(PS9-36) Suicide decision-making in adolescents: Comparing the consequences considered by ideators and attempters

Abstract Text:

Background: Suicide is a leading cause of death in adolescents (CDC, 2023), yet the factors influencing their decision to attempt suicide remain unclear. Prior research on suicide decision-making shows that adults often consider consequences of suicide, such as impact on family/friends and what happens after death (Millner et al., 2017; Xu et al., 2024), but these factors have not been studied in adolescents. In this study, we explored whether these consequences impacted adolescents’ decisions to attempt suicide by comparing those with suicidal ideation to those with a recent attempt.

Methods: Participants were adolescents (n = 43) recently hospitalized for suicidal thoughts and behaviors. Participants were categorized as either “ideators” or “attempters,” based on a medical record review of their reason for hospital admission. Participants completed the Pathway to Suicidal Action Interview (Millner et al., 2017), where they reported on recent suicidal behaviors and were asked about the degree to which they thought about the following consequences of suicide (rated on a 5-point scale ranging from “none” to “all the time”): impact on family/friends, what it means to die, what happens after death, the pain, blood, or violence involved in an attempt, and how other people would react if they learned about the attempt. For analyses, we categorized these ratings into two groups: not considered (“none” responses) and considered (any response other than “none”). Participants were then asked to expand upon what they specifically thought about each consequence in an open-ended question. Open-ended responses were coded using qualitative content analysis.

Results: Our sample included 14 suicide ideators and 29 attempters. Across both ideators and attempters, participants frequently considered the impact of a potential suicide attempt on their family/friends (93% of ideators; 93% attempters). The least considered consequence was the pain or violence involved in making an attempt (57% ideators; 59% attempters). Results show that ideators more frequently (57%) reported concerns about negatively impacting their family/friends (e.g., “I thought about my mom and that she would miss me a lot”, “[it would be] traumatic for them”) compared to attempters (21%). In contrast, attempters were more likely (41%) to mention neutral/nonspecific impacts on their family/friends (e.g., “I wondered how my family would be impacted”, “how my death would affect them”) compared to ideators (21%). Additional content analysis on other open-ended questions will be complete by October 2025.

Conclusion: Results demonstrate that adolescent ideators and attempters consider similar consequences of suicide as part of their decision-making process. Ideators are more likely than attempters to report thinking about specific, negative impacts of a suicide attempt on their family/friends. Although social connectedness is a well-established protective factor for suicide, these findings suggest that this factor may remain protective even when adolescents are mulling over a possible suicide attempt. These findings further our understanding of the complex decision-making processes preceding suicidal behavior.