An ecological approach to understanding the multilevel risk factors of youth suicidality in the United States

Abstract

Objectives

Although suicidality (e.g., suicidal ideation, planning, and attempts) is highly prevalent among adolescents in the United States (U.S.), few studies have explored the interrelationships of societal, community, family, and individual risk factors that collectively contribute to youth suicidality. This study aimed to estimate the complex interplay of multilevel factors associated with youth suicidality in the U.S., stratified by sex.

Study design

Population-based cross-sectional study.

Methods

Using data collected from a nationally representative sample (N = 17,263, 48.0 % female) in 2023, multigroup structural equation modeling was used to assess the direct effects and indirect pathways of social disadvantage, family adversity, and violence victimization on self-report suicidality (ideation, planning, and attempts) among male and female adolescents.

Results

Social disadvantage, family adversity, and violence victimization were intercorrelated and collectively contributed to youth suicidality, with sex-specific patterns. Among males, violence victimization showed the strongest direct and total effects on suicidality. Among females, however, family adversity had the strongest direct effect while social disadvantage showed the strongest total effects on suicidality. The correlation between violence victimization and suicidality was statistically stronger in males, whereas social disadvantage was more strongly correlated with family adversity in females.

Conclusions

To address the intercorrelated, multilevel factors associated with youth suicidality, comprehensive strategies and sex-specific protocols are needed. For males, it is recommended to screen for a broad range of violence victimization to facilitate early identification of at-risk groups. For females, addressing the impact of social disadvantage and family adversity is essential to reduce the risk of suicidality.