The Relationship between Internalizing and Externalizing Symptomatology and Parent/Adolescent Suicide Report Concordance: Implications for Prevention and Clinical Practice

Adolescent suicide is a global public health problem. Currently, most suicide prevention and treatment programs rely heavily on youth self-report in order to determine adolescent suicide risk. Parents may be useful informants, however, as there are times when parents are more likely to report suicidality than youth, particularly when youth display externalizing symptomatology, such as aggression and delinquency. This study compared parent-adolescent suicide report concordance among adolescents with internalizing versus externalizing symptoms and examined whether internalizing or externalizing youth were more or less likely than parents to report adolescent suicidal ideation. Using data from a subsample of adolescents recruited from inpatient and partial hospitalization programs for a separate study (n = 64), a one-sized z-test for proportions was used to compare parent-adolescent suicide report concordance for subsamples of adolescents with internalizing versus externalizing symptomatology. Two-sided z-tests for proportions were used to compare the proportions of parents and adolescents reporting adolescent suicidal ideation for discordant pairs in each subset. There were no statistically significant discrepancies in reports of suicidal ideation for the internalizing and externalizing subsets, nor were adolescents significantly more likely than parents to report adolescent suicidal ideation. Among the discordant pairs in the externalizing subset, the proportion of parents who reported that their adolescents had expressed suicidal ideation (60%) was higher than the proportion of adolescents who actually reported experiencing suicidal ideation (40%), though this difference was not statistically significant. For internalizing adolescents, the proportion of parents who reported their children had expressed suicidal ideation (63.0%) was significantly smaller than the proportion of adolescents who reported experiencing suicidal ideation (81.5%; p < .05). The clinical implications of these preliminary findings point to the importance of including parents in the process of assessing suicidality in order to help them recognize warning signs in their children.