Adolescents hospitalized for suicidality most frequently cited “my,” “family,” and “friends” as their reasons for living, according to a language analysis of safety-planning notes from 211 patients.
The three most common words were “my” (292 instances), “family” (89), and “friends” (73). Other frequently used terms included “want” (49), “future” (45), “mom” (36), “life” (19), “sister” (17), “go” (17), and “brother” (12). The word want was often connected with future aspirations, such as owning a home or starting a family. Less frequent responses included pets, religion, personal goals, and deterrents to suicide, such as not wishing to harm others. As part of standard clinical care, patients admitted for suicidality were asked to list three reasons for living. Nearly all patients (97%) provided three reasons.
The analysis included safety-planning sessions conducted on a 24-bed acute adolescent inpatient unit in Houston, Texas, between January and December 2023.
Participants ranged in age from 13 to 17 years (mean age, 15). Seventy-one percent were female, 22% were male, 5% identified as transgender male, fewer than 1% as transgender female, and 2% identified as nonbinary or gender-fluid. By race and ethnicity, 46% identified as Latino/Hispanic, 25% as Black/African American, 24% as White, 3% as multiracial, and 2% as Asian. Insurance coverage included 42% public-assisted, 33% none, and 25% private. On admission, 84% were categorized as high-risk for suicide based on the Columbia–Suicide Severity Rating Scale Screener. Seventy-two percent of therapy referrals were for self-harm or suicidality, followed by mood or anxiety management (14%).
Therapy began on average four days after admission, lasted about 35 minutes, and ranged from one to three sessions. Trained therapists documented responses verbatim in the electronic medical record. The median hospitalization length was six days. Language analysis was conducted using Sketch Engine software to produce word frequencies, concordances, and collocations. A total of 1,914 words were analyzed, representing 494 unique word types. The type-token ratio was 26%.
Adolescents provided a wide range of unique responses, including references to specific people, destinations, and personal mottos. “Additional reasons for living included idiosyncratic personal goals (e.g., I want to read 100 books this year) and aspirational achievements (e.g., Next year I’ll be the soccer team captain). One adolescent simply wrote YOLO (i.e., you only live once). Several participants listed deterrents to suicide as reasons for living, such as not wanting to cause harm to others (e.g., I saw how my dad cried, and I don’t want him to cry like that anymore) or to themselves (e.g., It would hurt to kill myself),” said Ana M. Ugueto, Ph.D., A.B.P.P., from the Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, and colleagues.
The study had several limitations. Findings were based on a single hospital site and may not generalize to other settings. Responses reflected what patients chose to share in a clinical context and may not capture all relevant factors. The analysis emphasized word frequency and patterns rather than qualitative interpretation.
“Identification of individualized reasons for living can provide unique insights into who and what is most important to adolescents,” the study authors concluded. “Reasons for living can feasibly be used to build rapport, establish therapy goals, and personalize evidence-based treatments, thereby reducing adolescents’ suicidal thoughts and behaviors.”
Disclosures: The authors reported no financial relationships with commercial interests.
Source: Psychiatry Online