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The risk of adolescent suicide across patterns of drug use: a nationally representative study of high school students in the United States from 1999 to 2009

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Objective

Substance use is associated with suicidal ideation, planning and attempts among adolescents, but it is unclear how this association varies across different types and number of substances. This study examined the association between patterns of substance use and suicidality among a nationally representative sample of high school students in the United States during the last decade.

Method

Data from the 2001 to 2009 Youth Risk Behavior Survey including 73,183 high school students were analyzed. Logistic regression analyses examined the association between lifetime use of ten common substances of abuse (alcohol, cocaine, ecstasy, hallucinogens, heroin, inhalants, marijuana, methamphetamines, steroids, and tobacco) and four measures of suicidality over the last year (suicidal ideation, suicide plan, suicide attempt, and severe suicide attempt requiring medical attention), controlling for potential confounders (socio-demographic variables, interpersonal violence, sexual intercourse, and symptoms of depression and eating disorder).

Results

Among the ten substances, univariate analysis demonstrates that adolescents reporting a history of heroin use have the strongest association with suicidal ideation, suicide plan, suicide attempts and severe suicide attempts in the last year (odds ratio = 5.0, 5.9, 12.0, and 23.6 compared to non-users), followed by users of methamphetamines (OR = 4.3–13.1) and steroids (OR = 3.7–11.8). Cocaine, ecstasy, hallucinogens and inhalants had a moderate association with suicidality (OR = 3.1–10.8). Users of marijuana, alcohol and tobacco also had an increased odds ratio of suicidality (OR = 1.9–5.2). The association between each of ten substances and the four measures of suicidality remained significant with multivariate analysis controlling for multiple confounders (p < 0.05), except for the association between alcohol use and severe suicide attempts. The seven illicit substances had a stronger association with severe suicide attempts as compared to all other confounding risk factors except depression. The number of substances used had a graded relationship to suicidality.

Conclusions

Substance abuse is a strong risk factor for suicidal thoughts and behaviors among American high school students, with the strength of this relationship dramatically increasing with particular illicit drugs and a higher number of substances. The findings reinforce the importance of routine screening for substance abuse in the assessment of adolescent suicide risk.

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References

  1. Bridge JA, Greenhouse JB, Weldon AH, Campo JV, Kelleher KJ (2008) Suicide trends among youths aged 10 to 19 years in the United States, 1996–2005. JAMA 300:1025–1026

    Article  PubMed  CAS  Google Scholar 

  2. Monitoring the Future (2011) Trends in lifetime prevalence of use of various drugs for eighth, tenth, and twelfth graders, University of Michigan http://www.monitoringthefuture.org/data/11data/pr11t1.pdf. Accessed 7 Sept 2012

  3. Shaffer D, Pfeffer CR (2001) Practice parameter for the assessment and treatment of children and adolescents with suicidal behavior. J Am Acad Child Adolesc Psychiatry 40(7 suppl):24–51

    Google Scholar 

  4. American Academy of Child and Adolescent Psychiatry, American Psychiatric Association (2004). Joint statement from the American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association for the hearing on suicide prevention and youth: saving lives. Senate Substance Abuse and Mental Health Services Subcommittee of the Health, Education, Labor and Pensions. http://www.aacap.org/galleries/LegislativeAction/SuicideH.pdf. Accessed 5 Aug 2012

  5. Miller M, Borges G, Orozco R et al (2011) Exposure to alcohol, drugs and tobacco and the risk of subsequent suicidality: findings from the Mexican Adolescent Mental Health Survey. Drug Alcohol Depend 113:110–117

    Article  PubMed  CAS  Google Scholar 

  6. Wichstrom L (2000) Predictors of adolescent suicide attempts: a nationally representative longitudinal study of Norwegian adolescents. J Am Acad Child Adolesc Psychiatry 39:603–610

    Article  PubMed  CAS  Google Scholar 

  7. Swahn MH, Bossarte RM, Ashby JS et al (2010) Preteen alcohol use initiation and suicide attempts among middle and high school students: findings from the 2006 Georgia Student Health Survey. Addict Behav 35:452–458

    Article  PubMed  Google Scholar 

  8. Kim DS, Kim HS (2010) Early initiation of alcohol drinking, cigarette smoking, and sexual intercourse linked to suicidal ideation and attempts: findings from the 2006 Korean Youth Risk Behavior Survey. Yonsei Med J 51:18–26

    Article  PubMed  Google Scholar 

  9. Roberts RE, Ramsay C, Yun X (2010) One-year incidence of suicide attempts and associated risk and protective factors among adolescents. Arch Suicide Res 14:66–78

    Article  PubMed  Google Scholar 

  10. Glowinski AL, Bucholz KK, Nelson EC et al (2001) Suicide attempts in an adolescent female twin sample. J Am Acad Child Adolesc Psychiatry 40:1300–1307

    Article  PubMed  CAS  Google Scholar 

  11. Rossow I, Hawton K, Ystgaard M (2009) Cannabis use and deliberate self-harm in adolescence: a comparative analysis of associations in England and Norway. Arch Suicide Res 13:340–348

    Article  PubMed  Google Scholar 

  12. Hemmingsson T, Kriebel D (2003) Smoking at age 18–20 and suicide during 26 years of follow-up—how can the association be explained? Int J Epidemiol 32:1000–1004

    Article  PubMed  Google Scholar 

  13. Robbins DR, Alessi NE (1985) Depressive symptoms and suicidal behavior in adolescents. Am J Psychiatry 142:588–592

    PubMed  CAS  Google Scholar 

  14. Epstein JA, Spirito A (2010) Gender-specific risk factors for suicidality among high school students. Arch Suicide Res 14:193–205

    Article  PubMed  Google Scholar 

  15. Howard MO, Perren BE, Sacco P et al (2010) Suicide ideation and attempts among inhalant users: results from the national epidemiologic survey on alcohol and related conditions. Suicide Life Threat Behav 40:276–286

    Article  PubMed  Google Scholar 

  16. Zubaran C, Foresti K, Thorell MR et al (2010) Depressive symptoms in crack and inhalant users in southern Brazil. J Ethn Subst Abuse 9:221–236

    Article  PubMed  Google Scholar 

  17. Britton PC, Conner KR (2010) Suicide attempts within 12 months of treatment for substance use disorders. Suicide Life Threat Behav 40:14–21

    Article  PubMed  Google Scholar 

  18. Hakansson A, Bradvik L, Schlyter F et al (2010) Factors associated with the history of attempted suicide: a criminal justice population examined with the Addiction Severity Index (ASI). Crisis 31:12–21

    PubMed  CAS  Google Scholar 

  19. Darke S, Ross J (2002) Suicide among heroin users: rates, risk factors and methods. Addiction 97:1383–1394

    Article  PubMed  Google Scholar 

  20. Borges G, Walters EE, Kessler RC (2000) Associations of substance use, abuse, and dependence with subsequent suicidal behaviour. Am J Epidemiol 151:781–789

    Article  PubMed  CAS  Google Scholar 

  21. Behnken MP, Le YCL, Temple JR et al (2010) Forced sexual intercourse, suicidality and binge drinking among adolescent girls. Addict Behav 35:507–509

    Article  PubMed  Google Scholar 

  22. Le YC, Behnken MP, Markham CM, Temple JR (2011) Alcohol use as a potential mediator of forced sexual intercourse and suicidality among African American, Caucasian, and Hispanic high school girls. J Adolesc Health 4:437–439

    Article  Google Scholar 

  23. Bergen HA, Martin G, Richardson AS, Allison S, Roeger L (2003) Sexual abuse and suicidal behavior: a model constructed from a large community sample of adolescents. J Am Acad Child Adolesc Psychiatry 42:1301–1309

    Article  PubMed  Google Scholar 

  24. Innamorati M, Lested D, Amore M et al (2010) Alcohol consumption predicts the EU suicide rates in young women aged 15–29 years but not in men: analysis of trends and differences among early and new EU countries since 2004. Alcohol 44:463–469

    Article  PubMed  Google Scholar 

  25. Fergusson DM, Lynskey MT (1995) Suicide attempts and suicidal ideation in a birth cohort of 16-year-old New Zealanders. J Am Acad Child Adolesc Psychiatry 34:1308–1317

    Article  PubMed  CAS  Google Scholar 

  26. Lewinsohn PM, Rohde P, Seeley JR (1994) Psychosocial risk factors for future suicide attempts. J Consult Clin Psychol 62:297–305

    Article  PubMed  CAS  Google Scholar 

  27. Reinherz HZ, Giaconia RM, Silverman AB et al (1995) Early psychosocial risk for adolescent suicidal ideation and attempts. J Am Acad Child Adolesc Psychiatry 34:599–611

    Article  PubMed  CAS  Google Scholar 

  28. Wanna G, Fombonne E (1998) Gender differences in rates and correlates of suicidal behavior among child psychiatric outpatients. J Adolesc 21:371–381

    Article  Google Scholar 

  29. Wong SS, Sugimoto-Matsuda JJ, Chang JY, Hishinuma ES (2012) Ethnic differences in risk factors for suicide among American high school students, 2009: the vulnerability of multiracial and Pacific Islander adolescents. Arch Suicide Res 16:159–173

    Article  PubMed  Google Scholar 

  30. Kandel DB (1988) Substance use, depressive mood, and suicidal ideation in adolescence and young adulthood. Adv Adolesc Ment Health 3:127–143

    Google Scholar 

  31. Beautrais AL, Joyce PR, Mulder RT (1997) Precipitating factors and life events in serious suicide attempts among youths aged 13 through 24 years. J Am Acad Child Adolesc Psychiatry 36:1543–1551

    PubMed  CAS  Google Scholar 

  32. Gould MS, Greenberg T, Munfakh JL, Kleinman M, Lubell K (2004) Teenagers’ attitudes about coping strategies and help-seeking behavior for suicidality. J Am Acad Child Adolesc Psychiatry 43:1124–1133

    Article  PubMed  Google Scholar 

  33. Shaffer D, Vieland V, Garland A, Rojas M, Underwood M, Busner C (1990) Adolescent suicide attempters. Response to suicide-prevention programs. JAMA 264:3151–3155

    Article  PubMed  CAS  Google Scholar 

  34. MacDonald R, Taylor J, Clarke D (2009) The relationship between early suicide behaviors and mental health: results from a nine-year panel study. J Adolesc 32:1159–1172

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This manuscript was supported by the Centers for Disease Control and Prevention (CDC; R49/CCR918619-05; Cooperative Agreement #1 U49/CE000749-01), University of Hawai‘i at Mānoa Department of Psychiatry, and the Stanford University Medical Scholars Program (Mr. Wong).The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the funding agencies.

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Authors and Affiliations

  1. Stanford University School of Medicine, Stanford, CA, USA

    Shane Shucheng Wong & Bo Zhou

  2. Department of Psychiatry, University of Hawaii, Honolulu, HI, USA

    Deborah Goebert & Earl S. Hishinuma

  3. Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA, 94305, USA

    Shane Shucheng Wong

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  1. Shane Shucheng Wong
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Correspondence to Shane Shucheng Wong.

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Wong, S.S., Zhou, B., Goebert, D. et al. The risk of adolescent suicide across patterns of drug use: a nationally representative study of high school students in the United States from 1999 to 2009. Soc Psychiatry Psychiatr Epidemiol 48, 1611–1620 (2013). https://doi.org/10.1007/s00127-013-0721-z

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  • DOI: https://doi.org/10.1007/s00127-013-0721-z

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