A recent doctoral dissertation has shed light on the significant connection between adverse childhood experiences (ACEs) and suicidality in adolescents. The study reveals that adolescents who have faced abuse, neglect, or other traumatic events during childhood are more likely to experience suicidal thoughts and behaviors. Notably, girls were found to be at a higher risk for suicidal events during treatment. The research also highlights a concerning gap in suicidality risk screenings, which failed to predict a significant number of suicidal events.
Adolescent suicide remains a critical public health issue in the United States, with extensive research conducted on the general adolescent population’s suicidal behaviors. However, less attention has been given to those who are particularly at risk—those exposed to ACEs. ACEs, which include domestic violence, physical, sexual, or emotional abuse, neglect, and a chaotic home environment, are linked to an increased likelihood of suicidality in adolescents.
The study employed both quantitative and qualitative research methods to explore the factors that contribute to suicidality and suicidal events among adolescents in community-based behavioral and mental health services across the U.S. Additionally, it examined how the therapeutic relationship between at-risk adolescents and their therapists influences outcomes and looked at the role of social media platforms in suicide risk detection.
The findings of the dissertation revealed that thoughts of suicide and suicide attempts among at-risk adolescents were significantly higher—double and triple, respectively—than those in the general adolescent population. Sexual abuse, in particular, emerged as a strong predictor of suicidality.
The research also noted that, on average, a suicidal event occurred approximately six months after an adolescent had been screened for suicidality at intake. Adolescents who screened negative for suicidality risk at intake took longer to experience a suicidal event, but almost half of those who eventually experienced suicidality had initially screened negative.
Celedonia, the researcher behind the study, suggested that this might be due to the lack of a fully developed therapeutic relationship at the time of intake, making it difficult for adolescents to openly disclose their suicidal thoughts or history. “This could potentially be explained by the therapeutic alliance between adolescents and their therapists not being fully formed at intake, and therefore adolescents may not have felt comfortable disclosing a history of suicidal thoughts and behaviors,” Celedonia explained.
The study also identified five key qualities that therapists found most important in creating a strong therapeutic alliance with at-risk adolescents. These included an ecosystemic approach, a strong working alliance, professionalism, warmth and support, and open communication. Among these, warmth and support were considered the most crucial qualities in fostering a productive therapeutic relationship.
The dissertation also analyzed the use of suicide risk detection systems embedded in social media platforms. The study raised important legal, ethical, and cultural concerns, particularly regarding the violation of privacy laws such as the General Data Protection Regulation (GDPR) in Europe and the Health Insurance Portability and Accountability Act (HIPAA) in the U.S. Moreover, it pointed out the stigma surrounding mental health, especially in low- and middle-income countries, which could affect the effectiveness of these systems.
The findings of this research underscore the need for more effective methods to detect and treat suicidality among at-risk adolescents. Celedonia suggested that routine suicidality risk screenings should be conducted post-intake, regardless of initial screening results, to better identify those at risk. Furthermore, treatment strategies should prioritize suicidality as the primary focus to reduce symptoms and prevent suicide.
“Given the high prevalence of suicidality among at-risk adolescents, using treatment approaches that specifically target suicidality as the main target of treatment may prove more effective at reducing suicidality symptoms, thereby preventing death by suicide,” said Celedonia.
Broader implications of the research include the need for greater focus on the prevention of sexual abuse among children and adolescents, as well as the provision of increased mental health resources for female adolescents.
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