Using the 2023 Pennsylvania Youth Survey (n=190,151 students), this cross-sectional study examined whether stronger social bonds and recognition across family, school, and community domains were associated with lower adolescent suicide risk (ideation, plan, attempt, injury), both directly and indirectly through individual/interpersonal risk factors (substance use, depression, bullying victimization), with rurality included as a covariate.
Suicidal ideation was reported by 16%, plan by 13%, attempt by 5%, and injury by attempt by 1%. Family attachment had the largest direct protective association with suicide risk; school commitment had the largest indirect protective association via reduced individual/interpersonal risk factors. Community recognition showed the largest direct protective association among social recognition domains; family recognition had the largest indirect effect through social bonds and lower risk factors. Rurality, substance use, depression, and bullying victimization were each associated with higher suicide risk.
Cross-sectional design limits causal inference. The sample is geographically restricted to Pennsylvania, which may limit generalizability. All measures were self-reported and dichotomous for suicide outcomes, which may reduce precision.
Clinicians and school health teams should assess family attachment, school connectedness, and community recognition as protective factors—not just individual risk—when screening adolescents for suicide risk. Coordinated, multisector prevention efforts (family, school, community) are especially important for rural youth.
