Peer‐adult network structure and suicide attempts in 38 high schools: implications for network‐informed suicide prevention

Abstract

Background Strengthening social integration could prevent suicidal behavior. However, minimal research has examined social integration through relationship network structure. To address this important gap, we tested whether structural characteristics of school networks predict school rates of ideation and attempts. Methods In 38 US high schools, 10,291 students nominated close friends and trusted adults to construct social networks. We used mixed‐effects logistic regression models to test individual student networks and likelihood of suicidal ideation (SI) and suicide attempts (SA); and linear regression models to estimate associations between school network characteristics and school rates of SI, SA, and SA among all with ideation. Results Lower peer network integration and cohesion increased likelihood of SI and SA across individual and school‐level models. Two factors increased SA: student isolation from adults and suicidal students’ popularity and clustering. A multivariable model identified higher SA in schools where youth–adult relationships were concentrated in fewer students (B = 4.95 [1.46, 8.44]) and suicidal students had higher relative popularity versus nonsuicidal peers (B = 0.93 [0.10, 1.77]). Schools had lower SA rates when more students named the same trusted adults named by friends and many students named the same trusted adults. When adjusting for depression, violence victimization and bullying, estimates for adult network characteristics were substantially unchanged whereas some peer effects decreased. Conclusions Schoolwide peer and youth–adult relationship patterns influence SA rates beyond individual student connections. Network characteristics associated with suicide attempts map onto three theory‐informed domains: social integration versus thwarted relational needs, group cohesion, and suicidal students’ social influence. Network interventions addressing these processes, such as maximizing youth–adult connections schoolwide and heightening influence of youth with healthy coping, could create more protective schools. Longitudinal and intervention studies are needed to determine how schools differentiate in network structure and clarify reciprocal dynamics between network characteristics and suicidal behavior.

Practitioner Review: Treatment for suicidal and self‐harming adolescents – advances in suicide prevention care

“…These findings are also consistent with the approach of mobilizing social/ environmental strengths, included as a key component in several of the treatment interventions that have been shown to yield benefits such as DBT, Safe Alternatives for Teens and Youths (SAFETY, Asarnow et al, 2017), and Multisystemic Therapy (Huey et al,2004). From the perspective of practitioners in schools and other group settings, the Wyman et al (2019) results highlight the potential of network-informed suicide prevention that strengthens protective bonds within the population, increases connections between youths and a small number of adults who can serve a protective function, and promoting the influence of healthy youths who are free of self-harm and suicidal tendencies.…”

“…From the perspective of practitioners in schools and other group settings, the Wyman et al. () results highlight the potential of network‐informed suicide prevention that strengthens protective bonds within the population, increases connections between youths and a small number of adults who can serve a protective function, and promoting the influence of healthy youths who are free of self‐harm and suicidal tendencies.…”

“…Identification and activation of parents and trusted adults who can function like ‘protective seatbelts’ and keep youths safe during moments when they experience suicidal/self‐harm urges may enhance the outcomes of care regardless of the type of treatment delivered. (Asarnow et al., ; King, Grupp‐Phelan et al., ; Wyman et al., ). Most youths spend a great deal of time in school, the impact of the school environment cannot be ignored as patterns within schools are associated with differences in the risk of SI and SAs. Practitioners in both school and mental health settings should consider the school environment in their treatment plans and work to enhance protective influences within the school.…”

“…The article by Wyman et al (2019) highlights the importance of school-based suicide prevention activities, as well as the importance of attending to the school environments of youths who are in treatment for SA/self-harm risk. In this analysis of school networks across 38 U.S. high schools, SAs were found to be more frequent in youths who were more isolated from adults and exposed to suicidal friends.…”

Editorial: Suicide and self‐harm: advancing from science to preventing deaths

“…and Wyman et al. () underscore the significance of social connectedness, a factor often neglected in clinical risk assessment. Miller and colleagues () emphasize the value of understanding patterns of stresses within individuals, an approach that may enhance identification of time‐points when intervention might prevent self‐harm.…”