Family functioning undoubtedly has a significant role to play in understanding both, the etiology, as well as the treatment of adolescent suicidality. Evidence consistently demonstrates that when family structures, dynamics, and processes are disturbed, there is a higher risk of not only adolescent suicide ideation, but also suicide attempts (Pfeffer, 1989). The fact that literature investigating the relationships between family functioning and adolescent suicide is lacking (Adams, Overholder, & Lehnert, 1994) is cause for worry, since family life is one of the most inescapable, and specific domains in the lives of adolescents; suicide attempts and completion of adolescents, might thus be reflective of a last resort in escaping a family situation that is perceived as unbearable (Pfeffer, Plutchik, Mizruchi, & Lipkins, 1986).
In highly industrialized counties, immense changes have taken place in the composition and functions of family units over the past several decades (Hamburg, 1992; Robins, 1995). While some of these changes may be beneficial, a host of others represent a detrimental effect on the development of adolescents (Robins, 1995). Due in part to these changes, a substantial majority of children and youth will spend several years of their life in one parent families (Hamburg, 1992; Steinberg, 1996). One third to half of these children living in one parent families, whose parents may then subsequently remarry, will likely see these second marriages come to an end in their adolescent years (Steinberg, 1996). These inconsistent patterns in parent relationships, and by extension, their relationships with their children predict stress for developing adolescents (Garnefski & Diekstra, 1997). The following paper attempts to explain the effects of one type of family change on adolescent suicidality, that of parental separation or divorce.
The divorce rate in the United States is high; about 40-50% of all married couples divorce, with rates for second or any subsequent marriages being even higher (American Psychological Association, 2018). Further, a small percentage of marriages also end in permanent separation, as opposed to legal divorce, and as such it would not be incorrect in approximating that about half of all marriages end in voluntary, permanent disruption (Amato, 2010). Research over the years reliably establish that adolescents of separated or divorced parents exhibit a variety of behavioral, emotional, social, academic, and health problems, when compared with children from intact families (Frisco, Muller, & Frank, 2007; Sun & Li, 2002).
The essential task of adolescence as described by Erikson is the development of identity. This is developed, in part through identification with their parents, particularly the same sex parent. Identity crisis can result, however, during divorce that could result in the absence of at least one parent. Consequently, parent-adolescent struggles could ensue, wherein:
…the mother may force the male child to identify with her, creating anxieties and marked defensiveness in the child. In contrast, the remaining parent is often manipulated…into playing the role of the absent parent. (Sorosky, 1977, p. 129)
The psychological effects on the adolescent are several. There is also a strong link between parental separation/divorce and adolescent suicidal behaviors (Consoli et al., 2013; Garnefksi & Diekstra, 1997; Gould et al., 1996; Xing et al., 2010).
Suicide among adolescents is a major public health crisis that warrants research attention. Suicidal behaviors can be understood as falling on a continuum from suicidal ideation to suicide completion. Suicidal ideation refers to thoughts or wishes to kill oneself; suicide attempts refer to behaviors that are self- inflicted with the intention of killing oneself, and suicide completion refers to death that has been self-inflicted. Suicide completion is one of the leading causes of the premature deaths within the adolescent population. While national rates and estimates of adolescent suicides are underreported due to errors in classifications by authorities (Hawton, Saunders, & O’Connor, 2012), it is still the third most common cause of death among adolescents and young adults in the age group of 10-24 (Eaton et al., 2008) and the most common cause of death of adolescent females between the ages of 15 and 19 (Patton et al., 2009). The rates of completed suicides among adolescents might be increasing (Bridge, Greenhouse, Weldon, Campo, & Kelleher, 2008) and suicidal ideation and suicidal attempts occur at an even higher frequency than suicide completion (Timmons, Selby, Lewinsohn, & Joiner, 2011). The epidemiology of suicidal ideation among 9-12th graders in the USA as of 2007 was reported to be 14.5%, with nearly 6.9% attempting suicide in the year prior (Eaton et al., 2008). A host of risk factors have been implicated, including psychopathology, drug and alcohol abuse, poor family relationships, childhood sexual abuse, and bullying (Hawton, Saunders, & O’Connor, 2012).
How parental separation and divorce increases the risk of adolescent suicidal behaviors, including suicidal ideation, suicide attempts, and suicide completion, are explained below.
A study (Rubenstein, Halton, Kasten, Rubin, & Stechler, 1998) of 272 high school students found that 13.6% of them were suicidal. Suicidal behaviors, here, were defined as those behaviors that were destructive and done with the intention of killing oneself. In assessing how parental marital status was directly associated with adolescent suicidal behavior, it was found that the cohesiveness and intactness of families have a complex impact on adolescents. Those adolescents with separated or divorced parents had higher rates of suicidality than adolescents whose parents were married and living together. Cohesiveness within families buffers against stressful events, lowering the risk of suicidality up to five times. Parental separation and divorce, however, reduce the levels of family cohesion, and increases the stress of adolescents. In experiencing themselves as part of a unit that suffers from a lack of cohesion, their stress as a function of their age, and the changes that come with it, is further compounded, resulting in an increased risk for suicidal behaviors. The stress from such negative life events, leading to adolescent suicidal ideation and attempts, become even more salient, when these parents are unable to provide and help their child through the resulting adjustment period. (Adams, Ovrholser, & Spirito, 1994).
Concurrent findings were reported even in other countries, like China (Xing et al., 2010) and Korea (Lee, Namkoong, Choi, & Park, 2014) over a decade later. Adolescents demonstrated an increased risk of suicidal ideation and suicide attempts if their parents were divorced. Divorce lowers social resources within the family, due to fewer, and inconsistent interactions with at least one parent. This subsequently causes poorer emotional bonding and lower levels of well-being, resulting in a higher likelihood of suicide attempts. Further, living with only a father after parental separation/divorce increases suicide attempts among adolescent girls, due to a lack of communication and bonding with the mother, lowering their life satisfaction and increasing their suicidal ideation. Asian adolescent boys living with one parent reported higher levels of suicidal ideation than adolescents whose parents were married and living together; experiencing significantly more adjustment, emotional, and behavioral problems (Ang & Ooi, 2004). In Trinidad and Tobago (Ali & Maharajh, 2005), adolescents with separated or divorced parents were reported to have the highest risk for suicidal ideation compared to other adolescents from intact family structures. These studies point to the fact that culture does not prove to confound the impact that parental separation and divorce have on adolescent suicidal behaviors.
The homes of adolescents who had attempted suicide were marked by conflictual family functioning arising from parental divorce that led to a pattern of instability, unhappiness, and poor parental functioning in the home. As a result of this, adolescents reported maladaptive adjustment, feeling rejected, unloved, and like they were not worthy of love, eventually culminating in a suicide attempt (Tishler, McKenry, & Morgan, 1981). Parental separation/divorce result in changes in the ways in which the family roles were previously distributed and serves to hamper familial and personal growth. Such dysfunctional roles are associated with suicidal thinking, and also leads to difficulties in effective problem solving as well as communication, which lead to suicidal ideation and suicide attempts. The redistributed family functions, to the adolescent, are reflective of concrete changes within their family unit, and can lead them to suicidal ideation, suicide attempt, and suicide completion (Martin, Rozanes, Pearce, & Allison, 1995).
Every suicide attempt is indicative of an underlying message. When individuals attempt and succeed in committing suicide, it is likely because the message was not heeded (Portes, Sandhu, & Grice, 2002). Within separated and divorced families, there is a high probability that the adolescents tried to signal their difficulties and issues. The chaos resulting from parental marital status, however rendered the parents unable to respond until the signal became impossible to ignore- by way of a suicide attempt. The adolescent in this case would be using their suicidal behaviors to somehow force their parents to take note, or to retaliate against them for not doing so in the first place (Paluzny, Davenport, & Kim, 1991). When parents allow their marital problems to result in a chaotic environment, adolescents are likely to perceive their entire family as suffering from problematic communication patterns, power dynamics, and inefficient control. Suicidal behavior then, is likely when adolescents view the parents themselves as emotionally deficient, inclined towards crises, unable to adapt to change, and inept at solving problems (Adams, Overholser, & Lehnert, 1994).
The interpersonal theory of suicide (Van Orden, Witte, Cukrowicz, Braithwaite, Selby, & Joiner Jr, 2010) suggests that most hazardous forms of suicidal ideation results from the occurrence of the two interpersonal constructs of thwarted belongingness and perceived burdensomeness. Thwarted belongingness results when the individuals need for social connected ness is not met. Loneliness, social isolation, and the lack of mutual caring relationships can lead to a sense of thwarted belongingness, which greatly increases the risk for lethal suicide attempts. Feeling of thwarted belongingness are also more likely to lead to a suicide attempt when combined with perceived burdensomeness. Perceived burdensomeness focuses on individuals feeling that they are expendable, and are not needed within the family system. Such feelings are highly associated with suicidal behavior in adolescents (Woznica & Shapiro, 1990).
The theory has found support and validity with respect to adolescents in a host of studies (Stewart, Eaddy, Horton, Hughes, & Kennard, 2017). The relationship of adolescent suicidal ideation and suicide attempt with familial risk factors change over time. Adolescence involves the developmental task of the search for identity that is also governed to some extent by the challenges posed by their “changing relationships with parents” (Stewart, Eaddy, Horton, Hughes, & Kennard, 2017, p. 438). Parental separation/divorce causes displacement in the parent-adolescent relationship, and represents one of the most important psychosocial risk factors for the suicidal behavior of adolescents (Bridge, Goldstein, & Brent, 2006). Such marital problems cause a profound sense of disruption in the relationship between the adolescent parent and has been found to be associated with suicide attempts and suicide completion (Gould et al., 1996). Adolescents’ relationships with their parents are reflective of an important and supposedly stable source of belonging for adolescents; it is an implicit assumption of their role as parents to provide a reciprocal relationship characterized by care and love (Timmons, Selby, Lewinsohn, & Joiner Jr, 2012). Thus, while feelings of parental belongingness and connectedness exhibit characteristics of a protective buffer against adolescent suicidal behavior (Resnick et al., 1997), parental displacement resulting from parental separation/divorce, disrupts their relationship and causes negative consequences in their sense of belonging. This is accomplished due to the lowered levels of not only the frequency, but also the quality of the interactions between the parent and adolescent (Timmons, Selby, Lewinsohn, & Joiner Jr, 2012; Xing et al., 2010). These studies, thus point to the fact that the loss of belongingness and heightened displacement resulting from the separation or divorce of parents lead to adolescent suicidal behaviors.
The extent to which the adolescent feels burdensome or expendable is also an important precipitant of suicidal behavior. Scapegoating or expendability can be defined as a “parental wish, conscious or unconscious, spoken or unspoken, that the child interprets as their (the parents’) desire to be rid of him, for him to die” (Sabbath, 1969, p. 272-273). This feeling is evoked quite commonly during parental divorce. If the adolescent is encouraged- in the process of separation-by one parent to turn against the other, the results are even more calamitous. Orbach (1989) describes a particularly disturbing account of a female adolescent who was scapegoated by her father, and attempted suicide three times, after he would repeatedly try to win her approval by saying that her mother did not want her as a daughter, and wished she had an abortion.
During both, separation and divorce, the adolescent may feel responsible for the dissolution of their parents’ marriage, feeling like their parents are better off without them (feelings of expendability), and subsequently impose on themselves the burden of attempting to keep them together. Fearing abandonment more and more, they will increasingly distance and withdraw themselves from the family to safeguard themselves from the pain caused by the disruption of the family. Their feelings of safety and security may also be threatened due to the inescapable pressures caused by divorce. For example, if the adolescents’ mother goes to work for the first time after the divorce, fears of loss and abandonment are further exacerbated. When all attempts at keeping the parents together and distancing themselves from their pain inevitably fail, adolescents become disillusioned with life, and are confused about why they should continue to live. (Sorosky, 1977). Further, and perhaps even more disturbingly, adolescents can feel burdensome during custody battles that ensure, especially when the paternity of the child is contested (Glennon, 2001).
Orbach (1989) suggests that such problematic family dynamics are likely to create a split in the relationship between the parents and the suicidal adolescent. Occasionally, in contrast to making the child feel expendable, the parents may actually use them problematically in trying to cope with their own negative feelings. In attempting to cope with this split, the adolescent resorts to suicidal behavior. They may feel that taking an extreme step such as committing suicide and simply defeating themselves instead of it happening at the hands of their family, is a better way of dealing with such insolvable problems; the adolescent feels that there is no other choice that they have, similar to the feelings expressed by Nora: “I have no chance to get out of this…I have been trying to kill myself…I want to show everyone that I have no chance.” (Orbach, 1989, p. 364).
Parental separation/divorce also represents real threats of newcomers coming into the family in the form of step parents. Such potentialities are especially stressful for girls and are associated with higher levels of suicidal ideations, due to the fear that they will lose not only their independence but also their relationship with their mother. While the relationship between the parent and adolescent during separation or divorce is influential, studies controlling for this factor still found a significant relationship between parental divorce and adolescent suicidal behaviors (Hetherington, 1989; Ponnet et al., 2005).
When the family structure collapses due to marital disruption, the adolescents report suicidal tendencies, such as a sixteen-year-old boy from Iran reporting, “I could not tolerate being away from my mother. I preferred to die.” (Bazrafshan, Sharif, Molazem, & Mani, 2015, p. 3). Unfortunately, parents seemingly do not prepare their children in advance of the separation/divorce, or fail to recognize its impact on the adolescent, as evidenced by a mother saying, “The very next day I got separated from my daughter’s father, she took some pills. Our divorce was a big shock for her.” (Bazrafshan, Sharif, Molazem, & Mani, 2015, p. 3).