Abstract
BACKGROUND: Suicide is a leading cause of death among adolescents in the United States. Timely suicide-related disclosure may be a gateway to life-saving interventions and support, yet little is known about how adolescents interpret the specific responses they receive after disclosing suicide ideation (SI) or suicide attempts (SAs). Existing research has relied heavily on self-report surveys and has not captured the concrete verbal, emotional, and behavioral reactions adolescents perceive as supportive or unsupportive. This study addresses this gap by qualitatively exploring adolescents' recalled experiences of disclosure responses from both informal and formal supports. METHODS: Semi-structured interviews were conducted with 82 adolescents (ages 12-19 years) who presented for clinical care related to SI or SA within the prior two weeks. Interviews drew from the Adolescent Suicide Ideation Interview and probed disclosure decisions and perceived reactions. Data were analyzed using thematic analysis to identify patterns in supportive and unsupportive responses. RESULTS: Analysis revealed a range of supportive (i.e., Providing Guidance and Supportive Action, Shared Emotional Experiences, Encouragement and Affirmation, Engagement and Communication, and Physical Presence and Comfort) and unsupportive (i.e., Forcible or Coercive Action, Minimizing or Dismissing Concerns, Blame and Guilt-Inducing Responses, and Anger and Hostile Reactions) disclosure responses. CONCLUSIONS: Supportive responses fostered safety and willingness to seek help, while unsupportive responses contributed to emotional distress and the desire to conceal in the future. Findings highlight the importance of caregiver and peer responses following suicide-related disclosure and suggest opportunities for interventions in crisis settings to enhance the disclosure experience.