Adolescent suicide risk behaviors predictive model : testing a model of negative life events, rumination emotional distress, resilience and social support

Abstract

Adolescent suicide risk behaviors is one of the major mental health problems which causes death among youths between 15 and 24 years of age, and has been increasing in number over decades globally including in Thailand. This empirical research aimed to develop effective preventive intervention focusing on interactions between the individual and his or her environment, and testing a set of well-specified conceptual theoretical models. The purpose of this study was to test a structural predictive model in order to gain an understanding of how risk factors (rumination and negative life events) and protective factors (resilience and social support) would influence emotional distress and eventually influence suicide risk behaviors. Cognitive Theory and Response Style Theory of Depression were used to serve as a conceptual framework to identify interactions between rumination and negative life events as risk factors, as well as resilience and social support as protective factors of suicide risk behaviors among Thai adolescents. The specific objectives of this study were to examine the effects of risk factors on suicide risk behaviors, such as how such risk and protective factors were interrelated, and altogether how they explicated the mechanisms contributing to suicide risk behaviors among Thai adolescents. A multi-stage random sampling technique was used to select 1,417 adolescents attending schools in Bangkok. Data were collected by a set of self-report questionnaires including the Thoughts, Feelings and Experiences Questionnaire, the Rumination Response Scale, the State-Trait Resilience Inventory, the Multidimensional Scale of Perceived Social Support and the Negative Event Scale. The results of LISREL structural equation modeling revealed that the model fitted the data well (Chi-Square = 225.48, df=194, p=0.0602, GFI=0.982, AGFI=0.967, RMSEA=0.013). The variance accounted for 41.9 percent in adolescent suicide risk behaviors. This model showed that negative life events and rumination had significant indirect effects on suicide risk behaviors through emotional distress. Importantly, resilience and social support could reduce the influencing effects of all variables, because resilience mediated the effects of rumination and negative life events on emotional distress; whereas social support mediated and moderated the effects of rumination and negative life events on suicide risk behaviors. The findings have illustrated the knowledge and understanding of what means could be manipulated by nursing interventions in order to prevent suicide risk behaviors among adolescents, as well as to promote optimal mental health in this vulnerable population.