Observed Interaction in Families of Adolescent Suicide Attempters
Attempted suicide during adolescence is disturbingly common. Prevention depends upon careful identification of factors that may contribute to its etiology and maintenance. Researchers have focused on a range of possible risk factors, including problems within the family. While promising, this research has suffered from a number of limitations, in particular an over-reliance on self-report methodology. The current study investigated family interactions of adolescent suicide attempters, using observational methods and a longitudinal design. Participants included 71 families of hospitalized attempters and 29 families of psychiatric controls. Families completed a variety of self-report measures as well as a videotaped problem-solving interaction task. Interactions were coded for a range of behaviors, including emotional validation and invalidation, problem-solving constructiveness, and problem-solving progress. It was expected that families of adolescent suicide attempters would display more negative behavior than families of hospitalized non-attempters, and that negative behavior within the suicide group would be related to individual factors such as psychopathology and beliefs about problem-solving. It was further expected that negative behavior at baseline would predict suicidal ideation and reattempted suicide during an 18-month follow-up period. There was at least partial support for each of the primary hypotheses. There were no significant differences in observed parent behaviors. However, adolescent attempters displayed significantly more emotional invalidation than psychiatric controls. Within the suicide group, negative beliefs about family conflict and problem-solving predicted observed negativity, for both parents and adolescents. In several cases, higher levels of adolescent psychopathology predicted more negative behavior as well. Finally, while parent behavior was not a significant predictor for subsequent adolescent suicidality, certain aspects of adolescent negativity predicted both reattempts and future suicidal ideation. Findings demonstrated that it is possible to observe distinct patterns of interaction in families of adolescent suicide attempters, and emphasized the value of a focus on adolescent, not just parent, behavior. Results suggested that adolescent attempters may have particular difficulty coping with affectively charged parent-adolescent conflict, and indicated that negative behavior (for both parents and adolescents) may be maintained by pessimistic cognitions. Results thus suggested important directions for future research, as well as possibly fruitful avenues for treatment and prevention.
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