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.