Teen girls who have greater difficulty effectively solving interpersonal problems when they experience social stress, and who experience more interpersonal stress in their lives, are at greater risk of suicidal behavior, suggests research published by the American Psychological Association.

Suicide is the second-leading cause of death among teens, and rates of suicidal behavior are particularly high among girls. Previous research has found that interpersonal stressors—such as conflict with peers, friends and family—are related to suicidal behavior. Some theories of suicidal behavior suggest that poor social problem-solving skills may contribute to the link, possibly because teens with poorer social problem-solving skills are more likely to see suicide as a viable solution to their distress when they feel they've exhausted other options.

The current study aimed to test these associations by considering both experimentally simulated and real-world measures of social stress. The research, "Social Problem-Solving and Suicidal Behavior in Adolescent Girls: A Prospective Examination of Proximal and Distal Social Stress-Related Risk Factors," was published online May 25 in the Journal of Psychopathology and Clinical Science.

"The findings provide empirical support for cognitive and behavioral theories of suicide that suggest that deficits in abilities to effectively manage and solve interpersonal problems may be related to suicidal behavior," said study lead author Olivia Pollak, MA, of The University of North Carolina at Chapel Hill. "Clinically, this is notable, as problem-solving features prominently in several treatments for suicidal or self-harming behaviors."

Participants were 185 girls ages 12 to 17 who had experienced some mental health concerns in the past two years. At the beginning of the study, participants completed surveys or interviews about their mental health symptoms and suicidal behaviors. Participants also completed a task assessing their social problem-solving skills, which involved responding to scenarios involving interpersonal conflicts or challenges with other people, such as peers, friends, family members and romantic partners.

The teens were then asked to perform a task that has been shown in previous studies to induce social stress—they had to prepare and deliver a three-minute speech before what they thought was an audience of peers watching via video link. Immediately after the stressful task, they again completed the social problem-solving task to see whether experiencing social stress led to declines in their problem-solving ability.

The researchers also followed the girls for nine months, checking in every three months, to ask them about the stressors they were experiencing in interpersonal domains, such as with peers, friends and family members, as well as about suicidal behaviors.

Overall, the researchers found that girls who showed greater declines in problem-solving effectiveness in the lab, and who also experienced higher levels of interpersonal stress over the nine-month follow-up period, were more likely to exhibit suicidal behavior over the nine-month follow-up period.

"Importantly, problem-solving deficits under distress may increase risk for future suicidal behavior only in combination with greater cumulative interpersonal stress in real life," Pollak said. "Risk for suicidal behavior was higher among adolescents who showed greater declines ineffectiveness and who experienced high levels of interpersonal stress over nine-month follow-up, consistent with robust evidence for links between interpersonal life stress and suicidal behavior."