Parent-adolescent discordance in suicidal intent assessment after a suicide attempt: a convergent mixed-methods study

Suicidal crisis in adolescence often emerges within a context of relational tension. Following a suicide attempt, the assessment of suicidal intent is critical yet complex, particularly when discrepancies arise between the adolescent's self-assessment and their parent's perception. These parent-adolescent discordances are understudied, despite their potential clinical significance. This prospective, monocentric, convergent mixed-methods study included 150 adolescent-parent dyads assessed after an SA. Suicidal intent was evaluated at baseline (T0) and 3 months later (T3) using parallel visual analogue scales completed independently by the adolescent and one parent. Discordance was defined as the difference between both scores. Linear regression models were used to explore associations with changes in suicidal distress. A subsample of 10 dyads underwent semi-structured interviews, analyzed through Interpretative Phenomenological Analysis (IPA). Adolescents rated their suicidal intent higher than their parents did (mean difference = + 2.53, p < 0.001). Three discordance profiles emerged: Parent-High Group, Concordant Group, and Parent-Low Group. Discordance was significantly associated with clinical outcomes at 3 months (p = 0.003). Adolescents in the Parent-Low Group showed the strongest improvements, while those in the Parent-High Group showed higher levels of persistent distress (p = 0.041). This association was attenuated after accounting for baseline adolescent-reported VAS severity. Qualitative analysis revealed the role of discordance as a marker of impaired communication, divergent interpretations, and challenges in parental adjustment. Parent-adolescent discordance in suicidal intent ratings provides clinical insight into the relational configuration of the post-attempt crisis. Its early assessment, alongside dedicated parental support, may improve crisis management. These findings support NICE recommendations for integrative and relational approaches to suicidal crises in adolescents.