Adopted teens try to kill themselves much more often than teens who live with their biological parents, says new research.
However, a group of Ohio researchers add, the risk for both groups drops greatly when there are strong family ties.
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That's the official word from a new study of more than 6 500 adolescents that appears in the latest issue of the journal Pediatrics.
"The real take-home message in this study is that a strong family unit with a strong sense of belonging is one of the best ways to prevent teen suicide, whether the child is adopted or living with their biological parents," says study author Dr. Gail Slap, a professor of pediatrics and internal medicine at Children's Hospital Medical Center, University of Cincinnati College of Medicine.
The researchers compensated for factors likely to influence the outcome - including divorce, single-parent households, even parental education and the family's economic level - in finding that adopted teens' rate of suicide attempts seem double that of those who live with biological parents.
But some experts say the study did not look deeply enough into issues like the teens' mental state and experience before drawing its conclusions.
"I think it's an important study that will hopefully help us to better recognise children at risk. But to say that it is unequivocally adoption that increases their risk - I think the study leaves too many unanswered questions to say for sure," says Dr. Cynthia Pfeffer, a teen suicide expert and director of the Childhood Bereavement Program at Weill Medical Center of Cornell University.
Among the areas the study didn't address are hereditary risk of depression, age of the child at adoption, and any pre-adoption experiences, including what may have occurred developmentally during the birth mother's pregnancy, says Pfeffer.
"Did their birth mother drink alcohol or use drugs - and did that influence the child's development in any way that could be a link to suicide later in life? We don't know these answers," says Pfeffer.
The study group was gleaned from a larger sampling of more than 90 000 adolescents who took part in the National Longitudinal Study of Adolescent Health - a school-based report that sampled students from grades 7 through 12.
The final group of 6 577 students selected for this arm of the study were living with either their adoptive parents (3.3 percent) or their biological parents (96.7 percent).
In addition to the students' gender, age and race, the researchers also noted mental and physical health; time spent in counselling; educational experiences, including grades; and high-risk behavior, which included smoking, alcohol and drug use, physical fighting and aggression, and impulsive behavior.
In terms of the families, they looked at income levels, parental education, and the overall sense of family "connectedness" to see "how big a role the parents played in the child's life, how connected the child felt to his or her parents, and how satisfied the mother felt with the child-parent relationship," says Slap.
The final analysis showed that 7.6 percent of the adopted children were likely to attempt suicide, compared to 3.1 percent of children living with their biological parents. But overall risk of suicide was much lower in both groups when strong family ties were present.
"Adoption doesn't predict suicide, but it should be taken into consideration when accessing a child's behaviour and their overall risk for suicide," says Slap.
The more important message, she emphasises, is the vital role that family love can play during the crucial teen years.
Other experts agree.
"I don't believe we should stigmatise adopted children by singling them out as suicide risks," says Pfeffer. But she adds, "I do believe that studies like this one can help raise awareness about teen suicide and help parents, teachers, doctors and other adults give special attention to the children that need it most."
Although there are no statistics on the number of attempted teen suicides, according to the American Psychiatric Association, 5 000 teens take their own life each year. Previous studies have been split on the role that adoption may play: seven studies have shown no difference between adopted and non-adopted teens; 15 studies showed poorer psychological adjustment among adopted teens; three studies revealed that adopted teens are actually better adjusted than non-adopted teens.
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