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. Author manuscript; available in PMC: 2021 Dec 1.
Published in final edited form as: Suicide Life Threat Behav. 2020 Jul 28;50(6):1149–1157. doi: 10.1111/sltb.12672

Pathways from parenting practices to adolescent suicidality: evidence on the role of emotional and behavioral symptoms from a prospective cohort of Canadian children

Mila Kingsbury 1, Ewa Sucha 1, Ian Manion 2, Stephen E Gilman 3, Ian Colman 1
PMCID: PMC8366387  NIHMSID: NIHMS1725679  PMID: 32720746

Abstract

Objective:

Investigate longitudinal relationships between parenting practices in childhood and adolescent suicidality, and assess the mediating role of emotional and behavioral symptoms.

Methods:

Data were drawn from the National Longitudinal Survey of Children and Youth, a Canadian population-based longitudinal cohort study. The sample included 9,490 children aged 10–11 who were followed up biennially to age 14–15. Parents reported their positive and punitive parenting practices when children were 10–11. Adolescents self-reported symptoms of depression/anxiety, hyperactivity, conduct disorder, and social aggression at 12–13, and past-year suicidal ideation and suicide attempts at 14–15.

Results:

The inverse associations between positive parenting at 10–11 and suicidal behaviours at 14–15 were significantly mediated by symptoms of hyperactivity, conduct disorder, and social aggression at 12–13. Direct relationships between punitive parenting and suicidal behaviours were observed. These associations were significantly mediated by hyperactivity and, among boys only, by conduct disorder and social aggression. The association between punitive parenting and suicide attempt was additionally mediated by depression/anxiety.

Conclusions:

Parenting in childhood may be associated with adolescent suicidality both directly, and indirectly through emotional and behavioural symptoms. Interventions aimed at reducing the use of harsh disciplinary strategies and promoting positive parent-child interactions may reduce the burden of adolescent suicidality.

Keywords: suicidal behavior, adolescence, parenting, mental health, longitudinal research

Suicidal ideation in adolescence is common, with 14–20% reporting thoughts of suicide in the last year (Evans et al. 2005; Cash & Bridge 2009), and 30% at any point in their lives (Evans et al., 2005; Fergusson, Woodward, & Horwood, 2000). Suicidal ideation in adolescence is highly distressing and can persist into adulthood, increasing risk for depressive disorder, substance abuse, and escalating suicidal behaviors (Fergusson, Horwood, Ridder, & Beautrais, 2005). Suicide is a leading cause of death for youth (Cash & Bridge 2009). Numerous potential risk or protective factors have been linked to adolescent suicidal thought (Evans et al. 2004); a recent review found 75 factors that increase or decrease risk for suicidality in adolescence (Dykxhoorn et al. 2017); however, a high proportion of these factors are non-modifiable or weakly amenable to intervention (Evans et al. 2004).

One set of potentially modifiable factors that have been associated with suicidality among adolescents is characteristics of the child’s parents and the parent-child relationship. Parental discord, for example, is associated with increased risk for adolescent suicidality (Evans et al. 2004), whereas strong attachment to parents (Fergusson et al., 2000) and having supportive parents are associated with decreased adolescent suicidality (Evans et al. 2004). Parents play a fundamental role in the social and emotional development of a child. Parents help children regulate their behaviour, through positive reinforcement of desired behaviours and steering children away from undesired behaviours (Lansford et al. 2014). How a parent chooses to discipline a child can influence emotional and behavioural development, and mental health. For example, the use of harsh disciplinary practices such as yelling or hitting a child has been associated with subsequent increased risk of depression, hyperactivity, and aggression in adolescence, particularly among boys (Kingsbury et al. 2019). Authoritarian parenting and harsh disciplinary practices are also associated with higher risk of suicidal thought and suicide attempt (Lai & McBride-Chang 2001; Xing et al. 2010; Donath et al. 2014). Conversely, positive parenting practices, such as demonstrations of affection towards their child, interest and involvement in their children’s activities, and praise for their children’s accomplishments, has been associated with subsequent lower risk of depression and aggression, particularly among girls (Boeldt et al. 2012; Kingsbury et al. 2019). Positive parenting has also been associated with reduced prevalence of adolescent suicidality (Lai & McBride-Chang 2001). However, evidence linking parenting practices to adolescent suicidality is largely based on cross-sectional studies, where temporality of effect can be difficult to disentangle.

If parenting practices are associated with adolescent suicidality, this association is likely due to the association between parenting and adolescents’ risk of psychopathology. For example, adolescent depression, anxiety, substance abuse, and conduct disorder are strongly linked with their risk of suicide (Fergusson et al., 2000). Moreover, Fergusson et al. (2000) found that the association between poor child-parent attachment and suicidal thought at ages 15 and 21 was attenuated after accounting for adolescent mental disorders, suggesting a developmental pathway between parenting and offspring suicidal behaviors through offspring psychopathology. Further work is needed to verify this potential pathway as this may inform interventions targeting parenting practices to improve offspring mental health overall and to reduce the burden of adolescent suicidality. Additionally, given noted sex differences in adolescent suicidal behavior (Beautrais 2002; Kaess et al. 2011), more research is needed to determine whether pathways might differ for boys and girls. Evidence suggests that parents may employ different strategies with boys and girls (McKee et al. 2007), and that boys and girls are at increasingly differential risk for both internalizing and externalizing problems across childhood and adolescence (Leve et al. 2005). It is also possible that girls and boys may respond differently to parenting practices; indeed, results from cross-sectional (Cero & Sifers 2013) and retrospective (Ehnvall et al. 2007) studies suggest that the associations between parenting and adolescent suicidality may differ for boys and girls. Further prospective evidence is needed to support this hypothesis.

We use longitudinal data from a cohort of children to investigate whether positive and negative parenting practices are associated with adolescent suicidality, whether adolescent mental health mediates these associations, and whether these pathways differ for boys and girls.

METHODS

Study population

The National Longitudinal Survey of Children and Youth (NLSCY) is a long-term study of the health and development of Canadian children. Information was collected every two years from 1994/1995 to 2008/2009. Response rate was 86.5%. Parents completed assessments on 13,819 children aged 10/11 in any of the first six cycles; our sample consisted of 7,507 children who were followed longitudinally to age 14–15, and who had complete data on covariates.

Measures

Adolescent suicidality

Questions on suicidal thought and attempt were part of a self-completed questionnaire for ages 12 to 17. Respondents were asked: “During the past 12 months, did you seriously consider attempting suicide” (suicidal ideation), and those who answered ‘yes’ to this question were asked: “During the past 12 months, how many times did you attempt suicide” (suicide attempt; re-categorized as none vs. at least one time). These questions are drawn from the Centre for Disease Control’s Youth Risk Behaviour Survey (YRBS), have demonstrated good reliability and validity (May & Klonsky 2011), and have been widely used to study suicidal behaviour in adolescence (Peter et al. 2008; McMartin et al. 2014).

Parenting

Parenting behavior was measured using self-report scales completed by the caregiver who identified themselves as “most knowledgeable about the child” (in approximately 90% of cases this was the child’s biological mother). The Parenting Scale was developed for the NLSCY using some items adapted from Strayhorn and Weidman’s Parent Practices Scale (Strayhorn & Weidman 1988), and some new items based on expert recommendation. Subscales were derived by Statistics Canada using principal component analysis and factor analysis, conducted on each half of the sample in Cycle 1; factor structure was compared across both half-samples (Statistics Canada 2001). For the present study, we considered punitive parenting, measured by 4 items assessing the frequency with which caregivers 1) raise their voice, scold, or yell; 2) use physical punishment; 3) calmly discuss the problem (reverse coded); and 4) describe alternate ways of behaving (reverse coded) in response to a child misbehavior. Items were rated on a 5-point scale from “never” (0) to “always” (4), and items were summed to create a total score from 0–16 (α = 0.55). Positive parenting was assessed using 5 items assessing the frequency that caregivers 1) praise the child; 2) focus positive attention on the child; 3) laugh with the child; 4) do something special that the child enjoys; and 5) engage in hobbies sports or games with the child. Items were summed to create a total score from 0–20 (α = 0.78).

Adolescent psychopathology

Symptoms of adolescent emotional and behavioural disorder were assessed at age 12/13 using self report. The behavior scales were constructed for the NLSCY using items from the Child Behavior Checklist (Achenbach 1991), the Montreal Longitudinal Survey (Tremblay et al. 2003), and the Ontario Child Health Study (Boyle et al. 1987), and were designed to correspond to DSM-III criteria. Subscales assessed symptoms of depression/anxiety (7 items, e.g., I am not as happy as other people my age; I am too fearful or nervous; α = 0.74), hyperactivity (7 items, e.g., I can’t sit still; I am impulsive, I act without thinking; α = 0.82), conduct disorder (6 items, e.g., I get into many fights, I bully or am mean to others; α = 0.77), and social aggression (5 items, e.g., When I am mad at someone, I say to others: let’s not be with him/her; α = 0.77). Adolescents responded to each item on a 3-point scale from “never or not true” (0) to “often or very true” (2). Subscale scores pro-rated for item-level missingness were provided by Statistics Canada.

Potential confounding variables

In addition to child sex, we considered the following characteristics of the primary caregiver as important confounders of the parenting-suicidal behavior relationship given their potential association with both exposure and outcome: caregiver age and sex, relationship to the child (biological parent or other), education (less than secondary, secondary school graduation, beyond high school, college or university degree), current working status: currently working (yes vs no), socioeconomic status (SES) defined as a ratio of household income to the low income cut-off score, smoking status (daily, occasionally or not currently smoking), alcohol misuse (frequency of binge drinking, defined as 5 or more drinks on one occasion, in the past 12 months), and depression score. Caregiver depression was assessed using a 12-item version of the CES-D (Radloff 1977; Poulin et al. 2005), measuring occurrence and severity of symptoms associated with depression during the previous week.

Statistical Analyses

We fitted linear regression models to estimate the associations of positive and punitive parenting practices measured at age 10–11 with suicidal thoughts and attempts at age 14–15. We then conducted a statistical mediation analysis to evaluate symptoms of depression/anxiety, hyperactivity, conduct disorder, and social aggression measured at age 12–13 as mediators of the association between parenting and suicidal outcomes (conceptual model in Figure 1). Process, a SAS macro, was used to obtain estimates of direct and indirect effects from the models described above (Hayes 2012). Estimates of indirect effects quantify the magnitude of the pathway between parenting behavioral and offspring suicidal behaviors through adolescent mental health – for example, the extent to which punitive parenting increases risk of adolescent suicide attempt because of the association between punitive parenting and adolescent depressive symptoms. In contrast, the direct effect quantifies the magnitude of the residual pathway – e.g., the extent to which punitive parenting increases risk of adolescent suicide attempt not through adolescent depressive symptoms. Bootstrap 95% confidence intervals for the indirect effect were used to establish whether each of the four factors were statistically significant mediators of the association between parenting and suicidal outcomes. Results of crude (unadjusted) analysis are presented in Supplementary Tables 1–2. Final analyses adjusted for child’s sex, sex and age of the primary caregiver, caregiver’s education and working status, SES of the household, and caregiver’s smoking, alcohol misuse, and depression score. Cases with missing information on any of the covariates were dropped from the analysis. Interactions between child’s sex and each parenting exposure were tested in mediation models and when statistically significant, stratified models by sex were fitted. If not, sex was added into mediation models as a covariate.

Figure 1.

Figure 1.

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Sample mediation model

RESULTS

The majority of primary caregivers were females (over 90%), had education beyond high school (over 60%), were currently working (75%), did not smoke (70%), and were biological parents to their child (97%) (Table 1).

Table 1.

Baseline characteristics, parenting behaviours, mediators, and suicidal behavior at each assessment for children age 10–11 followed longitudinally to age 14–15; NLSCY: cycle 1 to 7.

Age 10–11 Age 12–13 Age 14–15
Full sample (N= 7507) Girls (N=3,753) Boys (N=3,754) Full sample Girls Boys Full sample Girls Boys
Suicidal behaviour n (%)
 Suicidal thought 775 (10.34%) 555 (14.83%) 220 (5.86%)
 Suicidal attempt 396 (5.29%) 322 (8.60%) 74 (1.98%)
Mediators mean (SD)
 Depression/anxiety 3.38 (2.85%) 3.73 (2.93%) 3.03 (2.72%)
 Hyperactivity 3.98 (2.89%) 3.71 (2.83%) 4.26 (2.92%)
 Conduct disorder 1.13 (1.78%) 0.78 (1.45%) 1.49 (2.00%)
 Indirect aggression 1.55 (1.77%) 1.58 (1.77%) 1.51 (1.76%)
Parenting mean (SD)
 Positive 11.77 (2.69) 11.77 (2.68) 11.76 (2.71)
 Punitive 7.71 (2.64) 7.64 (2.59) 7.79 (2.70)
Caregiver characteristics at baseline
n (%) n (%) n (%)
 Sex - female 6922 (92.21%) 3484 (92.83%) 3438 (91.58%)
 Biological parent 7315 (97.44%) 3647 (97.18%) 3668 (97.71%)
 Postsecondary degree 2958 (39.4%) 1463 (39.15%) 1495 (39.98%)
 Smoking status
 daily 1982 (25.5%) 930 (25.14%) 962 (25.87%)
 occasionally 322 (4.34%) 169 (4.57%) 153 (4.11%)
 Currently unemployed 1361 (18.36%) 663 (17.88%) 701 (18.84%)
mean (SD) mean (SD) mean (SD)
 SES (LICO ratio) 2.13 (1.4) 2.11 (1.42) 2.14 (1.38)
 Binge drinking* 2.29 (9.82) 2.35 (9.93) 2.22 (9.71)
 Depression score 4.26 (5.31) 4.27 (5.42) 4.24 (5.2)
 Age 38.34 (5.10) 38.34 (5.16) 38.35 (5.03)
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*

How many times in the past 12 months had you have 5 drinks or more one on occasion?

There were an equal number of female and male children at baseline. At age 10–11, boys scored higher on hyperactivity symptoms (mean of 4.27 vs 3.72) and conduct disorder symptoms (1.48 vs 0.81), while girls had higher scores on depression/anxiety symptoms (mean of 3.74 vs 3.00) (Table 1). At age 14–15 girls had a higher prevalence of suicidal thoughts (13.88% vs 5.6%) and were more likely to report at least one suicidal attempt (7.84% vs 1.94%).

Missing Data

Missing data analysis revealed that those who dropped out of the sample before age 14–15 had primary caregivers who were older, more likely to be unemployed, and to have achieved a lower level of education. They experienced more positive parenting, less punitive parenting, and had lower symptoms of social aggression (Supplementary Table 3).

Mediation Models

Positive parenting

Results of the mediation analyses suggested that the protective association between positive parenting at age 10–11 and suicidal ideation at age 14–15 was due in part to fewer symptoms of hyperactivity (B=−0.004; 95%CI: −0.008,−0.001), conduct disorder (B=−0.004; 95%CI: −0.007,−0.001), and social aggression (B=−0.003; 95%CI: −0.006,−0.001) at ages 12–13 (Table 2a). Notably, there was no remaining association (i.e., direct effect) of positive parenting on suicidal ideation once adolescent psychopathology was accounted for. Similarly, the association between positive parenting and suicide attempt was accounted for by fewer symptoms of hyperactivity (B=−0.005; 95%CI: −0.009,−0.001), conduct disorder (B=−0.005; 95%CI: −0.009,−0.001), and social aggression (B=−0.004; 95%CI: −0.008,−0.001) at ages 12–13 (Table 2b).

Table 2a.

Regression coefficients (and 95% confidence intervals) for the relationship between positive parenting and suicidal ideation at age 14–15 as mediated by symptoms of depression/anxiety, hyperactivity, conduct disorder, or social aggression.

Depression/anxiety Hyperactivity Conduct disorder Social aggression
Parenting-> Mental disorder (path a) −0.028 (−0.056, 0.001) −0.041 (−0.07, −0.012) −0.023 (−0.040, −0.007) −0.026 (−0.043, −0.009)
Mental disorder-> Suicidal ideation (path b) 0.165 (0.137, 0.193) 0.107 (0.077, 0.136) 0.168 (0.125, 0.212) 0.124 (0.079, 0.168)
Parenting-> Suicidal ideation (direct effect/path c) 0.001 (−0.035, 0.036) 0.001 (−0.035, 0.036) −0.001 (−0.036, 0.034) −0.003 (−0.037, 0.032)
Indirect effect (path c’) −0.005 (−0.010, 0.000) −0.004 (−0.008, −0.001) −0.004 (−0.007, −0.001) −0.003 (−0.006, −0.001)
Effect size (indirect effect/direct effect) 5.00 4.00 4.00 1.00
Total effect (unadjusted for mental disorder) OR: 0.99, 95%CI: 0.96,1.03
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Note: significant effects are presented in bold

Table 2b.

Regression coefficients (and 95% confidence intervals) for the relationship between positive parenting and suicide attempt at age 14–15 as mediated by symptoms of depression/anxiety, hyperactivity, conduct disorder, or social aggression.

Depression/anxiety Hyperactivity Conduct disorder Social aggression
Parenting-> Mental disorder (path a) −0.027 (−.055, 0.001) −0.040 (−0.069, −0.012) −0.023 (−0.040, −0.007) −0.025 (−0.043, −0.008)
Mental disorder-> Suicide attempt (path b) 0.173 (0.135, 0.212) 0.117 (0.076, 0.159) 0.21 (0.154, 0.267) 0.171 (0.111, 0.231)
Parenting-> Suicide attempt (direct effect/path c) 0.007 (−0.044, 0.058) −0.001 (−0.051, 0.049) 0.001 (−0.049, 0.05) 0.001 (−0.048, 0.05)
Indirect effect (path c’) −0.005 (−0.010, 0.000) −0.005 (−0.009,-0.001) −0.005 (−0.009, −0.001) −0.004 (−0.008, −0.001)
Effect size (indirect effect/direct effect) 0.07 5.00 5.00 4.00
Total effect (unadjusted for mental disorder) OR: 0.99, 95%CI: 0.94,1.04
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Note: significant effects are presented in bold

Punitive parenting

The association between punitive parenting at age 10–11 and higher levels of suicidal ideation at age 14–15 was due in part to higher levels of hyperactivity for both boys and girls (B=0.003; 95%CI:0.001, 0.007), and, among boys, to higher levels of conduct disorder (B=0.008; 95%CI:0.003,0.013) and social aggression (B=0.01; 95%CI:0.004, 0.016) at ages 12–13 (Table 3a). The association between punitive parenting at age 10–11 and suicide attempt at age 14–15 was also due partly to higher symptoms of depression/anxiety (B=0.005; 95%CI:0.001,0.01) and hyperactivity (B=0.004; 95%CI:0.001,0.007) for boys and girls, and, among boys, to conduct disorder (B=0.009; 95%CI:0.002,0.017) and social aggression (B=0.012; 95%CI:0.001,0.024) at age 12–13 (Table 3b).

Table 3a.

Regression coefficients (and 95% confidence intervals) for the relationship between harsh parenting and suicidal ideation at age 14–15 as mediated by symptoms of depression/anxiety, hyperactivity, conduct disorder, or social aggression.

Depression/anxiety Hyperactivity Conduct disorder Social aggression
girls boys girls boys
Parenting-> Mental disorder (path a) 0.028 (0.002, 0.053) 0.032 (0.006, 0.058) 0.009 (−0.009, 0.027) 0.061 (0.036, 0.085) 0.025 (0.003, 0.048) 0.065 (0.043, 0.087)
Mental disorder-> Suicidal ideation (path b) 0.165 (0.137, 0.193) 0.107 (0.077, 0.136) 0.201 (0.142, 0.260) 0.127 (0.059, 0.195) 0.109 (0.054, 0.164) 0.147 (0.068, 0.226)
Parenting-> Suicidal ideation (direct effect/path c) 0.059 (0.026, 0.092) 0.06 (0.027, 0.092) 0.053 (0.014, 0.092) 0.071 (0.0130, 0.129) 0.053 (0.015, 0.092) 0.071 (0.013, 0.13)
Indirect effect (path c’) 0.005
(0.00, 0.009)		 0.003 (0.001, 0.007) 0.002 (−0.002, 0.006) 0.008 (0.003, 0.013) 0.003
(0.00, 0.006)		 0.01 (0.004, 0.016)
Effect size (indirect effect/direct effect) 0.08 0.05 0.04 0.11 0.06 0.14
Total effect (unadjusted for mental disorder) ALL: OR: 1.06, 95%CI 1.02, 1.10 Girls: 1.05 (1.00,1.09); Boys 1.09 (1.02, 1.16)
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Note: significant effects are presented in bold

Table 3b.

Regression coefficients (and 95% confidence intervals) for the relationship between harsh parenting and suicide attempt at age 14–15 as mediated by symptoms of depression/anxiety, hyperactivity, conduct disorder, or social aggression.

Depression/anxiety Hyperactivity Conduct disorder Social aggression
girls boys girls boys
Parenting-> Mental disorder (path a) 0.028 (0.003, 0.054) 0.032 (0.006, 0.058) 0.009 (−0.009, 0.027) 0.06 (0.036, 0.084) 0.025 (0.003, 0.047) 0.065 (0.043, 0.087)
Mental disorder-> Suicide attempt (path b) 0.173 (0.135, 0.212) 0.117 (0.076, 0.159) 0.236 (0.169, 0.304) 0.154 (0.042, 0.265) 0.17 (0.103, 0.237) 0.184 (0.051, 0.316)
Parenting-> Suicide attempt (direct effect/path c) 0.066 (0.019, 0.113) 0.068 (0.022, 0.115) 0.078 (0.026, 0.13) 0.017 (−0.085, 0.119) 0.078 (0.027, 0.129) 0.019 (−0.085, 0.123)
Indirect effect (path c’) 0.005 (0.001, 0.01) 0.004 (0.001,0.007) 0.002 (−0.002, 0.007) 0.009 (0.002, 0.017) 0.004 (0.00, 0.009) 0.012 (0.001, 0.024)
Effect size (indirect effect/direct effect) 0.08 0.06 0.03 0.53 0.05 0.63
Total effect (unadjusted for mental disorder) ALL: OR: 1.06, 95%CI 1.00, 1.11
Girls: 1.05 (0.99,1.11); Boys 1.08 (0.96, 1.22)
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Note: significant effects are presented in bold

DISCUSSION

In this large prospective sample of Canadian adolescents, parenting behaviors at age 10/11 were associated with suicidal ideation and attempt at age 14/15, and these associations were due partly to differences in adolescent mental health at age 12/13 related to specific parenting behaviors. Parenting behaviors were associated with suicidality in the expected directions: positive parenting was associated with lower levels of suicidal ideation and suicide attempt, and harsh/punitive parenting was associated with higher suicidal ideation and attempt.

Our results suggest that harsh parenting in late childhood may be associated with adolescent suicidality in two ways – both directly, and indirectly through adolescent emotional and behavioural symptoms. Positive parenting was also found to be associated with adolescent suicidality, entirely through the indirect path. Depression is perhaps the best known risk factor for suicidality (Kessler et al. 1999) – however, the causes of adolescent suicidal behavior are multifactorial and cannot be explained by depression alone (Weeks & Colman 2017). The present results suggest that parenting may have impacts on adolescent mental health beyond depression, and that these other mental disorders may impact later suicidal behavior.

Significant sex differences emerged with respect to harsh parenting: the associations between harsh parenting and both suicidal ideation and suicide attempt were explained by conduct disorder and social aggression for boys only. Among girls, only the direct paths from harsh parenting to suicidal ideation and suicide attempt were significant. These findings are in line with some evidence suggesting that boys and girls may be differentially susceptible to the effects of parenting (Barnett & Scaramella 2013), and harsh parenting in particular (Lefkowitz et al. 1978; Leve et al. 2005). For example, some authors have reported that harsh discipline is more strongly associated with externalizing problems among boys than girls (Gershoff 2002; Kerr et al. 2004). The present results suggest that harsh discipline may also be detrimental to girls, but that these effects may manifest themselves differently (i.e., through direct associations with suicidal behavior).

Our results add to evidence showing the potential detrimental impact of harsh and punitive parenting practices. Harsh parenting has been consistently associated with both internalizing (e.g., depression, anxiety; Leve et al., 2005) and externalizing symptoms (e.g., conduct disorder, hyperactivity; Bor, McGee, & Fagan, 2004; Olson, Choe, & Sameroff, 2017), and a few cross sectional studies have shown associations with suicidality (Lai & McBride-Chang 2001; Xing et al. 2010; Donath et al. 2014). Our results add longitudinal evidence for the association between such parenting behaviors and adolescent suicidal ideation and attempt. Taken together, we believe this evidence suggests that interventions aimed at decreasing the use of harsh and punitive parenting practices may serve to reduce adolescent suicidality.

Though positive parenting did not show direct associations with adolescent suicidality, the indirect path suggests that positive parenting may also have protective effects on adolescent suicidality through reduction of symptoms of mental and behavioral disorder. Positive parenting in childhood has been found to be protective against adolescent psychiatric and behavioral problems (Kuhlman et al. 2014; Olson et al. 2017), and our results suggest that interventions targeted at fostering positive parent-child relationships may have follow-on effects on adolescent suicidality. Community-based interventions aimed at improving parenting skills have been shown to be effective in reducing negative parenting behaviors and improving positive parenting in randomized control trials (Gardner et al. 2006), and have been applied in international contexts, including economically disadvantaged countries (Knerr et al. 2013). Very few studies have directly examined the impact of parenting interventions on suicidal behaviors, but some evidence suggests that such interventions may reduce important risk factors for suicide (McKenzie et al. 2011). One randomized controlled trial reported that a family intervention reduced suicide attempts among youth referred for emergency psychiatric hospitalization (Huey et al. 2004) and another found that parenting intervention reduced suicidal ideation among youth with a history of suicidal behavior, albeit only among those without depressive symptoms (Harrington et al. 1998). Our results suggest that parenting interventions in the general population should be investigated to determine if they are effective in reducing the burden of adolescent suicidality.

Though promising, these results must be interpreted in the context of certain limitations. Parenting was assessed in the NLSCY using caregiver self-report, and may therefore be influenced by social desirability or other facets of caregiver mental health. However, these self-reported items have been found to correlate reasonably well to observed parenting behaviors (Strayhorn & Weidman 1988). Similarly, adolescent psychological/behavioural symptoms were assessed via self-report, and as such may not reflect psychiatric diagnoses. Although these scales were designed to correspond to DSM-III criteria, and demonstrate good psychometric properties, they are not intended as diagnostic instruments.

Due to the longitudinal nature of the design, substantial loss to follow-up was noted between assessments at age 10/11 and 14/15. We noted a handful of significant differences between complete cases and those who dropped out of the study – most notably, higher positive and lower punitive parenting among those who dropped out. However, we found few associations between mental health at age 12/13 and subsequent dropout. Consequently, it is difficult to conclude whether results could be biased by differential dropout.

The design of the present study did not take into account the reciprocal influences between parenting and child behavior. Children are not passive recipients of parenting- rather, parents’ and children’s behaviors are likely to covary over time. For example, child misbehavior may elicit more harsh disciplinary techniques in an attempt to control behavior (Reitz et al. 2006). However, in recent study using NLSCY data, we found that parenting behavior in childhood predicted adolescent mental illness even after adjusting for baseline symptoms (Kingsbury et al. 2019). Our study assessed parenting of the primary caregiver – most often the mother. Fathers’ or other caregivers’ parenting practices may have distinct influences on adolescent mental health and suicidality (Onatsu-Arvilommi et al. 1998; Lai & McBride-Chang 2001; McKee et al. 2007). The use of a large, prospective study of Canadian youth is a strength of the study, and allows us to establish temporality of the observed effects. We also included a large number of covariates associated with both parenting and adolescent suicidality (e.g., caregiver mental health, family economic disadvantage).

Conclusions

Results of our study, in the context of the existing literature, suggest that parenting in childhood may be associated with adolescent suicidality both directly, and indirectly through mental health and behavior symptoms. Interventions aimed at reducing the use of harsh disciplinary strategies and promoting positive parent-child interactions may reduce the risk of adolescent suicidal ideation and attempt. In addition to symptoms of depression and anxiety, clinicians should be aware that symptoms of other mental/behavioral disorders may lie on the causal pathway towards suicidal behavior.

Supplementary Material

Supplementary Material

ACKNOWLEDGEMENTS

This research was partly supported by grants from the American Foundation for Suicide Prevention (SRG-0-031-16) and the Canadian Institutes of Health Research (A01-151538), the Research Council of Norway through its Centres of Excellence funding scheme, project number 262700, and the Canada Research Chairs program, for Ian Colman. Dr. Gilman’s contribution was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. This paper is based on data from Statistics Canada, and the opinions expressed do not represent the views of Statistics Canada.

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