Alliance Discussion with Dr. Phillip Baiden: Addressing Adverse Childhood Experiences in Youth Suicide Prevention
Suicide prevention researcher Dr. Philip Baiden, Associate Professor at the University of Texas at Arlington’s School of Social Work, joined us for an important alliance discussion on suicide prevention, moderated by Research!America’s own Jenny Luray, Senior Vice President for Strategy and Public Engagement. A leading expert in the field, Dr. Baiden’s vast expertise includes the social determinants of health, adolescent health risk behaviors, and substance use and mental health outcomes. Dr. Baiden spoke with us about his research on the relationship between adverse childhood experiences and suicidal behaviors in children and adolescents as we work toward a stronger understanding of suicide prevention and how to support those in need. Here are some of his thoughts on:
How to define and identify adverse childhood experiences that relate to youth suicidal behaviors:
“Adverse childhood experience (ACEs) are stressful or traumatic events that an individual experiences typically before the age of 18. The most cited in the literature include physical, sexual, and emotional abuse, physical neglect, emotional neglect, parental incarceration, domestic violence, household mental illness, substance use in the household, and parental separation or divorce. However, recently there has been a push to expand that definition of ACEs to also include children who are experiencing homelessness and bullying or cyberbullying. We also know that community violence, poverty, and housing inequality or experiences of racial discrimination, have the same devastating effects on the individual brain and life outcomes.”
“The mechanism through which ACEs affects mental health outcomes is varied but shows that the ACEs can trigger a unique stress response and disrupt ordinary child development. Stress is part of human life but there are various levels. We have a tolerable stress response – losing a loved one, being involved in a car accident – but when there is the right support mechanism, tolerable stress is manageable. It is when children don’t get the right support mechanism, that tolerable stress becomes toxic stress. That toxic stress goes on to affect the brain composition and how the brain responds to other life events, which then impacts various chronic conditions, including suicide. We do know from research that children who experience four or more adversities could be about seven times more likely to engage in substance use later in adulthood, and 12 times more likely to attempt suicide.”
Effective strategies and interventions from the Youth Suicide Research Consortium:
“The Youth Suicide Research Consortium is a group of [suicide] researchers across the United States led by Dr. Regina Miranda from Hunter College in New York. They focus primarily on how to prevent suicide among youth. I have focused on suicide among black youth within the consortium, doing research to identify risk factors and protective factors. We also focus on cutting edge research that can support clinicians and practitioners to best identify those who are at-risk and how to prevent [suicide].”
“Instead of focusing solely on the symptoms that we know are associated with suicide – hopelessness, depression, anxiety, quality of life – research shows that intervention should focus directly on preventing thoughts of suicide and the actual attempts. We have interventions such as cognitive behavioral therapy (CBT), dialectical behavior therapy, social skills training, as well as simple interventions such as supportive telephone calls or letters that are very effective in preventing suicidal thoughts and behaviors within the school environment. Interventions such as social emotional learning skills have been found to be very effective. Research also shows that regular physical activity helps the brain process stress, which can also help prevent suicidal thoughts and behaviors. While it is important to address hopelessness, depression, and mood-related factors, that alone is not sufficient. Direct intervention, such as CBT, which goes to the underlying thoughts and behaviors, has been found to be more effective than solely addressing the symptoms.”
Fundamental aspects of cognitive behavioral therapy:
“[CBT] is an intervention that focuses first on addressing the underlying cognition and thought processes, particularly when it comes to trauma-related events. There are various steps and processes that individuals go through during CBT intervention. They are taught to utilize those skills and tools that they learn during CBT when feeling depressed, sad, or hopeless to help them cope and prevent the occurrence of suicidal thoughts and behaviors.”
The primary funders for this research:
“There are several funding agencies that have prioritized suicide research and adverse childhood experiences, particularly among children, adolescents, and young adults. The National Institute of Mental Health and the CDC have funded [research] related to violence and injury prevention. The Substance Abuse Mental Health Services Administration also has ongoing funding related to suicide and opioid [use] among young adults, as well as the American Foundation for Suicide Prevention.”
Quick interventions for pediatric practitioners to ensure safety and wellbeing of kids in crisis:
“So, the first thing would be a thorough assessment of the child to know what risk factors are present. Does the child suddenly feel like life is not worth living all the time, hopeless, or sad, it needs to be addressed quickly. If the child has been bullied before, that it needs to be addressed. There must be follow-up to know how the child is feeling, what kind of support mechanism or support system is there for that child, if the child doesn’t have supportive parents or family or friends that he or she can confide in about how he or she is feeling, then what efforts will be made to make sure to connect that child to different support mechanisms.”
The current ages that are most at-risk for suicide:
“Among adolescents between the ages of 14 and 18, suicide is the third leading cause of death. And among young adults between the ages of 19 and 34 suicide is the second leading cause of death. So, this age group is very vulnerable. Certain populations are at greater risk than others, like LGBTQ and Black individuals. And the issue is not just self-identification of an LGBTQ individual that makes one vulnerable, but the experiences – discrimination, harassment, and safety concerns – that make it very difficult. This is where, as a society, we need to do better in terms of [changing] policies that make life unbearable for those individuals and predispose them to being at-risk of suicide. The underlying issue may not be suicide, but if it is mental health, depression, anxiety, and they are not seeking any services then it builds up. Same with racial discrimination. We also know that individuals who are unhoused are at a greater risk of suicide. These populations are more vulnerable, so they require more effort in providing services that are friendly so they can get the help.”
Watch the full discussion here.