Research on Child and Adolescent Psychopathology - Interview with the Authors: Dr. Regina Miranda

(this opens in a new tab)RCAP interview with Dr. Regina Miranda, Professor of Psychology at Hunter College about her recently published article titled - Content and process of adolescent suicide ideation: Implications for risk assessment (this opens in a new tab)

This study has several important clinical implications. The study found duration of ideation, imagery, and consideration of ingestion as a first method were particularly important characteristics associated with suicide attempts. Can you please briefly summarize these findings and help readers understand how they might apply them clinically in terms of suicide risk assessment and/or treatment?

This paper presents data on the form (e.g., duration, imagery) and content (e.g., method, wish to die) of suicide ideation among adolescents who had recently made a suicide attempt or who had recent suicide ideation, with or without a past history of a suicide attempt. Teens thought of a variety of methods of attempting suicide, including ingestion, penetration injury, hanging, jumping, and even for a very small number, firearms; but those who made suicide attempts (over half) considered ingestion as their primary method, while only about one-fifth of those who thought about killing themselves – but did not attempt suicide – did so. In addition, and perhaps unsurprisingly, those who made a suicide attempt reported a stronger wish to die, compared to those who ideated but had no prior experience making a suicide attempt. What this might suggest is that when teens are more serious about their wish to die, they consider a method that might be more available to them, or, as some past research suggests, that they think might be a less painful form of death. Of course, we cannot rule out that there might be a sampling bias, in that it might be that for this particular population, the teens more likely to present to an emergency department are those who attempt suicide via ingestion, versus other methods.

Apart from the methods they considered, the content of their suicide ideation – i.e., what they reported thinking about when they thought about killing themselves – was similar, in that about one-third of teens thought about what dying would be like and about what would happen to their bodies after they tried to kill themselves, just under half thought about whether someone would find them after their attempts, and close to three-fourths thought about the effect their deaths would have on others. However, the form of their suicide ideation varied depending on whether they had ever previously made a suicide attempt. Teens who ideated but had a past history of a suicide attempt were more likely to have ideation that was longer and to have imagery associated with their ideation, compared to those who ideated but had not ever previously attempted suicide. We need additional research to better understand what it means for teens to spend longer time ideating, in terms of risk.  Some of our own past research with teens suggests that greater length of recent suicide ideation is associated with increased risk of a future suicide attempt and of attempting sooner. The present study is cross-sectional, so we can’t draw conclusions about risk of future attempts, but it contributes to converging evidence that there are different types of suicide ideation. Treatment might need to vary depending on how teens ideate. For instance, treatment with teens who spend a longer period of time ideating might require interventions that help them disengage from their ideation, while treatment with teens who spend less time ideating might focus more on the circumstances that lead to their suicide ideation. Furthermore, treatment may need to address teens’ specific suicide ideation content. Additional research examining patterns of suicide ideation and using prospective designs, along with even more fine-grained analysis of adolescents’ suicide ideation content, would further help to inform assessment and interventions.

The study had a diverse sample, with 73% being Hispanic/Latine. Can you please help readers place these findings in that cultural context. Do we see different rates of ideation/attempts across race/ethnicity and/or other marginalized groups? Are there specific implications for training and cultural competence?

This particular study didn’t address the cultural context of adolescents’ suicide ideation. However, when we began this program of research, data from the Youth Risk Behavior Survey (YRBS) had long suggested that Hispanic/Latine teenagers – particularly Latina teens – had higher rates of suicide ideation and attempts than their non-Hispanic White counterparts, and at the time, compared to their Black peers, as well. Research programs like those of Luis Zayas, Carolina Hausmann-Stabile, Lauren Gulbas, and others were seeking to better understand why that was the case. Those rates shifted around 2017, when we started to see decreases among Hispanic/Latine youth, but simultaneously, there were continued increases in rates among non-Hispanic Black teens (who represent about 13% of our study sample). Data from the AAKOMA Project’s 2022 “State of Mental Health of Youth of Color” suggest even higher rates than those in the YRBS, and data from The Trevor Project suggest particularly high vulnerability for LGBTQ+ youth of color, including those identifying as Hispanic/Latine. Of note in our study is that over half of teens in our second sample identified as sexual minorities. When we consider the cultural context for teens, we need to consider their intersecting identities. This was not an area of focus in this study, but it is critical that we address it as we do additional analyses of what teens told us in their interviews.

What advice would you give to early career researchers interested in working to develop interventions to prevent suicide attempts? Are there particular areas of study that you feel are particularly promising?

Youth suicide research needs to take more intersectional, mixed-methods approaches that engage communities, especially as we consider the various combination of intrapersonal, interpersonal, and systemic factors that contribute to youth suicide risk and that would need to be addressed in treatment. I would recommend that early career researchers get training in both quantitative and qualitative research methods, not only for the sake of their own research, but also to enable them to adequately evaluate the research of others. I am encouraged that the field has become increasingly interested in understanding the nature of suicidal thoughts, and in doing so using novel methods that take advantage of advances in technology. But novel is not always better, and sometimes doing the difficult work of sitting in a room with someone to understand what leads them to think about killing themselves and what it is that they are actually thinking when they consider taking their lives has just as much – if not more – value.