Family Check up Effects on Suicidal Ideation and Behaviors: Long Term Effects

Suicidal ideation and attempts are highly prevalent in adolescence, and are related to a range of risk factors, including youth depression and family dysfunction (e.g. King et al., 2001). This paper examines the impact of the Family Check-Up (FCU; Dishion & Stormshak, 2007) prevention model on suicidal ideation and behaviors in late adolescence.   The FCU is an adaptive, family-focused, school based prevention program for adolescent emotional and behavior problems, and has been shown to reduce levels of depression and to improve family functioning.  

Students (N=998) were randomly assigned in 6th grade, and half the families were offered a multilevel intervention that included (a) a universal classroom-based intervention, (b) the FCU (selected), and (c) family management treatment (indicated).  All services were voluntary, and approximately 25% of families engaged in the FCU. Suicidal risk was measured by youth reports to two items on the Life Events Coping Inventory (Dise-Lewis, 1988), “I think about committing suicide,” and “I hurt myself physically.” This measure was completed by the subset of elevated-risk youth, based on teacher reports, at waves 1 - 3 (n = 388 at wave 1), and by all youth waves 6 and 7. Additionally, diagnostic interviews were administered to youth at age 19, using the Composite International Diagnostic Interview (CIDI; World Health Organization, 1997), with current analyses focused on reports of suicidal ideation or attempts.

Across waves 1 to 7, 6.8% to 14.2% endorsed suicidal ideation or self-harm on the LECI. On the CIDI, 10.7 % of youth endorsed recurrent thoughts of death, 5.6 % recurrent suicidal ideation, and 1.5% ever attempting suicide. A Latent Growth Model examined changes in suicide risk via LECI items across waves 1 to 7. Suicide risk followed a curvilinear trajectory, showing positive growth but significant deceleration in the rate of change over time. Intervention status predicted a significantly more negative quadratic change (estimate = -.21, SE = .09), with treatment predicting greater deceleration in suicide risk over time. We also examined the effects of treatment on age 19 suicidal ideation / attempts.  Intervention was associated with a significant reduction in suicidal ideation/attempt by age 19, but only for females (beta = -.80, SE = .36). 

These results highlight that the family-centered prevention program predicts significant reductions in suicidal ideation / attempts in late adolescence and early adulthood.  Future directions in this research include investigating the mechanisms of how participation in the FCU influenced suicide risk.