Protective factors for suicidal ideation and suicide attempts in adolescence: a longitudinal population-based cohort study examining sex differences.

Abstract

Background: Adolescence is a critical period with elevated vulnerability to suicidality. Despite the importance of protective factors in reducing suicidal ideation (SI) and suicide attempts (SA), research in this area remains limited. This study investigated the associations between protective factors in early adolescence and the subsequent outcomes of SI and SA a year later, while also examining sex differences in these associations.

Methods: This study utilized data from a representative sample at two timepoints, T1 (N = 2464, 50.8% females, mean age = 13.7, SD = 0.6) in 1998 and T2 (N = 2432, 50.4% females, mean age = 14.9, SD = 0.6) one year later, collected as part of the longitudinal Youth and Mental Health Study (YAMHS) in Norway. Individual, social and environmental protective factors were identified based on prior research and theoretical frameworks. We used linear (or ordinal logistic) regression analyses with SI (or SA) as dependent variable, and one protective factor, sex and their interaction as covariates.

Results: Positive self-perceptions (T1) were significantly associated with reduced SI and SA one year later (T2) for both sexes. Specifically, self-worth was more strongly associated with reduced SI in females (B = -0.16, 95% CI: -0.20 to -0.12, p <.001) than males (B = -0.08, 95% CI: -0.12 to -0.04, p <.001). The interaction between sex and social competence influenced the likelihood of SA, with males (OR = 0.24, 95% CI: 0.13 to 0.42, p <.001) showing a greater reduction than females (OR = 0.53, 95% CI: 0.35 to 0.80, p =.009), although this association only showed a trend towards significance (p =.083). Higher physical activity and school connectedness/wellbeing were associated with lower SI, and school connectedness/wellbeing to lower SA, with no sex differences. No significant associations were found between task-oriented coping, attachment, family functioning or socio-economic status and SI or SA.

Conclusions: Fostering positive self-perception, physical activity, and school connectedness/wellbeing is important for adolescent suicide prevention, as these factors contribute to reducing suicidality. Sex differences were observed in the associations between self-worth and SI, as well as social competence and SA. Future research should explore additional protective factors across sex and gender groups.