Many Teens’ Suicidal Thoughts Go Undetected by Parents

Parents were frequently unaware when their adolescent children had suicidal or morbid thoughts, but when they did believe their children thought about killing themselves, children often denied it, according to a study involving a large pediatric healthcare network.

The survey of more than 5,000 teen-parent pairs identified 413 adolescents who reported having thoughts of suicide, and for about half of those, the parents said they didn’t know about it, reported Jason Jones, PhD, of the Children’s Hospital of Philadelphia in Pennsylvania, and colleagues.

About twice as many teens (786) said they had recurrent thoughts of death or dying, and three quarters of their parents said they were unaware.

Conversely, when parents said they believed their children had thoughts of suicide, about half of children said they didn’t, and two-thirds of those whose parents thought they were having thoughts of death denied it, Jones and colleagues wrote in Pediatrics.

“Given the high prevalence of parental unawareness and adolescent denial of suicidal thoughts found in this study, it is possible that a large number of adolescents with suicide risk may not be detected by brief screens at routine check-ups,” the authors stated.

In a previous study, more than two-thirds of young people considering suicide reported not receiving mental health care, which may partially be due to the fact that their parents — who serve as “gatekeepers” for these services — are not aware that their child is having these thoughts, the authors wrote.

Providing access to mental health services is made increasingly important since up to 40% of adolescents who consider suicide act on these thoughts, according to Khyati Brahmbhatt, MD, and Jacqueline Grupp-Phelan, MPH, MD, both of the University of California, San Francisco, in an accompanying editorial.

As a result, broad intervention methods “may not suffice in moving the needle on completed suicides.” Instead, preventative measures should be designed with risk factors such as impulsivity, substance use, or whether an individual has a plan for suicide in mind, the editorialists added.

Jones and colleagues examined data from the Philadelphia Neurodevelopmental Cohort, a community-based sample, which the authors emphasized was “not enriched for individuals seeking psychiatric help.” This study looked at data from adolescents ages 11-17, where information about suicidal thoughts was collected from both adolescents and a “collateral informant” (mostly parents).

Adolescents and parents who met study qualifications completed a GOASSESS interview designed to screen individuals for symptoms of major psychiatric disorders. Both were asked about lifetime suicidal ideation of the child, and a trained professional afterwards inquired about treatment histories regarding their psychopathology, family histories, and demographic information.

Trained interviewers asked adolescents the following two questions, which were also asked of the parents in regards to their children:

• “Have you ever thought about killing yourself?”
• “Have you ever thought a lot about death or dying?”

Overall, 5,137 adolescents were included in the study, with an average age of around 15. Just over half were girls and 57% were white, with 32% of child-parent pairs reporting being African-American and 6% Hispanic or Latino. Individuals were excluded if they did not speak English or had physical or cognitive conditions that interfered with participating in the study. Prevalence of adolescents who thought about killing themselves was 8%, while about 15% had thoughts of death or dying.

Older adolescents were associated with better agreement with their parents’ responses, but differences varied by sex. Parents of young girls were typically more unaware of their children’s suicidal or morbid thoughts than they were for older children, while the opposite was true for boys (parents became increasingly unaware of their sons’ thoughts of death the older the boys were), the authors reported.

Editorialists Brahmbhatt and Grupp-Phelan noted that there could be multiple interpretations of the questions researchers asked participants, particularly “Have you ever thought a lot about death or dying?”, which may have affected the data published in this study, particularly for young kids.

Meanwhile, Jones and colleagues found that parents of minority children were more likely to be unaware of their children’s thoughts of death than parents of white children, although Hispanic or Latino ethnicity was associated with decreased odds of parental unawareness of thoughts of death, the authors wrote.

Fathers were more likely to be unaware that their children were having thoughts of killing themselves than mothers, the authors reported. If a child had previously undergone psychotherapy or had family histories of suicide, his or her parents were less likely to be unaware if their child considered suicide or had recurring thoughts of death, they wrote.

The authors noted that because this study focuses on a single center in one geographic area, the data may not be generalizable to larger populations. It could also be limited because the interviews conducted were relatively brief and the questions that were asked could be susceptible to recall bias, as well as misunderstanding, researchers reported. In addition, prevalence of suicidal ideation was lower than in a national survey of high school students, which the authors potentially attributed to the inclusion of younger adolescents in the study.