Assessing African American Adolescents' Risk for Suicide Attempts: Attachment Theory
Lyon, Maureen E., Benoit, Marilyn, O'Donnell, Regina M., Getson, Pamela R., Silber, Tomas, Walsh, Thomas, Adolescence
The threat of separation from a parent theoretically increases the risk of adolescent suicide attempts. The present study evaluated this and other hypothesized risk factors in a sample of adolescent suicide attempters and nonsuicidal controls, using the Psychiatric Consultation Checklist (Lyon, 1987). Stepwise logistic regression was used to predict group membership. It was found that threat of separation from a parental figure, insomnia, neglect, substance abuse, suicidal ideation, and failing grades were the strongest predictors of suicide attempt. Ten predictor variables correctly identified 97% of suicide attempters and 86% of nonattempters. Unexpected findings included high levels of truancy, threatening others, and separation from a parent before the age of 12 among nonattempters.
Suicide is one of the leading causes of death among Americans aged 15 to 24 years (Centers for Disease Control, 1998c; Guyer, MacDorman, Martin, Peters, & Strobino, 1998). Among those aged 15 to 19, suicide accounted for 13% of deaths in 1997 (Guyer, MacDorman, Martin, Peters, & Strobino, 1998). Although African American youths have historically had lower suicide rates than have whites, from 1980 to 1995 the suicide rate for African Americans aged 10 to 19 increased from 2.1 to 4.5 per 100,000 population. Among African Americans aged 10 to 14, the suicide rate increased the most (233%), while increasing 126% for African Americans aged 15 to 19. The largest rate of increase occurred for African Americans who live in the South (214%). By gender, the largest increase in suicide occurred among African American males (Centers for Disease Control, 1998a).
Those who make initial suicide attempts are at greater risk for subsequent suicide, with repeated attempts increasing in lethality over time (Eyman & Smith, 1986; Robbins & Alessi, 1985). Significant relationships have been found between major depression, suicidal ideation, health problems, and suicide attempts (Garrison, Jackson, Addy, et al., 1991; Alcohol, Drug Abuse, and Mental Health Administration, 1989).
The Centers for Disease Control (1998b) reported that, in a 12-month period, 20.5% of students in grades 9 through 12 seriously considered attempting suicide, 7.7% had attempted suicide one or more times, and 2.6% sought medical care after a suicide attempt. African American high school students (7.3%) were as likely as white students (7.3%) to attempt suicide.
One factor hypothesized to contribute to suicide attempts among adolescents is disturbance in the parent-child relationship (Sabbath, 1969). For example, a parent may have an unconscious or conscious wish to be rid of a child, who is regarded as "expendable." It has been postulated that people treat themselves as important others have treated them; thus, it may be that an adolescent who is no longer tolerated by a parent will engage in suicidal behavior. The significantly higher incidence of suicide attempts among rejected and abused young children (Brent, 1987), physically abused grade school children (Robbins & Alessi, 1985), sexually abused children (Adams-Tucker, 1982), and abused and/or neglected adolescents (Khan, 1987) provides support for this position. Further, Green (1978) found that self-destructive behavior in children was often precipitated by parental beatings or occurred in response to actual or threatened separation from key parental figures (see also Asarnow, 1992, regarding the association of suicidal ideation and attempts with family stress).
Studies have examined psychopathology, family functioning, and cognitive style in urban adolescents with suicide attempts (Summerville, Kaslow, Abbate, & Cronan, 1994); depression and distress among gay and lesbian African Americans (Cochran & Mays, 1994); depression and suicidal ideation in African American high school students (Lester & Anderson, 1992); psychopathology in African American female high school students with suicide attempts (Summerville, Abbate, Siegel, et al. …