Factors Associated With Reasons for Living Among Suicidal Adolescents

Abstract

Objective

The objective of this study was to identify baseline demographic and clinical factors associated with higher scores on the Reasons for Living Inventory for Adolescents (RFL-A) at baseline and over follow-up.

Method

Using data from a pilot clinical trial of a brief intervention for suicidal youth transitioning from inpatient to outpatient, we identified univariate associations of baseline characteristics with RFL-A and used regression to identify the most parsimonious subset of these variables. Finally, we examined to what extent changes in these characteristics over time were related to changes in RFL-A.

Results

Univariate analyses found that better external functional emotion regulation and social support were associated with higher RFL-A scores; more self-reported depression, internal dysfunctional emotion regulation, sleep disturbance, anxiety, and distress tolerance were associated with lower RFL-A scores. Multiple linear regression identified internal dysfunctional emotion regulation and external functional emotion regulation as the most parsimonious set of characteristics associated with RFL-A. Improvement in internal emotion regulation, sleep, and depression were related to improvements in RFL-A over time.

Conclusion

Our findings indicate that emotion regulation—specifically maladaptive internal strategies and use of external resources—is strongly associated with RFL-A. Improvements in internal emotion regulation (r = 0.57), sleep (r = −0.45), and depression (r = −0.34) were related to increases in RFL-A.

HIGHLIGHTS

• In the literature, greater reasons for living are associated with lower risk for future suicidal ideation and suicide attempts.

• The most salient correlate of concurrent and future lower RFL-A was dysfunctional internal emotion regulation. Improved sleep and decreases in depression were correlated with increases in RFL-A.

Keywords:

• Adolescents
• reasons for living
• suicide

DISCLOSURE STATEMENT

Dr. Brent receives research support from National Institute of Mental Health (NIMH), American Foundation for Suicide Prevention (AFSP), the Once Upon a Time Foundation, and the Beckwith Foundation; receives royalties from Guilford Press, from the electronic self-rated version of the Columbia Suicide Severity Rating Scale from eRT, Inc., and from performing duties as an UptoDate Psychiatry Section Editor; receives consulting fees from Healthwise; receives Honoraria from the Klingenstein Third Generation Foundation for scientific board membership and grant reviews; and is a scientific board member for AFSP. Intellectual Property, currently with no financial interest: Funding from the NIMH supported the development of intellectual property for BRITE, the As Safe As Possible (ASAP) intervention, the Computerized Adaptive Screen for Suicidal Youth measure, a suicide risk machine learning algorithm, and the Screening Wizard screening tool. Dr. Kennard receives royalties from Guilford Press, Inc. and serves on the board of trustees of the Jerry M. Lewis, MD, Mental Health Research Foundation. Dr. Goldstein receives research funding from the NIMH, AFSP, The Brain and Behavior Foundation, The Pittsburgh Foundation, University of Pittsburgh Clinical and Translational Science Institute and receives royalties from Guilford Press. Dr. Douaihy receives research support from NIMH, National Institute on Drug Abuse, Alkermes, Substance Abuse and Mental Health Services Administration, AFSP, Centers for Disease Control and Prevention, Health Resources and Services Administration, Goodblend/Parallel, and Foundation for Opioid Response Efforts. He receives royalties for academic books published by OUP, Springer, and PESI Media and Publishing. The remaining authors have no disclosures to report.

CLINICALTRIALS.Gov IDENTIFIER

NCT02272179.

Additional information

Funding

This research was supported bythe Pennsylvania Legislature, which provides financial support for the STAR-Center and its electronic data collection and management (no grant number, no specific awardees); the University of Pittsburgh, which provides financial support for Dr. David Brent’s Endowed Chair in Suicide Studies (no grant number, awardee: DB); and grants from the National Institute of Mental Health (R34MH100451, awardee: DB; R34MH100375, awardee BDK; and T32 MH018951, awardee: CB).

Notes on contributors

G. Gorraiz

G. Gorraiz, MD, Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

G. Porta

G. Porta, MS, UPMC Western Psychiatric Hospital, Pittsburgh, PA, USA.

D. L. McMakin

D. L. McMakin, PhD, Department of Psychology, Florida International University, Miami, FL, USA.

B. D. Kennard

B. D. Kennard, PsyD, A. B. Douaihy, MD, C. Biernesser, PhD, MSW, LCSW, MPH, A. A. Foxwell, PhD, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA. Children’s Health Medical Center, Dallas, TX, USA.

A. B. Douaihy

B. D. Kennard, PsyD, A. B. Douaihy, MD, C. Biernesser, PhD, MSW, LCSW, MPH, A. A. Foxwell, PhD, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA. Children’s Health Medical Center, Dallas, TX, USA.

C. Biernesser

B. D. Kennard, PsyD, A. B. Douaihy, MD, C. Biernesser, PhD, MSW, LCSW, MPH, A. A. Foxwell, PhD, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA. Children’s Health Medical Center, Dallas, TX, USA.

A. A. Foxwell

B. D. Kennard, PsyD, A. B. Douaihy, MD, C. Biernesser, PhD, MSW, LCSW, MPH, A. A. Foxwell, PhD, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA. Children’s Health Medical Center, Dallas, TX, USA.

K. Wolfe

K. Wolfe, PhD, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA. Children’s Health Medical Center, Dallas, TX, USA.

T. Goldstein

T. Goldstein, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. UPMC Western Psychiatric Hospital, Pittsburgh, PA, USA, and

D. A. Brent

D. A. Brent, MD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. UPMC Western Psychiatric Hospital, Pittsburgh, PA, USA.