Though much research has been conducted on risk factors for adolescent suicidality, most of this research has been performed using population-based, school-based, or clinical samples from psychiatric hospitals. Little research has been done using community-based samples of adolescents receiving behavioral and mental health services (BMHS) in the community. This is a significant gap in the literature given that this sub-population of adolescents is at increased suicidality risk due to elevated exposure to adverse childhood experiences (ACEs).

This thesis adds to the research on adolescent suicidality among adolescents receiving BMHS at a community-based behavioral and mental health care organization in the United States. Using a mixed-methods approach, this thesis examines the process involved in conducting research in the community setting and investigates correlates of suicidality among adolescents receiving BMHS in the community, as well as analyzes temporal patterns of suicidal events following suicidality risk screening. Additionally, this thesis studies qualities that foster trust between adolescents receiving BMHS in the community and their treating clinicians, as therapeutic alliance is an important component to effective treatment.

The study found that sexual abuse was the only significant predictor of suicidality at the multi-variate level. Survival analysis revealed that adolescents who screened negative for suicidality risk at intake had a longer time to reported suicidal event than adolescents who screened positive for suicidality risk. The log rank test for significance between the two survival distributions was significant. Five overarching categories of trust building techniques emerged: 1) Ecosystemic Approach, 2) Strong Working Alliance, 3) Professionalism, 4) Warmth & Support, and 5) Open Communication. Taken as a whole, the results from this thesis can be used to guide suicidality screening and treatment approaches in the community.