Abstract
INTRODUCTION: Suicide is a leading cause of death for adolescents and cross-sectional research suggests adolescents experiencing suicide attempts have more negative help-seeking attitudes. Less is known about the effect of suicidal experiences on subsequent help-seeking attitudes. The present study examined reciprocal, longitudinal associations between help-seeking attitudes and suicide attempts. METHODS: 8469 students from 20 high schools on the wait-list condition of a cluster randomized trial of a universal school-based suicide prevention program were included. Adolescents were assessed in grades 9-12 at four waves. Cross-lagged panel models estimated bidirectional associations between suicide attempts and help-seeking attitudes. RESULTS: Analyses collapsed across gender indicated students reporting negative attitudes towards help-seeking and suicide were more likely to engage in a subsequent suicide attempt. Students with reported suicide attempts reported more negative later attitudes. Attitudes towards help-seeking and suicide predicted suicide attempts in both genders, whereas attempting suicide influenced help-seeking attitudes in girls, rather than boys. CONCLUSIONS: Results suggest both boys and girls would benefit from interventions fostering positive attitudes towards help-seeking, such as the Sources of Strength intervention. Adolescents who attempt suicide are also particularly vulnerable to negative help-seeking attitudes, which may be influenced by the severity of psychological distress and interventions received post-attempt.