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Factors Associated with Distinct Patterns of Suicidal Thoughts, Suicide Plans, and Suicide Attempts Among US Adolescents

Abstract

The current study examined demographic, psychosocial, and substance use factors associated with distinct patterns of past 12-month suicide thoughts, plans, and attempts among adolescents drawn from a nationally representative sample of high schoolers. Data were from the 2015, 2017, and 2019 National Youth Risk Behavior Survey. Four mutually exclusive 12-month suicidal behavior patterns were identified: suicide thoughts only (pattern 1), suicide thoughts and plans without suicide attempt (pattern 2), suicide attempt with thoughts and/or plans (pattern 3), and suicide attempt without thoughts or plans (pattern 4). Multinomial logistic regression analyses were conducted to examine factors correlated with these distinct patterns. Psychosocial and substance use factors were modeled as independent predictors, controlling for demographic characteristics, as well as simultaneously to represent the potential for co-occurrence. The analytic sample included 7491 respondents. About 24% (n = 1734) of youth endorsed pattern 1, 38% (n = 2779) pattern 2, 35% (n = 2716) pattern 3, and 3% (n = 262) pattern 4. All psychosocial and substance use factors measured were individually associated with greater odds of suicide attempts with thoughts or plans (pattern 3) than patterns 1 or 2. Black and male youth were at greater odds of suicide attempts without thoughts or plans (pattern 4) than all other patterns. When modeled simultaneously, respondents who were bullied online, sad or hopeless, had a history of sexual violence, used cigarettes, and misused prescription opiates retained greater odds of suicide attempts with thoughts or plans (pattern 3) than patterns 1 or 2. Findings suggest screening for suicidal behaviors should include factors that differentiate between varying suicidal expressions and that may cue providers to intervene in the absence of suicide thoughts and plans.

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References

  • Alaska Department of Health and Social Services. (2017). Alaska 2017 Youth Risk Behavior Survey. Alaska Statewide: Alternative HS 2017 Compared to Alaska Statewide: Traditional HS 2017. Retrieved April 2, 2021 from https://dhss.alaska.gov/dph/Chronic/Documents/yrbs/2017AKYRBS_TradHS_AltHS_ComparisonGraphs.pdf

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.

    Google Scholar 

  • Auerbach, R. P., Millner, A. J., Stewart, J. G., & Esposito, E. C. (2015). Identifying differences between depressed adolescent suicide ideators and attempters. Journal of Affective Disorders, 186, 127–133. https://doi.org/10.1016/j.jad.2015.06.031

    Article  PubMed  PubMed Central  Google Scholar 

  • Becker, T. D., Arnold, M. K., Ro, V., Martin, L., & Rice, T. R. (2021). Systematic review of electronic cigarette use (vaping) and mental health comorbidity among adolescents and young adults. Nicotine and Tobacco Research, 23, 415–425. https://doi.org/10.1093/ntr/ntaa171 

    Article  Google Scholar 

  • Betz, M. E., Boudreaux, E. D. (2016). Managing suicidal patients in the emergency department. Annals of Emergency Medicine, 67(2), 276–282. https://doi.org/10.1016/j.annemergmed.2015.09.001

  • Borges, G., Nock, M. K., Abad, J. M. H., Hwang, I., Sampson, N. A., Alonso, J., et al. (2010). Twelve-month prevalence of and risk factors for suicide attempts in the World Health Organization World Mental Health Surveys. Journal of Clinical Psychiatry, 71, 1617. https://doi.org/10.4088/JCP.08m04967blu 

    Article  Google Scholar 

  • Bridge, J. A., McBee-Strayer, S. M., Cannon, E. A., Sheftall, A. H., Reynolds, B., Campo, J. V., et al. (2012). Impaired decision making in adolescent suicide attempters. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 394–403. https://doi.org/10.1016/j.jaac.2012.01.002

  • Bryan, C. J., Corso, K. A., Neal-Walden, T. A., & Rudd, M. D. (2009). Managing suicide risk in primary care: Practice recommendations for behavioral health consultants. Professional Psychology: Research and Practice, 40, 148–155. https://doi.org/10.1037/a0011141

  • Centers for Disease Control and Prevention. (2019). WISQARS. Leading causes of death reports, 1981–2017. Available at: https://webappa.cdc.gov/sasweb/ncipc/leadcause.html Accessed 11 July 2019.

  • Centers for Disease Control and Prevention. (2020a). Youth Risk Behavior Survey Data Summary & Trends Report: 2009–2019. Available at: https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBSDataSummaryTrendsReport2019–508.pdf. Accessed 10 Nov 2020.

  • Centers for Disease Control and Prevention. (2020b). Combining YRBS Data Across Years and Sites. Available at: https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2019/2019_YRBS_combining_data.pdf Accessed 10 Nov 2020.

  • Cha, C. B., Franz, P. J., Guzman, E., Glenn, C. R., Kleiman, E. M., & Nock, M. K. (2018). Annual Research Review: Suicide among youth – epidemiology, (potential) etiology, and treatment. Journal of Child Psychology and Psychiatry, 59, 460–482. https://doi.org/10.1111/jcpp.12831

    Article  PubMed  Google Scholar 

  • Chadi, N., Schroeder, R., Jensen, J. W., & Levy, S. (2019). Association between electronic cigarette use and marijuana use among adolescents and young adults: A systematic review and meta-analysis. JAMA Pediatrics, 173, e192574–e192574. https://doi.org/10.1001/jamapediatrics.2019.2574

  • Congressional Black Caucus Emergency Taskforce. (2019). Ring the alarm: The crisis of Black youth suicide in America. Retrieved November 10, 2020 from https://www.watsoncoleman.house.gov/uploadedfiles/full_taskforce_report.pdf

  • Cross, C. P., Copping, L. T., & Campbell, A. (2011). Sex differences in impulsivity: A meta-analysis. Psychological Bulletin, 137, 97–130. https://doi.org/10.1037/a0021591

  • Curtin, S. C., Hedegaard, H., Minino, A., Warner, M., & Simon, T. (2017). Suicide rates for teens aged 15–19 years, by sex—United States, 1975–2015. MMWR Morbidity and Mortality Weekly Report, 66, 816. https://doi.org/10.15585/mmwr.mm6630a6

  • Dawes, M. A., Mathias, C. W., Richard, D. M., Hill-Kapturczak, N., & Dougherty, D. M. (2008). Adolescent suicidal behavior and substance use: Developmental mechanisms. Substance Abuse, 2, 13–28. https://doi.org/10.4137/sart.s1044

  • Dworkin, E. R., Menon, S. V., Bystrynski, J., & Allen, N. E. (2017). Sexual assault victimization and psychopathology: A review and meta-analysis. Clinical Psychology Review, 56, 65–81. https://doi.org/10.1016/j.cpr.2017.06.002

    Article  PubMed  PubMed Central  Google Scholar 

  • Evans, E., Hawton, K., & Rodham, K. (2004). Factors associated with suicidal phenomena in adolescents: A systematic review of population-based studies. Clinical Psychology Review, 24, 957–979. https://doi.org/10.1016/j.cpr.2004.04.005

  • Gili, M., Castellví, P., Vives, M., de la Torre-Luque, A., Almenara, J., Blasco, M. J., Cebrià, A. I., et al. (2019). Mental disorders as risk factors for suicidal behavior in young people: A meta-analysis and systematic review of longitudinal studies. Journal of Affective Disorders, 245, 152–162. https://doi.org/10.1016/j.jad.2018.10.115

    Article  PubMed  Google Scholar 

  • Glenn, C. R., & Nock, M. K. (2014). Improving the short-term prediction of suicidal behavior. American Journal of Preventive Medicine, 47(3 Suppl 2), S176-S180 https://doi.org/10.1016/j.amepre.2014.06.004

  • Ivey-Stephenson, A. Z., Demissie, Z., Crosby, A. E., Stone, D. M., Gaylor, E., Wilkins, N., et al. (2020). Suicidal ideation and behaviors among high school students — youth risk behavior survey, United States, 2019. MMWR Supplements, 69, 47–55. https://doi.org/10.15585/mmwr.su6901a6

  • Jacobs, W., Idoko, E., Montgomery, L., Smith, M. L., & Merianos, A. L. (2021). Concurrent E-cigarette and marijuana use and health-risk behaviors among US high school students. Preventive Medicine, 145, 106429. https://doi.org/10.1016/j.ypmed.2021.106429

  • Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Hawkins, J., et al. (2016). Youth risk behavior surveillance — United States, 2015 MMWR Surveillance Summaries, 26, 1–174. http://dx.doi.org/10.15585/mmwr.ss6506a1externalicon

  • Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., et al. (2018). Youth risk behavior surveillance — United States, 2017. MMWR Surveillance Summaries, 67, 1–114. https://doi.org/10.15585/mmwr.ss6708a1

  • Klonsky, E. D., May, A. M. (2014). Differentiating suicide attempters from suicide ideators: A critical frontier for suicidology research. Suicide Life and Threatening Behavior, 44, 1–5. https://doi.org/10.1111/sltb.12068

  • Klonsky, E. D., Saffer, B. Y., & Bryan, C. J. (2018). Ideation-to-action theories of suicide: A conceptual and empirical update. Current Opinion in Psychology, 22, 38–43. https://doi.org/10.1016/j.copsyc.2017.07.020

    Article  PubMed  Google Scholar 

  • Lindsey, M. A., Sheftall, A. H., Xiao, Y., & Joe, S. (2019). Trends of suicidal behaviors among high school students in the United States: 1991–2017 Pediatrics, 144, e20191187. https://doi.org/10.1542/peds.2019-1187

  • Lu, W., Lindsey, M. A., Irsheid, S., & Nebbitt, V. E. (2017). Psychometric properties of the CES-D among black adolescents in public housing. Journal of the Society for Social Work and Research, 8, 595–619. https://doi.org/10.1086/694791

    Article  Google Scholar 

  • Mars, B., Heron, J., Klonsky, E. D., Moran, P., O’Connor, R. C., Tilling, K., et al. (2019a). What distinguishes adolescents with suicidal thoughts from those who have attempted suicide? A population-based birth cohort study. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 60, 91–99. https://doi.org/10.1111/jcpp.12878

  • Mars, B., Heron, J., Klonsky, E. D., Moran, P., O'Connor, R. C., Tilling, K., et al. (2019b). Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: A population-based birth cohort study. The Lancet Psychiatry, 6, 327. https://doi.org/10.1016/s2215-0366(19)30030-6

  • May, A. M., Klonsky, E. D. (2016). What distinguishes suicide attempters from suicide ideators? A meta-analysis of potential factors. Clinical Psychology Science Practice, 23, 5–20. https://doi.org/10.1111/cpsp.12136

  • McBride, N. M., Johnco, C., Salloum, A., Lewin, A. B., & Storch, E. A. (2017). Prevalence and clinical differences of suicidal thoughts and behaviors in a community sample of youth receiving cognitive-behavioral therapy for anxiety. Child Psychiatry & Human Development, 48, 705–713. https://doi.org/10.1007/s10578-016-0696-6

    Article  Google Scholar 

  • McHugh, C. M., Lee, R. S. C., Hermens, D. F., Corderoy, A., Large, M., & Hickie, I. B. (2019). Impulsivity in the self-harm and suicidal behavior of young people: A systematic review and meta-analysis. Journal of Psychiatric Research, 116, 51–60. https://doi.org/10.1016/j.jpsychires.2019.05.012

    Article  PubMed  Google Scholar 

  • McManama O’Brien, K. H., Becker, S. J., Spirito, A., Simon, V., & Prinstein, M. J. (2014). Differentiating adolescent suicide attempters from ideators: Examining the interaction between depression severity and alcohol use. Suicide and Life Threatening Behavior, 44, 23–33. https://doi.org/10.1111/sltb.12050

    Article  PubMed  Google Scholar 

  • Moore, S. E., Norman, R. E., Suetani, S., Thomas, H.J., Sly, P. D., & Scott, J. G. (2017). Consequences of bullying victimization in childhood and adolescence: A systematic review and meta-analysis. World Journal of Psychiatry, 7, 60–76. https://doi.org/10.5498/2Fwjp.v7.i1.60

  • Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C., & Lee, S. (2008). Suicide and suicidal behavior. Epidemiologic Reviews, 30, 133–154. https://doi.org/10.1093/epirev/mxn002

    Article  PubMed  Google Scholar 

  • Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the national comorbidity survey replication adolescent supplement. JAMA Psychiatry, 70, 300–310. https://doi.org/10.1001/2013.jamapsychiatry.55

    Article  PubMed  Google Scholar 

  • Nock, M. K., Kessler, R. C., & Franklin, J. C. (2016). Risk factors for suicide ideation differ from those for the transition to suicide attempt: The importance of creativity, rigor, and urgency in suicide research. Clinical Psychology: Science and Practice, 23, 31–34. https://doi.org/10.1111/cpsp.12133

  • Oravecz, R., & Moore, M. M. (2006). Recognition of suicide risk according to the characteristics of the suicide process. Death Studies, 30, 269–279. https://doi.org/10.1080/07481180500493492 

    Article  Google Scholar 

  • Panagioti, M., Gooding, P. A., Triantafyllou, K., & Tarrier, N. (2015). Suicidality and posttraumatic stress disorder (PTSD) in adolescents: A systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 50, 525–537. https://doi.org/10.1007/s00127-014-0978-x

  • Pompili, M., Serafini, G., Innamorati, M., Biondi, M., Siracusano, A., Di Giannantonio, M., et al. (2012). Substance abuse and suicide risk among adolescents. European Archives of Psychiatry and Clinical Neuroscience, 262, 469–485. https://doi.org/10.1007/s00406-012-0292-0

  • Poorolajal, J., Haghtalab, T., Farhadi, M., & Darvishi, N. (2016). Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: A meta-analysis. Journal of Public Health, 38, e282–e291. https://doi.org/10.1093/pubmed/fdv148

    Article  PubMed  Google Scholar 

  • Racine, M. (2018). Chronic pain and suicide risk: A comprehensive review Progress in Neuro Psychopharmacology and Biological. Psychiatry, 87, 269–280. https://doi.org/10.1016/j.pnpbp.2017.08.020

  • Rodway, C., Tham, S. G., Turnbull, P., Kapur, N., & Appleby, L. (2020). Suicide in children and young people: Can it happen without warning? Journal of Affective Disorders, 275, 307–310. https://doi.org/10.1016/j.jad.2020.06.069

    Article  PubMed  Google Scholar 

  • Sheftall, A. H., Davidson, D. J., McBee-Strayer, S.M., Ackerman., J., Mendoza, K., Reynolds, B., & Bridge, J. A. (2015). Decision-making in adolescents with suicidal ideation: A case-control study. Pychiatry Research, 228, 928. https://dx.doi.org/10.1016/j.psychres.2015.05.077

  • Stewart, J. G., Esposito, E. C., Glenn, C. R., & Gilman, S. E. (2017). Adolescent self-injurers: Comparing non-ideators, suicide ideators, and suicide attempters Journal of Psychiatric Research, 84, 105–112. https://doi.org/10.1016/j.jpsychires.2016.09.031

  • Underwood, J. M., Brener, N., Thornton, J., Harris, W. A., Bryan, L. N., Shanklin, S. L., et al. (2020). Overview and methods for the youth risk behavior surveillance system — United States, 2019. MMWR Supplements, 69, 1–10. https://doi.org/10.15585/mmwr.su6901a1

  • Witte, T. K., Merrill, K. A., Stellrecht, N. E., Bernert, R. A., Hollar, D. L., Schatschneider, C., & Joiner, T. E. (2008). “Impulsive” youth suicide attempters are not necessarily all that impulsive. Journal of Affective Disorders, 107, 107–116. https://doi.org/10.1016/j.jad.2007.08.010

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Funding

Dr. Sheftall’s time was supported, in part, by grants from the American Foundation for Suicide Prevention (AFSP; YIG-1–152-19-Sheftall) and the National Institute of Mental Health (NIMH; 1R21MH116206-01A1). Dr. Lindsey’s time was supported, in part by a grant from the National Institute of Mental Health (NIMH; 1R34MH119290-01).

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Correspondence to Meghan Romanelli.

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Ethics Approval

Primary Data Source-National YRBS: For all years, the CDC’s Institutional Review Board (IRB) approved the YRBS protocol. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Current Study

This study was determined as not human subjects research as data were not directly obtained by these researchers through intervention/interaction and identifiable private information was not utilized. A secondary data analysis was completed of the National YRBS, publicly available and de-identified data. Data is available for download at: https://www.cdc.gov/healthyyouth/data/yrbs/data.htm

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Informed consent was obtained from all respondents of the National YRBS. Location parental permission procedures were followed.

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The authors declare no competing interests.

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Romanelli, M., Sheftall, A.H., Irsheid, S.B. et al. Factors Associated with Distinct Patterns of Suicidal Thoughts, Suicide Plans, and Suicide Attempts Among US Adolescents. Prev Sci 23, 73–84 (2022). https://doi.org/10.1007/s11121-021-01295-8

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Keywords

  • Suicidal ideation
  • Suicide
  • Attempted
  • Adolescent mental health
  • Suicide assessment