Introduction
Adolescence is characterised by major developmental and psychological
shifts, often coinciding with increased suicidal ideation and behaviour
(Bridge, Goldstein, & Brent, 2006; Husler, Blakeney, & Werlen, 2005).
Globally, it is estimated that one person dies from suicide every 40
seconds, with suicide the second leading cause of death among those aged
15 to 29 years (WHO, 2016). Among Australians aged 15 to 24 years,
suicide is the leading cause of death and accounts for over one third of
deaths (36%). These statistics are alarming and highlight the high
prevalence of suicide in young Australians.
Although suicidal thoughts and comorbid problems should serve as an
internal signal to seek help, suicidal adolescents frequently withhold
their distress from adults or professional services (McCarty, et al.,
2011; Pisani, Schmeelk-Cone, Gunzler, & Petrova, 2012). As a result,
less than a third of suicidal adolescents receive treatment at the time
of their death/attempt, despite 80% to 90% presenting with a
diagnosable psychological disorder (Gould, et al., 2003; Sheppard,
Deane, & Ciarrochi, 2018; Wu, Liu, Fan, & Fuller, 2010). For
adolescents at risk of suicide, communicating their distress and
suicidal ideation with others may lead to life saving interventions
(Pisani et al., 2012).
Despite the prevalence of mental illness among young people, many remain
untreated or experience multiple help-seeking contacts before receiving
appropriate care (MacDonald, Falnman-Adelman, Anderson, & Iyer, 2018).
Appropriate help-seeking and pathways to care (PtC) are essential for
prevention and early intervention in suicidal adolescents . However,
research on the PtC for adolescents with suicide ideation is limited.
Most research on PtC has focused on help-seeking in response to
hypothetical suicide ideation , or first-episode psychosis .
Appropriate PtC for suicidal adolescents can reduce the impact of mental
health problems and the incidence of relapse or recurrence (Allen &
McKenzie, 2015). In two Australian studies, one with university students
(Deane, Wilson, & Ciarrochi, 2001) and another with high school
students (Wilson, Deane, & Ciarrochi, 2005a), it was found that an
increase in suicidal ideation significantly predicted lower intentions
to seek help from formal (e.g. mental health professional, general
practitioner, helpline) and informal (e.g. friends, family, parents)
contacts in both clinical and non-clinical samples. This phenomenon has
been referred to as “help-negation” and this along with low rates of
help-seeking in suicidal individuals, highlights the need to better
understand the processes involved in help seeking. One rarely explored
opportunity is to expand knowledge about PtC for those who are
successful in seeking help. Greater insights into PtC would allow
suicide prevention services to better identify strategies (e.g., health
literacy, referral strategies etc) to target appropriate links in the
pathways to care.
Although the importance of formal contacts has been recognised in the
help seeking process, often families, friends and caregivers play a
significant role in the pathways to professional services, and act as
primary contacts on the PtC for adolescents (Fridgen, et al., 2013;
McGorry, 2007; Rickwood, et al., 2007). Families have been found to be
highly involved in the PtC of adolescents and have been identified as
the most common first contact for help (Del Vechhio, et al., 2015;
Fridgen, et al., 2013). They also recommend further help-seeking
contacts (Chadda, Agarwal, Singh, & Raheja, 2001), or directly initiate
contact with help sources (Ehmann, et al., 2014; Giasuddin, et al.,
2012).
An adult caregiver’s familiarity with mental health issues, particularly
personal experience of mental health problems and psychological
treatment, may influence the nature of an adolescent’s PtC and increase
their likelihood of seeking help (Lutgens, Malla, Joober, & Iyer, 2015;
Schmeelk-Cone, Pisani, Petrova, & Wyman, 2012; Sullivan, Marshall, &
Schonert-Reichl, 2002). However, research on caregiver’s familiarity
with mental illness and PtC for their children has been mostly limited
to first-episode psychosis and with conflicting findings. For example,
Chen et al. (2005) found caregiver experience of mental illness was
associated with shorter delays to treatment, whereas Norman et al.
(2007) reported the reverse relationship and Lutgens et al. (2015)
reported that caregiver familiarity did not affect the delay in
treatment of psychosis. The disparity in findings has been attributed to
different service contexts and sample characteristics.
In the context of suicide, it is possible that family members with a
personal history of suicide or mental health problems may have; a higher
sensitivity to symptoms of suicidality, more positive attitudes towards
help seeking, and be more familiar with appropriate contacts. It has
been suggested that familiarity through personal experience may offer
caregivers greater sensitivity to and preparedness to navigate these
complexities, the ability to better recognise early signs of
psychological distress, and encourage more effective help-seeking (Chen,
et al. 2005; Lutgens, et al., 2015; Sullivan, et al., 2002). However,
these potential benefits have not yet been empirically tested. Even when
caregivers recognise the need for help, some report that it is often
difficult to access support (Stewart, et al., 2018). Thus, an
understanding of the relationship between caregiver’s personal
experiences of suicidality and prior mental health treatment and how
these might be related to their young person’s PtC in the context of
seeking help for suicidal behaviours is needed.
More specifically, we explore the relationship of these caregiver
variables and delay in the young person’s help seeking journey from
initial identification of a problem through to attending a specialist
suicide prevention service. This study aims to describe the: (i)
duration between the onset of presenting problem and seeking
professional help for suicidal youth, (ii) duration between the onset of
presenting problem and accessing a SP service for suicidal youth, (iii)
number of steps in pathways to accessing a SP service for suicidal
youth, (iv) primary contacts and initial contacts involved in the PtC
for suicidal youth, and determine (v) whether caregiver’s personal
experience of suicidality and mental health treatment is associated with
PtC for suicidal youth.