‘We call this an upstream suicide prevention – by focusing on parenting and children’s coping upstream, early in their development, then later in their life the suicide risk is reduced’
Children who have experienced the death of a parent are at an increased risk for mental health disorders, depression, and suicide, but a new study from a researcher with UConn’s Department of Human Development & Family Sciences is shining light on how supporting surviving parents can help reduce suicide risk in vulnerable youth.
“Researchers have studied suicide for many decades,” says Na Zhang, an assistant professor and lead author of the new study. “However, we still don’t have a good way to predict suicide, suicidal ideation, or suicidal behavior. We know some of the factors that are related; however, overall the predictability is not as high as we want it to be.”
Zhang’s study, published in the journal Development and Psychopathology, examined the unanticipated reduction in suicide risk among parentally bereaved youth when their surviving parent or caregiver participated in the Family Bereavement Program, or FBP – an evidence-based intervention originally developed by the REACH Institute at Arizona State University and now available to community agencies and providers in a second version, known as Resilient Parenting for Bereaved Families.
“This intervention itself is not a suicide prevention program,” Zhang explains. “It focuses on helping bereaved parents do the hard work of providing effective parenting while they themselves are grieving.”
The original FBP included 12 group-based sessions comprised of separate groups for caregivers and children as well as two family sessions, all focused on supporting the parenting skills and needs of the surviving parents and caregivers of children coping with the loss of a parent.
The program developers found that, at six and 15-year follow-ups, youth suicide risk for participating families was significantly reduced, and Zhang wanted to understand why.
“Imagine you have a pill, a medicine, and you want to treat your cold or your physical disease or illness,” she says. “You know this pill works to treat the disease, but you want to know how these pills work. You want to know what kind of effect, and what chain of effects, is in the body, and what kind of biological or chemical changes happen that can lead to the outcome that you see as desirable.”
She continues, “The goal of the intervention was to prevent mental health disorders, including internalizing problems such as depression and anxiety, but also externalizing problems like aggression and conduct problems. There was no specific intervention strategy about suicide, or reducing suicide risk. We call this an upstream suicide prevention – by focusing on parenting and children’s coping upstream, early in their development, then later in their life the suicide risk is reduced. I was really interested in how this upstream preventive intervention could have such a long-term effect to reduce suicide risk.”
Through a secondary data analysis, Zhang reexamined information from the baseline and posttest examinations as well as 11-month, six-year, and 15-year follow-ups for 156 of the families that participated in the program. The sample included families where a parent had died between four and 30 months prior, the child was between eight and 16 years old, and the family was not currently receiving other mental health services.
Zhang tested six different factors – called mediators – that researchers hypothesized could be connected to the reduced suicide risk for youth with caregivers involved in the program.
“The mediators are what you can call the ‘active ingredients’ of this intervention,” she explains.
She found that two of the mediators – reduced aversive self-views and increased child positive connectedness to their caregivers – were associated with upstream parenting and downstream reduced suicide risk. Reduced aversive self-views – which refer to lower levels of self-esteem, control over things that happen in their world and sense of personal identity – in particular stood out in the data as an important effect of the program.
The effects of aversive self-views on suicide risk was first hypothesized 30 years by a theoretical paper which proposed that suicide came from people’s need to escape from these kinds of negative feelings about themselves. This is the first study to find that reducing aversive self-views through a program six years earlier is part of a pathway to the effects of the program to actually reduce suicide risk.
“For the surviving parents who were randomized into the program, we know that their parenting improved, and that improved parenting led to reductions in the youth reporting aversive self-views or negative self-views,” says Zhang. “They reported less negative views of themselves and their relationship to their world, and that was related to reductions in suicide risk. And what’s more interesting is that, when we put these two active ingredients together – the self-views and the caregiver connectedness – the aversive self-views remained statistically significant. So that really shows that this concept of self-views is a very important intervention target that we want to consider when we think about whether this intervention can reduce suicide risk over the long term.”
This study, she says, is the first to show that a causally induced change in parenting led to a chain of positive effects in the parentally bereaved youth, including reduced suicide risk.
“The paper also is the first to show that not only is parenting leads to a positive chain of events leading to the reduction in suicide risk,” Zhang says, “but also how – how can positive, high-quality parenting translates to reductions in youth suicide risk. Here, we show that these aversive self-views are such an important pathway to explain how parenting leads to reductions in suicide risk.”
Zhang says that further study is needed to have more of a systematic way to access suicide risk, and also to differentiate suicidal ideations from suicidal behaviors or suicidal attempts, which she was not able to assess due to limitations in the data she analyzed.
Her study also looked at parenting globally – not delving into the individual aspects of parenting, like discipline, protection, sensitivity, and guided learning – which could explain why other mediators, like complicated grief, that she had hypothesized might also be “active ingredients” that explained the effects of the program to reduce suicide risk in parentally bereaved youth.
“The take home message here is that it’s important for researchers to identify the possible risk factors or protective factors for youth suicide risk, suicidal ideation, or suicidal behaviors, so that they can design more targeted interventions to address those factors in their program to reduce that risk,” Zhang says. “And here what we’re finding is that these self-views seem to be really relevant.”
Zhang’s coauthors on the study included Irwin Sandler, Jenn-Yun Tein, and Sharlene Wolchik from the Arizona State University Department of Psychology’s REACH Institute.
Support for this research was provided by National Institute of Mental Health Grant R01 MH4915 and the New York Life Foundation. Zhang’s work was also supported by a National Research Service Award in Primary Prevention by the National Institute on Drug Abuse T32DA039772
A portion of this work was presented at the annual meeting of the Society for Prevention Research in 2020, which was held virtually.