1. Clinical interviews of adolescents and their parents revealed that half of parents were unaware of their adolescents’ lifetime thoughts of suicide.
2. Older adolescent age, Hispanic ethnicity, adolescents’ history of psychiatric treatment, and family history of suicide were associated with decreased odds of parental unawareness; fathers were more likely than mothers to be unaware of adolescents’ thoughts of suicide.
Evidence Rating Level: 3 (Average)
Study Rundown: Parents and other caregivers are important sources of collateral information when identifying adolescents at risk for suicide and in need of mental health services. Previous research suggests that parents are often unaware of adolescents’ suicidal thoughts, but these studies were conducted in small, high-risk samples, and little is known about demographic or clinical characteristics associated with parental awareness. In this cross-sectional study, researchers conducted computerized, structured clinical interviews of adolescents and their parents to compare their reports of adolescents’ lifetime suicidal thoughts. Half of parents whose adolescents endorsed lifetime thoughts of suicide were unaware of these thoughts. Adolescents denied thoughts of suicide approximately half of the time when their parents reported that their adolescents had these thoughts. Older adolescent age, Hispanic ethnicity, adolescents’ history of psychiatric treatment, and family history of suicide were associated with decreased odds of parental unawareness. Fathers were more likely than mothers to be unaware of adolescents’ thoughts of suicide.
These findings are limited by their geographically limited sample. Furthermore, researchers did not assess current suicidal thoughts, plans, or attempts, which may be more informative than lifetime suicidal thoughts. Nonetheless, the study is strengthened by its large, ethnically diverse sample and collection of extensive sociodemographic information. For physicians, these findings highlight the importance of working with parents, especially those with demographic and clinical characteristics that may predispose to unawareness, in order to better assess for suicide risk and recognize warning signs in adolescents.
Study author, Jason D. Jones, PhD, speaks to 2 Minute Medicine: Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania.
“We identified substantial discrepancies between parent and adolescent reports of adolescents’ suicidal thoughts – stemming from both parental unawareness and adolescents’ denial of suicidal thoughts. With depression and suicide screening becoming more common in pediatric health care, it is important for physicians and clinicians to be aware of these discrepancies.”
In-Depth [cross-sectional study]: Researchers conducted computerized, structured clinical interviews of 5137 adolescents aged 11 to 17 years and collateral informants (usually parent or stepparent) recruited in a large pediatric health care network as part of the Philadelphia Neurodevelopmental Cohort. The study collected and compared adolescent and parent reports of adolescents’ lifetime suicidal thoughts and sociodemographic information, including family history of suicide, trauma exposure, and mental health treatment history. Adolescents were excluded if they were not proficient in English, had significant developmental delays, or had other physical or cognitive conditions that interfered with study participation.
Among parents of the 8.1% of adolescents who endorsed lifetime thoughts of killing self, 49.9% were unaware (κ = 0.466). 75.6% of parents were unaware of their adolescents’ recurrent thoughts of death or dying (κ = 0.171). Adolescents denied thoughts of suicide in 48.4% of cases and thoughts of death in 67.5% of cases in which parents reported that their child had these thoughts. Older adolescent age was associated with better agreement between adolescents and parents on thoughts of death or dying (odds ratio [OR]: 0.76; 95% confidence interval [CI]: 0.59-0.99), as was Hispanic ethnicity (OR: 0.48; 95% CI: 0.24-0.95). Fathers were more likely to be unaware of adolescents’ thoughts of killing themselves than mothers. Adolescents’ history of psychiatric treatment and family history of suicide were associated with decreased odds of parental unawareness.
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