Parent-Adolescent Agreement About Adolescents’ Suicidal Thoughts

Abstract

To examine agreement between parent and adolescent reports of adolescents' suicidal thoughts and explore demographic and clinical factors associated with agreement in a large community sample. METHODS: Participants included 5137 adolescents 11 to 17 years old (52.1% girls; 43.0% racial minority) and a collateral informant (97.2% parent or stepparent) from the Philadelphia Neurodevelopmental Cohort. Families were recruited from a large pediatric health care network. Adolescents and parents completed a clinical interview that included questions about adolescents' lifetime suicidal thoughts. RESULTS: Agreement was moderate for thoughts of killing self (κ = 0.466) and low for thoughts of death or dying (κ = 0.171). Discrepancies stemmed from both parental unawareness of suicidal thoughts reported by adolescents and adolescent denial of suicidal thoughts reported by parents. Fifty percent of parents were unaware of adolescents' thoughts of killing themselves, and 75.6% of parents were unaware of adolescents' recurrent thoughts of death. Forty-eight percent of adolescents denied thoughts of killing themselves, and 67.5% of adolescents denied thoughts of death reported by parents. Several demographic (eg, age) and clinical (eg, treatment history) characteristics were associated with agreement. CONCLUSIONS: Early identification and intervention hinge on reliable and valid assessment of suicide risk. The high prevalence of parental unawareness and adolescent denial of suicidal thoughts found in this study suggests that many adolescents at risk for suicide may go undetected. These findings have important clinical implications for pediatric settings, including the need for a multi-informant approach to suicide screening and a personalized approach to assessment based on empirically derived risk factors for unawareness and denial.

Fearlessness about death predicts adolescent suicide attempt: A preliminary analysis

“…We were unable to reach every patient from the research pool for follow‐up, raising the possibility of bias and limiting generalizability. As Jones et al (2019) showed modest agreement between adolescent and parent report of adolescents’ suicidal ideation, it is possible that the use of caregiver report to assess attempts during follow‐up might underestimate our outcome. However, this concern is somewhat mitigated by the fact that the outcome we assessed was not ideation but behavior.…”

Integrating Multiple Informants’ Reports: How Conceptual and Measurement Models May Address Long-Standing Problems in Clinical Decision-Making

“…These patterns in multi-informant reports also have predictive utility: In a recent study of psychiatric inpatient intake assessments, patterns of agreement or disagreement in parent-adolescent reports of adolescent affective symptoms facilitated prediction of treatment outcomes (Makol, De Los Reyes, Ostrander, & Reynolds, 2019). In fact, an emerging body of evidence indicates that informants who vary in their contexts and perspectives provide meaningful information about cross-contextual consistencies in behavior (De Los Reyes, Henry, Tolan, & Wakschlag, 2009; Hartley, Zakriski, & Wright, 2011; Kwon, Kim, & Sheridan, 2012), mental health service use (Jones et al, 2019; Makol & Polo, 2018), and treatment outcomes (Becker-Haimes, Jensen-Doss, Birmaher, Kendall, & Ginsburg, 2017). In sum, research across psychopathology domains, informants, measurement methods, and developmental periods support that multi-informant reporting patterns yield meaningful clinical information.…”

Association between family history of suicide attempt and neurocognitive functioning in community youth

“…Lifetime suicidal ideation was assessed with the question, ‘Have you ever thought about killing yourself?’ Affirmative responses were followed up with questions about current ideation. Interviewers were trained in a standardized protocol for responding to suicide risk, as described previously (Jones et al, 2019). Lifetime trauma exposure was assessed with eight items assessing exposure to a range of potentially traumatic stressors.…”