Cognitive and Contextual Factors in Suicide Ideation Persistence in Adolescents

Cognitive and Contextual Factors in Suicide Ideation Persistence in Adolescents. Deaths from suicide continue
to be a major public health concern, particularly among youth for whom suicide ranks as the second leading
cause of death. Recent suicide ideation is reported by almost 20% of high school students, and the majority of
those report persistent ideation of more than one year. If the factors that associate with persistent and remitting
suicide ideation can be identified, then resources can be directed to those most at risk, with a likely impact on
rates of suicide. Depression, hopelessness, and psychiatric diagnoses have been studied as risk factors for
over 50 years, yet they are neither sufficient, nor effective, for understanding suicide risk. It is important to
evaluate cognitive and contextual factors for suicide ideation, which are understudied, particularly for rural
youth. Cognitive factors that may relate to suicide ideation are defeat, entrapment, grit, and self-efficacy.
Contextual factors with potential to make an impact on suicide ideation are socio-economic status, access to
lethal means, social support, food and housing security, and access to health care. The proposed study aims
to fill these knowledge gaps through a 12-month longitudinal study of 225 non-clinical, rural adolescents
between the ages of 14 and 18 who report a history of suicide ideation. The current study proposes that
cognitive and contextual factors will differentiate adolescents with and without suicide ideation history in the
baseline sample. It is further expected that the cognitive factors defeat and entrapment will associate with
persisting suicide ideation, and self-efficacy and grit will associate with remitting suicide ideation at follow-ups.
Lastly, it is expected that contextual factors will associate with persisting (low SES and access to lethal means)
vs. remitting (social support, food and housing security, access to health care) suicide ideation at follow-ups.
Adolescents in 9th-11th grades will be recruited to complete a research protocol of self-report and behavioral
measures at their home schools at baseline (n=700); adolescents with suicide ideation history (est. n=225) will
be recruited into follow-up assessments at 6- and 12-months post baseline. Teacher reports for the 225
adolescents with suicide ideation history will also be collected. Binominal linear regression will be used to
examine which factors differentiate adolescents with and without suicide ideation history at baseline. To test
hypotheses about cognitive and contextual factors associating with suicide ideation persistence and
remittance, change groups will be scored (persistent and remitting ideation across time points). Repeated
measures ANOVA will be conducted to test group by time interactions to determine if adolescents with
persistent ideation show differential change in cognitive and contextual factors compared to adolescents with
remitting ideation. The findings will inform youth suicide research, which will significantly impact upstream
prevention and early intervention by identifying new factors that increase, protect, and moderate risk.

Grant Number: 2R15MH113045-02
NIH Institute/Center: NIH
Principal Investigator: Amy Brausch