Parent–Child Communication About Suicide: Parental Disclosure of Suicide Attempt History in a Pediatric Behavioral Health Sample

1. Introduction

Suicide is the third leading cause of death among youth aged 5–17 years (Center for Disease Control and Prevention [CDC], 2024). Youth with a parental history of suicide attempt are 4–6 times more likely to experience suicidal thoughts and behaviors (Brent et al., 2002; Brent et al., 2003). The mechanisms associated with the intergenerational pathway of suicide risk are not clearly understood. Previous research shows both biological and environmental influences on the transmission of suicide risk from parent to child (Ortin-Peralta et al., 2021; Ortin-Peralta et al., 2024; Brent et al., 2002, O’Reilly et al., 2020).

Open discussions of mental health are consistently identified as an important component of suicide prevention (Sheehan et al., 2019; Frey et al., 2018; Brausch et al., 2025; Bettis et al., 2023; Sullivan et al., 2025; Hallford et al., 2023; Rodriguez et al., 2025; Mirichlis et al., 2024) yet research on parents’ disclosure of their own STB to their children remains limited. Prior studies examining disclosure to other adults highlight barriers such as fear of causing distress and decision-making processes involving perceived risks and benefits (Sheehan et al., 2019; Frey et al., 2018), but do not address disclosure within the parent–child relationship.

As primary sources of support, parents play a critical role in their children’s exposure to and understanding of mental health and STB (Bratu et al., 2025). Despite this, little is known about how parental disclosure of their suicide attempt influences youth mental health outcomes. The present study aimed to (1) identify barriers and facilitators of parental disclosure of their suicide attempt history to their child and (2) explore patterns between disclosure status and youth suicidal outcomes.

2. Methods

We conducted an exploratory mixed methods study to examine parental disclosure among biological parents with a history of suicide attempt who had a child aged 5–17 years. Parents answered questions about their own and their child’s history of STBs followed by a semi-structured interview about discussions they had with their children and others about mental health and suicide.

2.1. Study Participants

Parents were recruited from a major metropolitan children’s hospital. Eligible participants were biological parents with a documented history of suicide attempt who had a biological child aged 5–17 years receiving behavioral health services at the hospital within 12 months prior to study initiation. Eligibility was determined through medical record review identifying documentation of a suicide attempt in at least one biological parent. A total of 1,056 parents meeting initial criteria were contacted for participation.

Exclusion criteria included inability to speak or read English, inability to provide informed consent, and non-biological caregiver status (e.g., adoptive parents, step-parents, foster parents, or legal guardians).

Eligible parents were mailed flyers that contained a synopsis of the study. If both parents were known to have a history of suicide attempt, only one parent was contacted for recruitment. Parents who were interested in participating were asked to call study staff to determine eligibility. Alternatively, parents could scan a QR code that directed them to a REDCap form where they gave their name, number, a phone number where they could be reached, and specify a day and/or time that they preferred for return contact. Of the 1,056 parents contacted, 31 (2.9%) expressed interest in participating. Of those, 21 (67.7%) were screened and confirmed eligible, and 12 (57.1% of those screened; 1.1% of those initially contacted) consented to participate. Parents received confirmation of their scheduled study appointment and a reminder call the day prior to the interview. Transportation and all costs associated with participation were covered by the research team.

Although eligibility included biological mothers and fathers, all enrolled participants were female.

2.2. Data Collection

Study team members conducted one-on-one interviews with parents between April 2024 and January 2025. Interviewers used a semi-structured interview format, with participants completing a variety of structured measures (e.g., Columbia Suicide Severity Rating Scale [C-SSRS]; Posner, 2007) assessing their own and their child’s history of STBs. These semi-structured assessments were followed by a qualitative semi-structured interview. Interviewers used a guide that included questions about parental discussions of mental health and suicide with their children and with others (See Supplementary Material). All interviews took place in private observation rooms and lasted between 1.5–2 hours. Interviews were audio-recorded, transcribed verbatim, and de-identified prior to analysis. Participants were provided breaks during the study visit as needed and received payment for participation. This study was approved by the hospital’s Institutional Review Board (IRB) and written informed consent was obtained from all participants.

2.3. Procedures for Minimizing Risks

Prior to conducting interviews, all study staff were trained to work with individuals who had a history of suicide attempt. A safety protocol was implemented that included offering to contact a clinician from crisis services who would conduct a risk assessment and determine current level of risk if participants disclosed current suicidal ideation and/or any other significant ongoing psychiatric symptoms during the study visit. All participants were provided with a list of resources at the conclusion of the interview they could use to seek assistance as needed.

2.4. Analysis

Although 12 parents consented to participate, analyses were conducted with 11 participants due to a recording equipment malfunction that resulted in the loss of one interview. Only audio-recorded and transcribed interviews were included in the analysis. Transcripts were analyzed using thematic analysis, coding themes based on questions in the interview guide and exploring emergent themes. ATLAS.ti software (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany, 2024) was used to support data organization and qualitative analysis.

3. Results

Parents were 31–48 years of age (Mean=39 years) and had children aged 5–17 years (M=12 years). Additional demographic details are presented in Table 1. All parents reported discussing mental health in general with others, and most parents had general mental health conversations with their child (90.9%). Given the small sample size and reporting restrictions that preclude presentation of cell sizes fewer than 10, subgroup findings are presented descriptively to provide context for qualitative themes rather than to test group differences.

3.1. Suicide Outcomes

All parents had a history of suicide attempt with number of lifetime attempts ranging from 1 to more than 5. Parent’s age at most recent attempt ranged from 15–41 years old (M=22 years). The range of time between interview date and parent’s most recent attempt was 1 month to 31 years (M=18 years).

When reporting on their child’s STB history, majority of parents indicated that their child had no known history of STB (54.5%). A known history of suicide attempt was reported for 45.5% of children (Table 1), with the number of attempts ranging from 0 to more than 5. Child’s age at most recent suicide attempt ranged from 9–15 years (M=12 years).

3.2. Mental Health Discussions and Suicide Attempt Disclosure

3.2.1. Parental Disclosure to Child

Almost all parents (90.9%) reported engagement in non-suicide-related mental health discussions with their child and 36.4% reported disclosing their suicide attempt history to their child (Table 2).

3.2.2. Parental Disclosure to Others

Disclosure to “others” referred to individuals external to the parent–child relationship (e.g., spouse/partner, healthcare provider, friend). All parents (100%) reported having non-suicide mental health discussions with others and almost two-thirds (63.6%) of parents reported disclosing their suicide attempt history to others. For 27.3% of parents, disclosure to others was not discussed during the interview (Table 3). It is important to note that the absence of reported disclosure during the interview does not indicate that parents have never disclosed their suicide attempt to others.

3.3. Parent Disclosure and Child Suicide Outcomes

Most parents did not discuss their suicide attempt with their child (63.6%) and most children did not have a known history of suicide attempt (54.5%). However, of the children who did have a known history of suicide attempt, only 20% of their parents disclosed their own history of suicide attempt. (Table 4.)

3.4. Contextual Influences on Disclosure

Collectively, themes illustrated parental disclosure decisions are embedded within relational, cultural, structural, and psychological contexts.

3.4.1. Interpersonal Barriers

Many parents described fear of being judged by others, including family members, friends, and community members. Additionally, parents frequently described experiences in which their mental health concerns were minimized or dismissed. Examples of quotes are in Table 5.

3.4.2. Cultural and Societal Influences

Stigma surrounding mental health and suicide was frequently cited as a barrier to disclosure. Parents described broader cultural messages that mental health care was unnecessary or excessive (Table 6).

3.4.3. Structural Stressors

Parents described financial instability, housing insecurity, and single-parent household stressors as shaping family communication dynamics. Economic challenges were described as limiting emotional availability and focus on mental health (Table 7).

3.4.4. Psychological Barriers

Some parents described distrust of mental health systems or discomfort with vulnerability. Parents described feelings of guilt and shame surrounding suicidal behaviors. Reluctance to engage in discussions was described by both parents and children. Examples of these quotes are in Table 8.

4. Discussion

When examining parental disclosure of suicide attempt history, most parents disclosed to other adults, whereas only a small amount disclosed to their children. This pattern highlights disclosure within adult relationships may feel more accessible than disclosure within the parent–child dyad. Findings indicate that parental disclosure decisions are shaped by multilevel influences, including interpersonal, cultural, structural, and psychological factors.

Interpersonal experiences of judgment and dismissal emerged as central barriers to disclosure. Many parents described fear of being judged, misunderstood, or stigmatized if they disclosed their suicidal behavior history. Others reflected on growing up in environments where mental health concerns were minimized or dismissed, shaping their present-day communication patterns. These relational experiences may contribute to hesitation in initiating conversations with their own children, particularly when parents anticipate invalidation or emotional harm. Prior research has demonstrated that perceived negative responses to suicide-related disclosure can inhibit future help-seeking and open communication (Sheehan et al., 2019; Sullivan et al., 2025), reinforcing the importance of relational context in disclosure decisions.

Beyond individual relationships, broader cultural and societal beliefs about mental health influenced parental disclosure decisions. Parents described persistent stigma surrounding suicide and psychiatric diagnoses, as well as cultural messages that mental health care is unnecessary or excessive. Such minimization may reflect generational norms or community-level beliefs that discourage emotional vulnerability. These findings align with research demonstrating stigma reduces both mental health help-seeking and openness in discussing suicidal behaviors (Bettis et al., 2023). In this context, parental disclosure is not solely a personal decision but one embedded within prevailing cultural narratives about strength, resilience, and self-reliance.

Structural stressors—including financial instability, housing insecurity, and unstable or unsafe home environments—also shaped disclosure decisions. Parents described living in “survival mode,” with limited emotional bandwidth to prioritize vulnerable conversations. These findings may be interpreted through Maslow’s hierarchy of needs (Maslow, 1943), which posits that foundational physiological and safety needs must be met before higher-order relational and emotional needs can be prioritized. When parents are navigating economic hardship or instability, disclosure may feel secondary to immediate survival concerns. Consistent with prior work linking socioeconomic disadvantage to reduced mental health engagement (Ngamini Ngui et al., 2012; Finegan et al., 2018), structural instability may constrain opportunities for reflective, emotionally open dialogue within families.

Finally, at the individual level, psychological barriers such as shame, distrust, and reluctance to engage in emotionally vulnerable conversations were evident. Parents described internalized guilt surrounding prior suicide attempts and discomfort discussing their mental health history. Distrust of mental health systems and fears of negative consequences further complicated disclosure decisions. These psychological experiences likely interact with interpersonal and structural contexts, reinforcing hesitation to disclose. Disclosure therefore appears to be a relational process influenced by both internal emotional states and external environmental factors.

4.1. Strengths and Limitations

This study should be interpreted while considering several limitations across structural, methodological, and sample-level domains. Structurally, participants were recruited from a single pediatric behavioral health setting within one geographic region, which may limit generalizability to parents not engaged in clinical services or to families from different sociocultural contexts. All participants were female, limiting understanding of male perspectives and broader caregiver populations.

Methodologically, the small sample size and low response rate raise the possibility of self-selection bias, as parents more comfortable discussing mental health may have been more likely to participate. The low response rate may also reflect the sensitive nature of the study topic and recruitment based solely on medical record identification of suicide attempt history. The cross-sectional design precludes conclusions regarding directionality between parental disclosure and youth suicidal outcomes. Additionally, reliance on parent self-report may have introduced recall or social desirability bias, and youth perspectives were not directly assessed.

Despite these limitations, the study has notable strengths. The exploratory mixed methods design allowed for structured characterization of STBs and in-depth qualitative exploration of disclosure processes. This approach facilitated examination of disclosure within interpersonal, cultural, structural, and psychological contexts rather than treating it as an isolated behavioral decision. One-on-one semi-structured interviews provided rich contextual data on stigma, relational dynamics, and environmental stressors that are often underrepresented in suicide research. To our knowledge, this is among the first studies to directly examine parental disclosure of suicide attempt history to children within a clinical pediatric sample, offering insight into multilevel influences that may inform family-centered suicide prevention strategies.

4.2. Future Directions

These findings highlight the persistent role of mental health stigma in limiting conversations about suicidal behaviors, even among parents with lived experience and children receiving behavioral health services. Efforts to reduce stigma within families, social networks, and healthcare systems may be critical for increasing parents’ comfort with discussing suicidal behaviors in developmentally appropriate ways. Expanding these conversations may allow for earlier identification of risk and more effective implementation of suicide prevention strategies that extend beyond the clinical setting and into the home.

Importantly, parents who engaged in discussions about suicide described these conversations as opportunities to strengthen trust and emotional closeness with their children. Within a sample in which many youth had known histories of suicidal ideation and/or attempts, fostering open communication may serve as a protective factor by ensuring that youth feel supported and have a trusted adult to whom they can turn during times of distress. Interventions that support parents in navigating disclosure decisions and promote open, stigma-free conversations about mental health and suicide may therefore play a meaningful role in reducing youth suicidal behaviors and enhancing family-based prevention efforts.

5. Conclusions

In this exploratory mixed methods study of parents with a history of suicide attempt raising children aged 5–17 years, parental disclosure decisions were shaped by multilevel influences rather than singular motivations. Findings indicate that disclosure is embedded within interpersonal experiences (e.g., judgment and dismissal), cultural and societal narratives (e.g., stigma and minimization), structural stressors (e.g., socioeconomic instability and environmental adversity), and psychological processes (e.g., shame, distrust, and reluctance).

Disclosure therefore emerged as a nuanced, context-dependent relational process rather than a uniformly protective or harmful act. Parents who described open conversations often emphasized relational trust and emotional closeness, suggesting that developmentally appropriate disclosure may serve as one pathway toward strengthening family-level protective factors.

Future research incorporating youth perspectives and longitudinal designs is needed to better understand how disclosure evolves over time and how multilevel contextual factors interact to influence youth mental health trajectories. Interventions aimed at reducing stigma, addressing structural stressors, and supporting parents in navigating emotionally complex disclosure decisions may enhance family-centered approaches to youth suicide prevention.