavior. Yet very little evidence exists regarding how changes in risk factors over time relate to suicidal behavior.
Does risk for suicidal ideation and attempts change from childhood through young adulthood? In other words, if a youth is at risk for suicidal ideation at age 14, will they still be at risk when they are 25?
Dr. Thompson’s study examined the relationship between suicide risk factors and suicidal ideation and attempts. To do so, she used data collected via the National Longitudinal Study of Adolescent Health, a survey which over the course of 13 years collected in-home self-assessments from adolescents that took into account race and gender, and measured factors such as suicidal behavior, depressive symptoms, impulsivity, alcohol problems, partner abuse, and history of suicidal behavior among family and friends.
The survey was conducted at four different time points, referred to as waves, with 80 percent of participants completing all four waves of data collection. Wave 1 was conducted in 1995, when the participants were between the ages of 12-17 (7th-12th graders.). Wave 2 was completed one year later. The third wave was conducted five years later. The fourth and final wave, conducted 13 years after the first, took place when the participants were between 25-32 years of age. Dr. Thompson included in her analysis the 9,027 respondents who had completed all four waves of the surveys.
Three different groups of youth were identified from the data set in regard to suicidal ideation and behavior: “low risk, “adolescent limited risk,” and “persistently high.” The study then examined, over time, three different types of trajectories for these participants.
Approximately 94 percent of individuals had a very low risk for suicide attempt across all time points. This group was considered the “low risk” trajectory group.
Higher levels of depression, delinquency, impulsivity, alcohol problems, history of partner abuse and having a friend or family member die by suicide represented approximately five percent of the youth. This was the “adolescent limited risk” group. These participants reported a higher risk for suicide attempts, but only during adolescence. They did not show risk during early adulthood.
As young adults, the “adolescent limited risk” group had a higher level of depressive symptoms and partner abuse than their “lower risk” peers. They also, interestingly, had fewer alcohol problems compared to the “low risk” group. The higher likelihood for suicide attempt in adolescence was not present later, when they entered young adulthood; risk factors seemed to decrease with maturation.
In contrast, the roughly one percent of participants categorized as “persistently high” risk for suicide showed a consistently increased likelihood of attempting suicide. In comparison to their “adolescent limited” peers, the “persistently high risk” youth (which displayed lower levels of alcohol and depressive symptoms during adolescence) showed an increase for alcohol use and depression as they entered young adulthood.
Throughout the study, the “persistently high risk” group had higher levels of alcohol problems, delinquency, depression and impulsivity, and were at higher risk for suicide attempts than those in the “low risk trajectory” group.
Not all individuals who have suicidal ideation and behavior as adolescents will continue to experience this during young adulthood. Risk factors and suicide risk can decline over time and with maturation.
It is important to consider developmental stage when evaluating risk for suicidal behavior and deciding how to intervene.
There is a very small group who are at higher risk for suicide attempt as they transition from adolescence into emerging adulthood. To identify a youth or young adult at increased risk for suicide, keep an eye out for increasing depression, delinquency, and alcohol problems.
Thompson, M.P. & Swartout, K. (2017). Epidemiology of suicide attempts among youth transitioning to adulthood. Journal of Youth and Adolescence. https://doi.org/10.1007/s10964- 017-0674-8
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