1. Adolescent suicide risk: four psychosocial factors
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Philip A. Rutter
Suicide is a leading cause of death among those aged 15-24 (Berman &
Jobes, 1995; Centers for Disease Control, 2002). Consequently, in the U.S.,
a National Health Objective (National Institute of Mental Health, 2001) urges
researchers to focus on ways to decrease the adolescent suicide rate by more
than 25% within the decade.
Adolescent suicide research has, by and large, focused on demographic risk
factors (Brent, Baugher, & Bridge, 1999; Levy, Jurkovic, & Spirito, 1995).
This approach provides descriptive data and correlates demographics with
suicide risk. Numerous studies have examined the incidence of suicidal
thoughts and suicide attempts by age, race, educational level, family
background, religion, socioeconomic level, sexual orientation, and other
demographic variables (D'Augelli, Hershberger, & Pilkington, 1996; Levy,
Jurkovic, & Spirito, 1995). Such studies focused on who is at risk, but did not
explain why certain youths may be at risk for suicide. For example,
adolescents with substance abuse problems, psychiatric disorders, family
disruption/stress, antisocial behavior, or family suicide history are said to be
at greater risk for completing suicide. This does not explain the context of an
adolescent's propensity for suicide, and is problematic in the formulation of
effective intervention strategies (Grholt, Ekebrg, & Wichstrom, 2000).
This approach also suggests that adolescents of a certain demographic may
be at higher risk for suicide, but focusing on demographics alone may lead to
misidentifying those not at risk, as well as bypassing those who are actually
at risk for suicidal behavior (Pfeffer, Klerman, Hurt, Lesser, Peskin, & Seifker,
1991). For example, D'Augelli and Hershberger (1995) suggested that gay,
lesbian, and bisexual adolescents exhibit greater suicide risk than their
heterosexual peers. However, Rutter (1998) found that sexual orientation
alone did not impact suicide risk. Rutter and Soucar (2002) reported that
adolescents who endorsed items citing the presence of social support from
peers and family displayed less suicide risk, regardless of their sexual
orientation.
The majority of suicides occur among Caucasian adolescents; consequently,
most interventions are based on Caucasian adolescents' suicidal behavior.
Yet, rates among Native American, Hispanic, and African American
adolescents have increased dramatically in the past decade. Recent research
suggests that racial and ethnic minority adolescents exhibit suicide risk
differently, are unlikely to be assessed accurately, and are often overlooked

2. as "at risk" (Canino & Roberts, 2001; Choquet, Kovess, & Poutignat, 1993;
Scouller & Smith, 2002).
Blum, Beuhring, Shew, Bearinger, Sieving, and Resnick (2000) have
suggested that researchers look within more proximal social contexts to
understand what predisposes some adolescents to increased suicide risk. In
keeping with the aforementioned National Health Objective (National
Institute of Mental Health, 2001), examining the psychosocial correlates
within a particular demographic group may be a more efficacious approach to
predicting who is at highest risk for suicide. The purpose of the present study
was to ascertain the salience of combining four psychosocial variables as
potential predictors of suicide risk.
METHOD
Participants
A sample of one hundred adolescents, with an equal number of male and
female participants, was recruited from a sexual minority support agency (n
= 50) and an urban university (n = 50). Fifty-three percent of the
participants were Caucasian, 25% African American, 6% Asian, 3% Hispanic,
and 13% identified themselves as either biracial or Native American.
Fourteen percent were 17 years old, 37% were 18 years old, and 49% were
19 years old. In terms of sexual orientation, 26% self-identified as
homosexual, 24% as bisexual/questioning, and 50% as heterosexual. This
was a nonclinical sample and participation was voluntary.
Procedure
The exploration of psychosocial factors in relation to suicide risk is by no
means new. There is extensive literature on how certain individual factors
can affect suicidal behavior. The current study explored adolescent suicide
risk across multiple psychosocial factors (hopelessness, negative self-
concept, hostility, and low social support). The instrument combined the
Suicide Probability Scale (SPS; Zachary, Roid, Cull, & Gill, 1983), the Beck
Hopelessness Scale (BHS; Beck, Brown & Steer, 1989), the Suicide
Questionnaire (SQ; Meehan, Lamb, Saltzman, & O'Caroll, 1992), and a
demographics form (Rutter, 1998).
The SPS is a reliable 36-item Likert-type self-report inventory focusing on
hopelessness, hostility, suicidal ideation, and negative self-concept. The BHS
is a psychometrically sound self-report measure that has 20 true-false
statements to assess negative beliefs about the future. Scores range from 0
to 20, with higher scores indicating greater levels of hopelessness. The SQ
was modified from its original form as an inpatient clinical interview.

3. Reliability and validity have yet to be established, although the SQ has been
reported to exhibit high face validity and to offer a nonthreatening method of
assessing suicidal ideation, plans, and attempts (Muehrer, 1995). The
demographics form contains questions about the adolescent's ethnicity,
sexual orientation, and education level, as well as questions about the level
of social support received from friends, family, and school staff.
FINDINGS
To assess suicide risk across demographic and psychosocial variables,
participants were first grouped into a lowest quartile (Group 1; n = 25) and a
highest quartile (Group 2; n = 25) according to their scores on the SPS.
Participants in Group 2 has a significantly higher score (M = 7.72, SD =
3.59) on the BHS than those in Group 1 (M = 2.44, SD = 1.66). A
statistically significant positive relationship was found between SPS and BHS
scores (p < .01).
Groups 1 and 2 (lowest and highest SPS quartiles) were compared across
responses to three items (7, 8, and 9) from the SQ. These items asked
participants if they experienced injury resulting from their suicide attempt
(item 7), if their attempt was serious enough to require medical care (item
8), and whether hospitalization was required after their suicide attempt (item
9). A t test indicated a statistically significant difference (p < .01) between
the two groups on their responses to item 7. Group 1 experienced much
lower injury from their suicide attempt (M = 2.00, SD = 1.98) than Group 2
(M = 2.76, SD = 2.76). The comparison of the two groups on item 8
(attempt serious enough to require medical care) and item 9 (hospitalization
required after suicide attempt) suggested differences between groups, but
results were not statistically significant (item 8:F = 4.00, p = .051, and item
9:F = 1.39, p = .24). Results from t tests approached statistical significance
regarding a relationship between perceived social support and SPS scores (p
= .057).
Finally, demographics were explored using the two groups. No statistically
significant correlation between any one demographic and suicide risk was
found. Analysis included comparing SPS scores across race (F = .03, p = .
855), gender (F = .88, p = .352), and sexual orientation (F = .02, p = .887).
DISCUSSION
Limitations of this study should be noted. First, the sample included a group
of sexual minority youth recruited from a support agency. This support may
have skewed their responses in a positive direction. Second, while the data
can serve as impetus for a larger project, the current findings are exploratory
in nature and may not be generalizable. Third, the assessment of support

4. could have been more comprehensive. With this said, the data do offer
insight into the significance of psychosocial factors in assessing adolescent
suicide risk.
A higher SPS score was related to a higher level of hopelessness and to
greater seriousness of the suicide attempt. High and low scores on the SPS
differed significantly in their BHS scores and their responses to item 7 of the
SQ (injury resulting from suicide attempt). While the two SPS groups differed
in terms of social support (high scores reported low social support and low
scorers reported high social support, this difference was not quite statistically
significant.
These data are consistent with and build upon previous research that focused
on the individual psychosocial factors of hopelessness (D'Augelli,
Hershberger, & Pilkington, 1997), hostility (Cull & Gill, 1989), poor self-
concept (Cetin, 2001; Harter & Marold, 1994), and low social
support/isolation (Rutter & Soucar, 2002). What emerges from the data in
the present study are that these four factors (hopelessness, hostility,
negative self-concept, and isolation) collectively correlate with increased
suicide risk.
Hopelessness is a significant indicator of adolescent depression and potential
for suicide. Hopelessness and its clinical manifestations can be situational or
transient (Beck, Brown, & Steer, 1989). Combined with adolescents'
impulsive nature, the presence of hopelessness can be quite dangerous
(Hollander, 2000). Therefore, accurate assessment of adolescent suicide risk
should include an indication of current levels of hopelessness (Dori &
Overholser, 1999).
Hostility has long been associated with suicide. Schneidman (1969) defined
self-injury as hostility turned inward. More recently, hostility among
adolescents has been associated with punitive self-injury aimed at an
external person, such as a parent or peer (Meehan et al., 1992).
Self-concept is also a psychosocial factor that warrants inclusion. Research
indicates that adolescents incorporate personal, school, and social failures as
elements of their self-concept (Berman & Jobes, 1995; Harter & Marold,
1994). Researchers exploring this variable have maintained that poor self-
concept can lead to self-loathing and to an adolescent's consideration of
suicide (Grholt et al., 2000; Hatter & Marold, 1992).
Finally, social support is related to healthier adolescent functioning. Support,
as a construct, has been defined as a sense of belonging, specifically among
peers, teammates, community, or family members (Grholt et al., 2000).
Adolescents reporting strong social support (low isolation) exhibit higher

5. levels of resilience and lower levels of suicide risk. Adolescents are also less
likely to be suicidal if they perceive their family, friends, and peers to be
more accepting, and if they have more positive friendships (Harter, Marold,
Whitesell, & Cobbs, 1996). Those who feel supported by counselors, parents,
or peers exhibit healthier coping mechanisms and maintain a more positive
outlook about their future (DeWilde, Kienhorst, Diekstra, & Wolters, 1993).
In contrast, adolescents who lack social support and experience isolation may
behave in self-injurious ways (Himmelman, 1993; Remafedi, Farrow, &
Deisher, 1991; Spruijt & de Goede, 1997).
These four psychosocial variables, taken collectively, appear to improve the
ability to assess and predict adolescents' suicide risk. This should be verified
through additional research using a larger sample, a variety of school
settings, and with additional items to assess social support.
Future work could clarify whether improving any one of the four psychosocial
factors will influence the other factors and decrease overall suicide risk. For
example, clinical strategies aimed at increasing levels of social support may
reduce an adolescent's level of hostility, hopelessness, or negative self-
concept. The results of this and prior studies warrant exploring the individual
and collective impact of these variables in reducing levels of suicide risk. We
speculate, for example, that the gay and lesbian participants in the present
study may have exhibited lower suicide risk because they were members of a
community-based youth center for sexual minorities. Their membership may
have contributed to less isolation, hopelessness, and hostility, and to feeling
better about themselves.
While many today conceptualize suicide as an experience located within the
individual, pioneering work on suicide focused on underlying social factors
that impact individuals, leading them to be more, or less, suicidal. Durkheim
(1897/1951) stressed the importance for individuals to feel connected and to
be socially integrated. Those with weaker social ties and those suffering from
a bewildering sense of not belonging, what he referred to as anomie, are
more likely to commit suicide. This is consistent with the four psychosocial
factors that the present study has found to correlate with suicide risk among
some adolescents.
This perspective suggests the need to design dual-approach interventions
that work with both the individual and within society. The individual may
benefit from strategies to reduce hopelessness, hostility, negative self-
concept, and isolation. Social policy makers wishing to reduce suicide might
consider strategies that would combat anomie by encouraging small group
participation for marginalized individuals. Further, while our study examined
adolescents, the findings may have implications for other groups (e.g., the
elderly).

6. Other factors should not be ignored in assessing adolescent suicide risk,
including previous suicide attempts, a history of others in the family who
have been suicidal, mental illness, alcohol and drug use, and other self-
destructive behaviors. Nevertheless, school counselors, therapists, and
others in the helping professions will be better equipped to intervene and
reduce suicide risk when they focus on adolescents' level of hopelessness,
hostility, negative self-concept, and isolation.
The authors wish to thank the School of Education Research Center, Laura
Goodwin, and Kimberly White for their assistance.
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The authors wish to thank the School of Education Research Center, Laura
Goodwin, and Kimberly White for their assistance.
Philip A. Rutter is an assistant professor within the Counseling Psychology
and Counselor Education program at the University of Colorado at Denver.
Andrew E. Behrendt is a consultant and private practitioner in Philadelphia,
Pennsylvania.
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