(PS11-7) An Examination of Anger, Suicidal Ideation, and Perceived Social Support Among Psychiatrically Hospitalized Adolescents

In recent years, psychiatric hospitals have seen markedly elevated rates of admission. Given the growing demand for treatment, there is a need for a more nuanced understanding of the clinical profiles of adolescent inpatient populations especially in regards to suicidal ideation and aggression, which are leading causes of hospitalization. Though often treated as separate presenting problems, research shows that suicidal ideation and aggression (towards self and others) as well as underlying anger are significantly associated, and frequently co-occur. Additionally, while social support can serve as a protective factor for symptoms of suicidality and alleviate some of the anger associated with aggression, it is less clear what this relationship looks like when symptoms overlap. Thus, this study aims to investigate potential differences in the perceived levels of social support of adolescents across different symptom severity groups. 

The current sample included 491 adolescents aged 11-18 (M = 14.96 ± 1.75) admitted to a psychiatric inpatient unit for acute safety concerns. The majority were assigned female at birth (71.3%) and identified as White (57.8%). Additionally, 28.1% identified as Hispanic or Latino and 65.6% as a sexual and/or gender minority. Upon admission, adolescents completed self-report measures of anger (PROMIS Pediatric Anger Scale), suicidal ideation (SI; Suicidal Ideation Questionnaire-JR), peer relationships (PROMIS Peer Relationships Scale), and family functioning (Family Assessment Device-12). The sample was divided into 3 subgroups based on clinical cutoffs for suicidal ideation and anger scores: high SI (n = 90), high anger (n = 129), high SI/high anger (n = 272). 

A one-way MANCOVA analysis showed that when controlling for sex, groups were significantly different in their perceived levels of social support [F (4, 972) = 8.316, p < .001, Wilks’ λ = .935, partial n² =.033]. Post hoc tests revealed a significant difference in mean levels of family functioning between high anger and high SI/anger groups (p < .001) as well as high SI and high SI/anger groups (p < .001). Scores were significantly higher in the high SI/anger group when compared to the other groups, indicating higher levels of perceived family dysfunction. There also was a significant difference in mean levels of perceived peer relationships between high anger and high SI/anger groups (p = .021). Scores were significantly lower in the high SI/anger group compared to the high anger group, indicating lower levels of perceived peer support. 

This study underscores the importance of assessing for suicidal ideation in combination with anger when treating adolescents in inpatient settings. Results suggest that youth who report elevations in SI and anger may be more likely to experience lower levels of both peer and family social support as compared to adolescents with elevations in only one symptom category. Results of this study serve as an important first step in understanding how to best care for this distinct population and underscore the potential utility of emphasizing interventions aimed at strengthening relationships.