Suicidal Ideation Among Midwestern Students: a social ecological approach

Background Suicide is the 2nd leading cause of death for adolescents in the United States and adolescents represent 11% of all suicide cases. Meanwhile, Indiana has the 2nd highest adolescent suicide rate (14.5 per 100,000) and adolescents represent 19% of all suicide cases (See Figure 1). However, Illinois has the 5th lowest adolescent suicide rate (10.6 per 100,000) and adolescents represent only 6.5% of all suicide cases (See Figure 1). Therefore, identifying adolescents at risk for suicide remains a top priority for clinicians and mental health professionals. One possible approach is to identity adolescents that have serious thoughts of committing suicide, or suicidal ideation, because an estimated 75% of suicide victims reported having suicidal ideation within the past year. Objectives The objective of this study is to explain the interplay between state of residence and suicidal ideation, while identifying key characteristics, school environments, and other risk factors that may explain the varying adolescent suicide rates between two neighboring Midwestern states with similar demographics. Methods Data from the 2015 Youth Risk Behavior Survey tested a 2-level Hierarchical Linear Model that assessed the impact of student level risk factors, school level risk factors, and state of residence on suicidal ideation in the past 12 months. Results State of residence has a direct effect on student’s hopelessness (β = 0.407, p < .05) and an indirect effect on suicidal ideation (β = 2.430, p < .001) (See Table 1). Suicidal Ideation is a function of student-level hopelessness experience of bullying (β = 0.881, p < .001), alcohol use (β = 0.432, p < .001), and experience of sexual assault (β = 0.865, p < .001), as well as prescription drug misuse at both the student (β = 0.453, p < .001) and school (β = 0.308, p < .001) levels (See Table 1). Conclusion Students residing in Indiana are at a 50% greater risk of experiencing hopelessness than students residing in Illinois. Since experiencing hopelessness increases the risk of suicidal ideation by 1,136%, Indiana students are at a much greater risk for suicidal ideation. The low generalizability, the cross-sectional nature, and the use of self-reported measures limit this study. Subsequent studies or interventions should focus not only on student’s feelings and experiences, but rather a combination of school, community, and state factors as well. Explaining key differences in hopelessness between these two Midwestern states may help to better inform prevention efforts.