Overview and aims:
Thoughts of suicide (suicidal ideation) are common in adolescents and are a well-established risk factor for suicidal behaviour. However, most young people who think about suicide will not go on to act on their thoughts.
Several theoretical models of suicide are consistent with an ‘ideation-to-action’ framework. This framework proposes that the factors involved in the development of suicidal thoughts are distinct from those involved in the transition from thoughts to attempts. Several research studies have provided support for this framework and found that many well-established risk factors for suicide (including depression, hopelessness and impulsivity) strongly predict the development of suicidal thoughts, but only weakly predict attempts among those thinking about suicide.
The aims of this study were to:
- identify factors that differentiate individuals with suicidal thoughts from those who have made a suicide attempt.
- identify factors that predict a future suicide attempt among those who have experienced suicidal thoughts.
Sample:
Participants for this study were from the Avon Longitudinal study of Parents and Children (ALSPAC). This is a birth cohort study which enrolled over 14,000 pregnant mothers in Avon, UK in 1991/1992. ALSPAC participants have been followed up regularly since birth via questionnaires and research clinics. This study focused on assessments of suicidal thoughts and self-harm at ages 16 and 21 years. Nearly 5,000 young people completed the study questionnaire at age 16 years.
What did we do?
The first part of the study looked to identify factors which distinguished between adolescents who had attempted suicide by age 16 years from those who had thought about suicide but never made a suicide attempt. The second part of the study looked to identify factors that predicted future suicide attempts at age 21 years, among those who reported suicidal thoughts at age 16 years. We also looked for factors that predicted a future suicide attempt among those who reported having engaged in non-suicidal self-harm in adolescence. We looked at lots of different types of predictors including demographics, psychosocial, cognitive, and mental health factors.
What did we find?
In the first part of the study, we found that 9.6% of adolescents had experienced suicidal thoughts and 6.8% had made a suicide attempt at age 16 years. The factors which most clearly distinguished between adolescents who had thought about suicide and those who had made an attempt at this age were exposure to self-harm in other people, and the presence of a psychiatric disorder.
In the second part of the study, we found that most adolescents who had thought about suicide or had engaged in non-suicidal self-harm did not make an attempt on their life over the 5-year follow-up. Consistent with the ideation to action theories of suicide, we found that many of the risk factors we looked at were not very good at predicting which of the adolescents who had previously experienced suicidal thoughts would go on to attempt suicide by age 21 years. Our findings suggest that the best predictors were substance use, non-suicidal self-harm, sleep, personality traits, and exposure to self-harm in others. Young people who reported both suicidal thoughts and non-suicidal self-harm at age 16 years appeared to be at particularly high risk, with approximately 1 in 5 (21%) attempting suicide by the age of 21. Asking about these factors could help to inform risk assessments and might help clinicians to identify which adolescents are at greatest risk of attempting suicide in the future.
Project team:
- University of Bristol, UK: Becky Mars (PI); David Gunnell; Jon Heron; Paul Moran; Kate Tilling
- University of Glasgow, UK: Rory O’Connor
- The University of British Columbia, Canada: David Klonsky
- University of Cambridge: Paul Wilkinson
Funders/Supporters
This study was funded by the American Foundation for Suicide Prevention
Publications and other outputs:
Mars, B., Heron, J., Klonsky, E. D., Moran, P., O’Connor, R. C., Tilling, K., Wilkinson, P., & Gunnell, D. (2019). Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: a population-based birth cohort study. The Lancet. Psychiatry, 6(4), 327–337. https://doi.org/10.1016/S2215-0366(19)30030-6
Mars, B., Heron, J., Klonsky, E. D., Moran, P., O’Connor, R. C., Tilling, K., Wilkinson, P., & Gunnell, D. (2019). What distinguishes adolescents with suicidal thoughts from those who have attempted suicide? A population-based birth cohort study. Journal of Child Psychology and Psychiatry, 60(1), 91–99. https://doi.org/10.1111/jcpp.12878
IASR spotlight on suicide video: In this video, Becky talks about what is meant by the ‘ideation to action’ framework and gives a summary of some of the key psychological theories in this area
Contact for further details: Becky.mars@bristol.ac.uk