Cultural Influences on the Pathway from Adult Disconnection to Alcohol Use: A Moderated Mediation Study of Suicide Attempts in Adolescents

Suicide is a public health problem that requires wide-scale intervention. Universal approaches may not adequately address the cultural differences creating further inequities. The present study integrated a developmental and multicultural lens to tailor the suicide ideation to action framework for adolescents from diverse cultural backgrounds. We tested the mediating role of problematic alcohol use on the relationship between adult disconnection and suicide attempts in a national sample of 11,577 adolescents (ages 12-17 years; Mage = 15.4; 52% female) and a subsample of 1422 at-risk adolescents (ages 12-17 years; Mage = 15.5; 66.5% female) who endorsed suicidal ideation at the first timepoint. After examining the complex data from the National Longitudinal Study of Adolescent Health using structural equation modeling, results indicated that problematic alcohol use mediated the relationship between disconnection to mothers and teachers and suicide attempts one year later. Moderated mediation findings revealed that the pathway from mother and teacher disconnection to problematic alcohol use did not significantly change depending on sex or socioeconomic status. The indexes of moderated mediation revealed that the indirect effect for the students of color was significantly lower than White students indicating that the mediation is stronger for White students compared to students of color for both predictors mother and teacher disconnection. A subsample analysis of Black vs. White students also revealed a stronger effect for White students compared to Black students. For all adolescents, problematic alcohol use may be an important mechanism by which feelings of disconnection from mothers and teachers increase suicide risk. Understanding what drives adolescents from different cultural backgrounds to engage in problematic alcohol use is important in the prevention and treatment of suicidality in adolescents. Treatments targeted to improve communication with mothers and teachers may help to not only increase feelings of connectedness, but help foster healthy behaviors