Impact of Perceived Responses to Suicide-Related Disclosure on Future Suicide Ideation and Attempts among Adolescents

How people respond when adolescents disclose their suicidal thoughts or behaviors may significantly shape their help-seeking and mental health outcomes. Drawing on the Intimacy Process Model and Interpersonal Theory of Suicide, the present study examined interpersonal needs as mediators of the relationship between adolescents' supportive and unsupportive experiences with suicide-related disclosure and future suicide ideation (SI) and attempts (SAs). Ethnoracially diverse adolescents (n = 119; 78% female), aged 12-19 years (M = 15.2, SD = 1.9), were recruited from hospitals and clinics following SI or SA and interviewed about how others responded to their disclosure of SI/SA. Interpersonal needs (perceived burdensomeness, thwarted belongingness) were measured at one-month follow-up, SI severity was measured at baseline and 3-month follow-up, and SA since baseline was assessed at 1-, 3-, and 12-month follow-up. Thirty-nine percent of adolescents (n = 47) did not disclose their SI/SA, 43% (n = 51) had a supportive disclosure experience, and 18% (n = 21) had an unsupportive disclosure experience. Perceived supportiveness vs. unsupportiveness of responses was not associated with interpersonal needs nor with SI. Only thwarted belongingness predicted SI at 3 months, adjusting for baseline SI, among adolescents who disclosed their SI or SA. However, a perceived supportive (vs. unsupportive) response to disclosure significantly predicted lower odds of making a SA by 12 months. Treatments should address thwarted belongingness to reduce SI severity among adolescents presenting for clinical care following SI or SA. Increasing supportive experiences with suicide-related disclosure may reduce adolescents' risk of SAs.