Half of Parents Unaware of Teen's Suicidal Thoughts

Troy Brown, RN

January 14, 2019

Half of parents are unaware that their adolescent has thought about committing suicide, and three fourths of parents are unaware that their child thinks about death frequently, new survey data show. Further, adolescents often deny thoughts of suicide when parents do ask about it.

"Given the high prevalence of parental unawareness and adolescent denial of suicidal thoughts found in this study, it is possible that a large number of adolescents with suicide risk may not be detected by brief screens at routine check-ups," the researchers write.

"This highlights the urgent need for continued training of pediatric primary care physicians in the evaluation and management of suicidal ideation and the importance of collecting information from multiple informants and rectifying discrepant reports." 

Jason D. Jones, PhD, from the Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Pennsylvania, and colleagues published their findings online today in Pediatrics.

The study included 5137 adolescents ages 11 to 17 years (52.1% girls; 43% racial minority) and a parent or guardian (97.2% of whom were a parent or stepparent) from the Philadelphia Neurodevelopmental Cohort (PNC). Parents and adolescents completed a clinical interview that included questions about whether the adolescent had ever had suicidal thoughts and whether he or she thought about death frequently.

"Importantly, participants were not recruited from mental health treatment programs; thus, the PNC is a community-based sample not enriched for individuals seeking psychiatric help," the researchers write.

Agreement between adolescent and adult reports was moderate for thoughts of suicide (κ = 0.466) and low for thoughts of death or dying (κ = 0.171). Discrepancies resulted both from parents being unaware of adolescents' suicidal thoughts and adolescents denying suicidal ideation reported by parents.

Half (49.9%) of parents were unaware of adolescents' suicidal thoughts, while three fourths (75.6%) of parents did not know their child had recurrent thoughts of death. Among those whose parents gave "yes" answers, 48.4% of adolescents denied thinking about committing suicide and 67.5% of adolescents denied thinking about death.

"Parental awareness of symptoms that adolescents may deny is a noteworthy finding of this study. Including parents and other sources of information in assessments may help capture a larger percentage of adolescents who are at risk," Khyati Brahmbhatt, MD,  and Jacqueline Grupp-Phelan, MD, from University of California San Francisco Benioff Children’s Hospitals, write in an accompanying commentary.

They say further research about factors that lead adolescents to deny suicidal ideation and their association with the risk for attempted suicide may improve screening and interventions.

The odds of parental unawareness and adolescent denial were lower among older adolescents, possibly indicating that younger adolescents may be less likely to receive services. It may also reflect a lower ability of younger adolescents to interpret questions about suicidal ideation and death, which could influence reporter concordance.

The commentators write "that as many as 40% of adolescents who think about suicide act on these thoughts." For this reason, methods to identify those at highest risk for suicide need to have higher specificity than they currently offer. Brahmbhatt and Grupp-Phelan agree with the researchers about the need for multi-informant assessments and careful exploration of disagreements.  

"Interventions that are aimed more broadly at everyone with suicidal ideation and/or underlying risk factors (eg, depression) may not suffice in moving the needle on completed suicides," Brahmbhatt and Grupp-Phelan explain.

One author serves on the scientific board and reports stock ownership in Taliaz Health, unrelated to this work. The remaining authors and commentators have disclosed no relevant financial relationships.

Pediatrics. Published online January 14, 2019. Abstract, Editorial

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