Adolescents' suicide risk and multimodal autonomic responses in three parent-child contexts.

BACKGROUND: Parent-child conflicts are implicated in adolescents' suicide risk, while positive parent-child interactions appear protective. Understanding how adolescents at elevated risk respond to parent-child interactions could inform suicide prevention. Parent-child contexts provoke intricately patterned, parasympathetic and sympathetic autonomic responses, which are thought to facilitate situationally appropriate self-regulation but may be maladaptive when atypical. Examining interactions of baseline and task-related autonomic components has promise for identifying clinically relevant response profiles. METHODS: Participants were clinically referred adolescents (N = 162; Mage=12.03 yrs; 47% female; 60% minoritized race/ethnicity). Over half (61%; n = 99) were considered at elevated suicide risk based on suicide/self-harm thoughts/behaviors on any measure (self-report, interview, ecological momentary assessment). Adolescents completed three parent-child interaction tasks with differing self-regulation demands: a conflict discussion, a positive discussion, and a reading challenge. Autonomic responses were measured using respiratory sinus arrhythmia (RSA), cardiac pre-ejection period (PEP), and skin conductance level (SCL). Multivariate logistic regressions for each parent-child context predicted suicide risk status using task-related change in all autonomic indices in the context of (i.e., as moderated by) baseline autonomic activity. RESULTS: Elevated suicide risk status was associated with context-specific, sympathetic patterns: pronounced threat-like (PEP) response to the conflict discussion, pronounced disengagement-like (SCL) response to the positive discussion, and an amotivation-like (PEP) response to the reading challenge. Results were independent of subjective affect covariates. CONCLUSIONS: Autonomic dysregulation may help explain suicide risk. Findings are consistent with interpersonal suicide theories and may help pinpoint contextually bound interpersonal affective processes associated with youths' suicide risk.