Comparing subgroups of suicidal homeless adolescents: Multiple attempters, single attempters and ideators

Abstract

This study compared multiple attempters, single attempters, ideators and non-suicidal homeless adolescents from the Midwestern United States. The data were collected in 1999–2000 from youths aged 16–19 years. More than one-quarter (26.7%) of the 405 participants made multiple lifetime attempts, 9.8% attempted suicide once, 48.9% thought about – but did not attempt – suicide and 14.6% never attempted or thought about suicide. Multiple attempters, relative to all other youths, evidenced more family, street, psychological and psychiatric problems. Single attempters reported more suicidal ideation than did ideators, and single attempters endured more family problems and were more likely to meet criteria for post-traumatic stress disorder (PTSD) than were non-suicidal participants. Finally, both single attempters and ideators experienced more psychological problems and number of psychiatric diagnoses than did non‐suicidal youths.

The Editor on behalf of the Editorial Board of Vulnerable Children and Youth Studies are saddened to note the untimely death of Dr. Kevin Yoder and convey sincere condolences to his family, friends and the academic community where he will be screly missed.

Keywords:

• multiple suicide attempts
• homeless adolescents

Acknowledgements

The Midwest Longitudinal Study of Homeless Adolescents was supported by the National Institute of Mental Health (MH57110); Les B. Whitbeck, Principal Investigator.

Notes

1. One interviewer was assigned to each city with two exceptions. First, due to its size, St Louis, Missouri was assigned two interviewers. Secondly, two cities in Iowa (Cedar Rapids and Iowa City) were assigned the same interviewer.

2. The suicidal ideation items contain questions about thoughts of death and suicide. There is debate about whether thoughts of death should be included in suicidal ideation scales. Lewinsohn et al. (1996) include thoughts of death in their definition of suicidal ideation, and factor analytical evidence suggests that thoughts of death and suicide often ‘load’ together on the same factor (Yoder et al., 2008). Nevertheless, death ideators and suicide ideators may form separate groups that differ on the study variables. This was tested with the data, and the two groups differed significantly on only four of 28 variables. When compared to death ideators, suicide ideators had lower self-esteem and higher suicidal ideation, and they were more likely to have a diagnosis of PTSD and major depressive episode. Given the small number of differences it was decided to keep both groups together in the suicidal ideation group, as reported in Table I.

3. For multi-item scales, person-mean substitution was used to handle missing values – the mean value of the remaining items was imputed for the missing items if at least half of the items had legitimate values. Missing value substitution was not used for the single-item variables, and analyses were based on listwise deletion of any remaining missing cases. After employing these procedures, n = 405 (of the original 444) participants were available for analyses. Adolescents included in the analyses were more likely to have family members with legal problems (χ² ₍₁₎ = 5.26, P < 0.02, Cohen's h = 0.19) and expressed lower average levels of hopelessness (t ₍₄₄₂₎ = 1.80, P < 0.07, Hedge's g = 0.31) when compared to excluded youths. Included and excluded youths did not differ on the remaining study variables.

4. Pairwise comparisons between multiple and single attempters (without correcting for multiple comparisons) yielded four additional statistically significant differences. Multiple attempters had greater exposure to friends' suicidality and more psychiatric diagnoses, and they were more likely to have spent time directly on the street and to have a diagnosis of major depressive episode.