The Relationship Between Family Dynamics and Help-Seeking and Disclosure of Adolescent Self-Harm and Suicidality: A Population-Representative Study: Relation entre dynamique familiale et recherche d'aide, et dévoilement des actes d'automutilation et de la suicidalité chez les adolescents : étude représentative de la population.

Background: Few studies have explored the potential for family dynamics to hinder or promote help-seeking and disclosure behaviours among adolescents who self-harm or experience suicidality. We sought to examine whether family dynamics may influence self-harm-related disclosure to parents or other family members and online help-seeking.

Methods: We identified youths, 14-17 years, in the 2014 Ontario Child Health Study (OCHS) who self-reported past-year suicidal ideation (with or without a suicide plan or past suicide attempt[s]) and/or non-suicidal self-harm. The OCHS is a provincially representative, cross-sectional survey. The person most knowledgeable about the adolescent, usually the mother, reported family dynamics: family dysfunction and positive and negative parenting practices. We used logistic regression to generate adjusted odds ratios.

Results: A total of 359 adolescents positively endorsed past-year suicidal ideation and/or non-suicidal self-harm. Disclosure and help-seeking were common (≥67.3% and ≥25.6%, respectively). Adolescents experiencing suicidal ideation and greater family dysfunction were more likely to share their suicidal thoughts with non-family compared to not telling anyone (OR = 1.09, 95% CI: 1.01 to 1.18) and were less likely to tell their parents or other family members about their suicidal thoughts when compared to non-family such as teachers, partners, or friends (OR = 0.82, 95% CI: 0.71 to 0.94). Positive parenting was not associated with any form of disclosure or online help-seeking for non-suicidal self-harm or suicidal ideation. As adolescent exposure to negative parenting increased, so did the likelihood that they would seek help online for their suicidal thoughts (OR = 1.22, 95% CI: 1.08 to 1.37). Sensitivity analyses replicated or were very similar to findings from the main models.

Conclusion: We found that negative family dynamics were related to reduced sharing of suicidal thoughts with parents or other family members and greater online help-seeking. Our findings suggest that the importance of negative family dynamics to disclosure and support-seeking for adolescent suicidality may be under-recognized.