Reducing suicide risk in parentally bereaved youth through promoting effective parenting: testing a developmental cascade model

Abstract Children who experience parental death are at increased risk for suicide. The Family Bereavement Program (FBP) is an upstream preventive intervention for parentally bereaved families that was found to reduce suicide risk in parentally bereaved youth up to 6 and 15 years later. We tested whether FBP-induced improvements in effective parenting led to changes in multiple proximal factors that prior theory and research implicated in the cascading pathway to suicide risk, namely, aversive self-views, caregiver connectedness, peer connectedness, complicated grief, depressive symptoms, and emotion suppression. The sample was 244 bereaved youth and their surviving caregiver from 156 families. Families were randomized into the FBP (12 group-based sessions for parents, youth, and two joint sessions) or a literature control condition. Multimethod and multiinformant data were collected at baseline, posttest, 6-year and 15-year follow-up assessments. Results showed that program-induced improvements in effective parenting at posttest were associated with reduced aversive self-views and increased caregiver connectedness at the 6-year follow-up, and each mediator was in turn associated with reduced suicide risk at the 6- and 15-year follow-up. The mediated pathways via aversive self-views remained significant while controlling for caregiver connectedness. Self-related concepts may be important targets in upstream suicide prevention for at-risk youth.

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Reducing suicide risk in parentally bereaved youth through promoting effective parenting: Testing a developmental cascade model.

10.31234/osf.io/4t2dv ◽

2021 ◽

Author(s):

Na Zhang ◽

Irwin Sandler ◽

Jenn-Yun Tein ◽

Sharlene Wolchik

Keyword(s):

Suicide Risk ◽

Preventive Intervention ◽

Emotion Suppression ◽

Effective Parenting ◽

Parentally Bereaved ◽

Increased Risk ◽

Death Of A Parent ◽

The Family ◽

Post Test

Children who experience the death of a parent are at increased risk for suicidality. The Family Bereavement Program (FBP) is a preventive intervention for parentally bereaved families that was found to reduce suicidal thoughts or attempts in parentally bereaved youth up to 6 and 15 years later. In this study, we tested whether FBP-induced improvement in parenting led to changes in multiple factors that prior theory and research implicated in the pathway to suicide risk, namely, aversive self-views, caregiver and peer connectedness, grief, depressive symptoms and emotion suppression. The sample was 244 bereaved youth and their surviving caregiver from 156 families. Families were randomized into the FBP (twelve group-based sessions for parents, youth, and two joint sessions) or literature control condition. Caregivers and youth completed baseline, post-test, 6 years and 15 years follow-up assessments. Results showed that program-induced improved parenting at post-test was associated with reduced aversive self-views and increased caregiver connectedness at 6 years follow-up, and each was in turn associated with reduced suicide risk at 6 and 15 years follow-up. The mediated pathways via aversive self-views remained significant while controlling for the pathways via caregiver connectedness. We discussed the theoretical and clinical implications of the findings.

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The Family Bereavement Program: Description of a Theory-based Prevention Program for Parentally-Bereaved Children and Adolescents

OMEGA - Journal of Death and Dying ◽

10.2190/om.68.4.a ◽

2014 ◽

Vol 68 (4) ◽

pp. 293-314 ◽

Cited By ~ 28

Author(s):

Tim S. Ayers ◽

Sharlene A. Wolchik ◽

Irwin N. Sandler ◽

Joan L. Twohey ◽

Janelle Lutzke Weyer ◽

...

Keyword(s):

Preventive Intervention ◽

Parental Death ◽

Social Adaptation ◽

Concurrent Programs ◽

Empirically Supported ◽

Parentally Bereaved ◽

Bereaved Children ◽

The Family ◽

Program Description ◽

Future Work

This article describes a preventive intervention to promote resilience of parentally bereaved youth. This intervention includes separate but concurrent programs for youth and caregivers that were developed to change empirically-supported risk and protective factors. We first discuss the risk that parental death confers to youth mental health and social adaptation outcomes. Next, we discuss the theoretical framework underlying this program. After describing the content and structure of the program, we describe the results of an experimental field trial and discuss directions for future work.

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Repetition of deliberate self-harm and subsequent suicide risk: Long-term follow-up study of 11 583 patients

The British Journal of Psychiatry ◽

10.1192/bjp.185.1.70 ◽

2004 ◽

Vol 185 (1) ◽

pp. 70-75 ◽

Cited By ~ 264

Author(s):

Daniel Louis Zahl ◽

Keith Hawton

Keyword(s):

Relative Risk ◽

Suicide Risk ◽

Single Episode ◽

Deliberate Self Harm ◽

Young Females ◽

Follow Up Study ◽

Increased Risk ◽

Self Harm

BackgroundRepetition of deliberate self-harm (DSH) is a risk factor for suicide. Little information is available on the risk for specific groups of people who deliberately harm themselves repeatedly.AimsTo investigate the long-term risk of suicide associated with repetition of DSH by gender, age and frequency of repetition.MethodA mortality follow-up study to the year 2000 was conducted on 11583 people who presented to the general hospital in Oxford between 1978 and 1997. Repetition of DSH was determined from reported episodes prior to the index episode and episodes presenting to the same hospital during the follow-up period. Deaths were identified through national registers.ResultsThirty-nine percent of patients repeated the DSH. They were at greater relative risk of suicide than the single-episode DSH group (2.24; 95% CI 1.77–2.84). The relative risk of suicide in the repeated DSH group compared with the single-episode DSH group was greater in females (3.5; 95% C11.3–2.4) than males (1.8; 95% C1 2.3–5.3) and was inversely related to age (up to 54 years). Suicide risk increased further with multiple repeat episodes of DSH in females.ConclusionsRepetition of DSH is associated with an increased risk of suicide in males and females. Repetition may be a better indicator of risk in females, especially young females.

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Psychiatric Diagnoses as Predictors of Suicide

The British Journal of Psychiatry ◽

10.1192/bjp.157.3.339 ◽

1990 ◽

Vol 157 (3) ◽

pp. 339-344 ◽

Cited By ~ 52

Author(s):

Peter Allebeck ◽

Christer Allgulander

Keyword(s):

Patient Care ◽

Psychiatric Diagnosis ◽

Military Service ◽

Suicide Risk ◽

Psychiatric Care ◽

Strong Predictor ◽

Neurotic Disorder ◽

Increased Risk ◽

Almost All

In a cohort of 50 465 Swedish men conscripted for military service in 1969–70, the relative risk for suicide was 3.1 (95% CI 2.3–4.0) among those who had a psychiatric diagnosis at conscription, and 16.7 (95% CI 13.8–20.1) among those who had a psychiatric diagnosis in in-patient care during a 13-year follow-up. Of the diagnoses at conscription, only neurotic disorder, personality disorder and drug dependence were associated with a significantly increased risk for future suicide. Among those who were admitted to hospital, almost all inpatient diagnoses were associated with a significantly increased suicide risk. Although a psychiatric diagnosis in in-patient care was a strong predictor of suicide, only 44% of all 247 men who committed suicide had ever been treated in in-patient psychiatric care.

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Suicidal ideation and subsequent completed suicide in both psychiatric and non-psychiatric populations: a meta-analysis

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796016001049 ◽

2016 ◽

Vol 27 (2) ◽

pp. 186-198 ◽

Cited By ~ 22

Author(s):

A. A. M. Hubers ◽

S. Moaddine ◽

S. H. M. Peersmann ◽

T. Stijnen ◽

E. van Duijn ◽

...

Keyword(s):

Suicidal Ideation ◽

Suicide Risk ◽

Psychiatric Patients ◽

Meta Analysis ◽

First Year ◽

Completed Suicide ◽

Increased Risk ◽

Different Populations ◽

Risk Ratios

Aims.Several authors claimed that expression of suicidal ideation is one of the most important predictors of completed suicide. However, the strength of the association between suicidal ideation and subsequent completed suicide has not been firmly established in different populations. Furthermore, the absolute suicide risk after expression of suicidal ideation is unknown. In this meta-analysis, we examined whether the expression of suicidal ideation predicted subsequent completed suicide in various populations, including both psychiatric and non-psychiatric populations.Methods.A meta-analysis of cohort and case–control studies that assessed suicidal ideation as determinant for completed suicide in adults. Two independent reviewers screened 5726 articles for eligibility and extracted data of the 81 included studies. Pooled risk ratios were estimated in a random effects model stratified for different populations. Meta-regression analysis was used to determine suicide risk during the first year of follow-up.Results.The risk for completed suicide was clearly higher in people who had expressed suicidal ideation compared with people who had not, with substantial variation between the different populations: risk ratio ranging from 2.35 (95% confidence interval (CI) 1.43–3.87) in affective disorder populations to 8.00 (95% CI 5.46–11.7) in non-psychiatric populations. In contrast, the suicide risk after expression of suicidal ideation in the first year of follow-up was higher in psychiatric patients (risk 1.40%, 95% CI 0.74–2.64) than in non-psychiatric participants (risk 0.23%, 95% CI 0.10–0.54). Past suicide attempt-adjusted risk ratios were not pooled due to large underreporting.Conclusions.Assessment of suicidal ideation is of priority in psychiatric patients. Expression of suicidal ideation in psychiatric patients should prompt secondary prevention strategies to reduce their substantial increased risk of suicide.

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Evaluating the efficacy of the Family Check-Up Online: A school-based, eHealth model for the prevention of problem behavior during the middle school years

Development and Psychopathology ◽

10.1017/s0954579419000907 ◽

2019 ◽

Vol 31 (5) ◽

pp. 1873-1886 ◽

Cited By ~ 1

Author(s):

Elizabeth A. Stormshak ◽

John R. Seeley ◽

Allison S. Caruthers ◽

Lucia Cardenas ◽

Kevin J. Moore ◽

...

Keyword(s):

Middle School ◽

Self Efficacy ◽

Preventive Intervention ◽

Self Regulation ◽

High Rate ◽

At Risk Youth ◽

Minimal Risk ◽

The Family ◽

Online Format ◽

Family Centered

AbstractThis study evaluated the efficacy of a family-centered preventive intervention, the Family Check-Up (FCU), delivered as an online, eHealth model to middle school families. To increase accessibility of family-centered prevention in schools, we adapted the evidence-based FCU to an online format, with the goal of providing a model of service delivery that is feasible, given limited staffing and resources in many schools. Building on prior research, we randomly assigned participants to waitlist control (n = 105), FCU Online as a web-based intervention (n = 109), and FCU Online with coaching support (n = 108). We tested the effects of the intervention on multiple outcomes, including parental self-efficacy, child self-regulation, and child behavior, in this registered clinical trial (NCT03060291). Families engaged in the intervention at a high rate (72% completed the FCU assessment) and completed 3-month posttest assessments with good retention (94% retained). Random assignment to the FCU Online with coaching support was associated with reduced emotional problems for children (p = .003, d = −0.32) and improved parental confidence and self-efficacy (p = .018, d = 0.25) when compared with waitlist controls. Risk moderated effects: at-risk youth showed stronger effects than did those with minimal risk. The results have implications for online delivery of family-centered interventions in schools.

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Six-Year Follow-up of a Preventive Intervention for Parentally Bereaved Youths

Archives of Pediatrics and Adolescent Medicine ◽

10.1001/archpediatrics.2010.173 ◽

2010 ◽

Vol 164 (10) ◽

Cited By ~ 34

Author(s):

Irwin Sandler ◽

Tim S. Ayers ◽

Jenn-Yun Tein ◽

Sharlene Wolchik ◽

Roger Millsap ◽

...

Keyword(s):

Preventive Intervention ◽

Parentally Bereaved

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Suicide as an outcome for mental disorders

The British Journal of Psychiatry ◽

10.1192/bjp.170.3.205 ◽

1997 ◽

Vol 170 (3) ◽

pp. 205-228 ◽

Cited By ~ 1585

Author(s):

E. Clare Harris ◽

Brian Barraclough

Keyword(s):

Mental Disorders ◽

Suicide Risk ◽

English Language ◽

Common Mental Disorders ◽

Meta Analysis ◽

Strong Association ◽

Search Terms ◽

Increased Risk ◽

Mortality Ratio

BackgroundMental disorders have a strong association with suicide. This meta-analysis, or statistical overview, of the literature gives an estimate of the suicide risk of the common mental disorders.MethodWe searched the medical literature to find reports on the mortality of mental disorders. English language reports were located on MEDLINE (1966–1993) with the search terms mental disorders', ‘brain injury’, ‘eating disorders’, ‘epilepsy’, ‘suicide attempt’, ‘psychosurgery’, with ‘mortality’ and ‘follow-up studies’, and from the reference lists of these reports. We abstracted 249 reports with two years or more follow-up and less than 10% loss of subjects, and compared observed numbers of suicides with those expected. A standardised mortality ratio (SMR) was calculated for each disorder.ResultsOf 44 disorders considered, 36 have a significantly raised SMR for suicide, five have a raised SMR which fails to reach significance, one SMR is not raised and for two entries the SMR could not be calculated.ConclusionsIf these results can be generalised then virtually all mental disorders have an increased risk of suicide excepting mental retardation and dementia. The suicide risk is highest for functional and lowest for organic disorders with substance misuse disorders lying between. However, within these broad groupings the suicide risk varies widely.

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