Dynamic associations between help-seeking and suicidal ideation across family conflict contexts following psychiatric hospitalization

Adolescents are at elevated risk for recurrent suicidal thoughts and behaviors (STB) following discharge from psychiatric hospitalization, yet little is known about how help-seeking behaviors unfold dynamically during this high-risk transition period. Prior research suggests that family conflict may function both as a direct risk factor for STB and as an interpersonal context associated with how adolescents respond during periods of suicidal distress. Clarifying when adolescents are most likely to seek support, and how family context shapes these dynamic associations, is critical for informing intervention efforts. The present study used ecological momentary assessment (EMA) and time-varying effect modeling (TVEM) to examine dynamic associations between general problem-related help-seeking (i.e., talking to someone about one's problems) and suicidal ideation (SI) intensity during the three weeks following psychiatric hospitalization for STB in a sample of 96 adolescents (ages 13-18). Associations between SI and help-seeking were also examined across levels of family conflict. Help-seeking was positively associated with SI intensity early in the post-discharge period, with effects attenuating over time. Thus, adolescents may be more likely to seek support during moments of heightened distress shortly after returning to their environments. Associations differed by family context: adolescents reporting lower and average family conflict demonstrated stronger coupling between SI intensity and help-seeking, whereas no significant association emerged among adolescents reporting higher conflict. Findings suggest that help-seeking may be more closely aligned with periods of elevated distress early after hospitalization, particularly among adolescents with lower family conflict. Interventions that strengthen supportive relationships, particularly within family contexts, may facilitate help-seeking during this high-risk transition period.