Victimization, Suicidal Ideation, and Alcohol Use From Age 13 to 15 Years: Support for the Self-Medication Model

A longitudinal examination into childhood abuse and substance use to PTSD symptoms and deviant peer association: Impact of developmental timing of abuse

BACKGROUND

Following child abuse, adolescents often endorse PTSD symptoms and use substances. However, few studies have addressed the longitudinal underlying effects of deviant peer association and revictimization and the developmental impact of PTSD symptoms and substance use.

OBJECTIVE

To address these limitations, the current study utilized the susceptibility and self-medication hypothesis to examine abuse in childhood ages 0-12 and adolescence ages 12-16 as predictors of substance use in mid-adolescence at age 16 and symptoms of (PTSD) in late adolescence at age 18 mediated by associating with deviant peers and revictimization using a sample of 596 (73.8 % racial minority; 50.7 % male) adolescents from Longitudinal Study of Child Abuse and Neglect.

METHODS

This study utilized structural equation modeling (SEM) to examine the direct and indirect effects of child abuse, substance use, deviant peer affiliation, and PTSD symptoms across different developmental periods using bootstrapping procedures.

RESULTS

Results indicated that substance use in mid-adolescence mediated the relationship between abuse in adolescence and PTSD symptoms in middle adolescence, while the abuse in childhood was not indirectly related. Furthermore, the indirect effect between abuse in childhood and PTSD symptoms at age 16 was mediated by PTSD at age 12 and deviant peer affiliation at age 14. Substance use in adolescence, PTSD symptoms, and adolescent peer social networks may be a point of intervention to reduce future adverse outcomes.

CONCLUSION

The findings of this study provided evidence of the long-term consequences of experiencing child abuse and subsequent adverse outcomes, including PTSD symptoms, substance use, and adolescent deviant peer affiliation. This study also highlighted preventive and intervention mechanisms to attenuate these adverse outcomes.

On the Importance of Considering Concurrent Effects in Random-Intercept Cross-Lagged Panel Modelling: Example Analysis of Bullying and Internalising Problems

Random-intercept cross-lagged panel models (RI-CLPMs) are increasingly used to investigate research questions focusing on how one variable at one time point affects another variable at the subsequent time point. Due to the implied temporal sequence of events in such research designs, interpretations of RI-CLPMs primarily focus on longitudinal cross-lagged paths while disregarding concurrent associations and modeling these only as residual covariances. However, this may cause biased cross-lagged effects. This may be especially so when data collected at the same time point refers to different reference timeframes, creating a temporal sequence of events for constructs measured concurrently. To examine this issue, we conducted a series of empirical analyses in which the impact of modeling or not modeling of directional within-time point associations may impact inferences drawn from RI-CLPMs using data from the longitudinal z-proso study. Results highlight that not considering directional concurrent effects may lead to biased cross-lagged effects. Thus, it is essential to carefully consider potential directional concurrent effects when choosing models to analyze directional associations between variables over time. If temporal sequences of concurrent effects cannot be clearly established, testing multiple models and drawing conclusions based on the robustness of effects across all models is recommended.

Differentiating the association between age of alcohol use initiation and conditional suicidal behaviors among adolescents

INTRODUCTION

Suicide and early alcohol use initiation are public health concerns. Previous studies have explored the associations between age of alcohol use initiation and suicidal behaviors, which progresses from ideation to action. Distinguishing between the various associations can help gain a deeper understanding of suicidal behaviors and aid in developing social suicide prevention strategies.

METHODS

The study utilized the Youth Risk Behavior Survey to investigate this association. A total of 17 209 students were finally included in the study. Conditional suicidal behaviors included no suicidal behavior (NS), suicidal ideation without a plan or attempt (SINPA), suicide plan without an attempt (SPNA) and suicide attempt (SA).

RESULTS

Among 17 209 students, the prevalence of suicidal ideation, suicide plan, and suicide attempt were 21.4%, 17.3%, and 11.1%, respectively. Moreover, 15.2% of the students used alcohol before age 13, whereas 31.7% of students used alcohol at age 13 or older. Compared to NS, students using alcohol showed significant associations with SA (OR = 2.34, p < .001; OR = 1.29, p < .01), SPNA (OR = 1.68, p < .001; OR = 1.19, p < .05) and SINPA (OR = 1.55, p < .001; OR = 1.40, p < .001). Comparing with SINPA and SNPA, students using alcohol before age 13 were associated with SA (OR = 1.61, p < .001; OR = 1.46, p < .001), whereas those using alcohol at or after the age 13 were not associated with SA (OR = 0.98, p > .05; OR = 1.09, p > .05).

DISCUSSION

This study demonstrated that early alcohol use initiation was significantly associated with suicide attempts among students with suicidal ideations or plans.

Sexual Victimization in Adolescence: Pathways of Risk from Sexual Harassment via Risky Alcohol Use and Delinquency Among U.S. Adolescents

Sexual harassment is a common, yet understudied form of peer victimization experienced by adolescents during a critical period in the development of sexual identity. Adverse sexual experiences early in life (e.g., child sexual abuse) can increase risk of future sexual assault victimization; however, it is unclear as to whether sexual harassment victimization is also a risk factor for sexual assault. We examined the prospective association between peer sexual harassment and experiencing sexual victimization in the following year among a community sample of 13-15-year-old adolescents (N = 800, 57% female) from the northeastern USA. We also examined whether risky alcohol use and delinquency mediated the association between sexual harassment and sexual assault victimization, as well as whether the paths differed by gender. Results indicated that sexual harassment victimization prospectively predicted later sexual victimization for both girls and boys. Using a parallel mediation path model, we determined that for girls, sexual harassment victimization predicted both risky alcohol use and delinquency, but only risky alcohol use was predictive of sexual victimization. For boys, sexual harassment victimization predicted delinquency but not risky alcohol use. Risky alcohol use was not associated with sexual victimization for boys. Findings indicate that sexual harassment victimization increases risk of later sexual victimization in adolescence, but the pathways differ by gender.

Personality-specific pathways from bullying victimization to adolescent alcohol use: a multilevel longitudinal moderated mediation analysis

Bullying victimization is common in adolescence and has been associated with a broad variety of psychopathology and alcohol use. The present study assessed time-varying associations between bullying victimization and alcohol use through internalizing and externalizing symptoms and whether this indirect association throughout time is moderated by personality. This 5-year longitudinal study (3,800 grade 7 adolescents) used Bayesian multilevel moderated mediation models: independent variable was bullying victimization; moderators were four personality dimensions (anxiety sensitivity, hopelessness, impulsivity, and sensation seeking); internalizing symptoms (anxiety, depressive symptoms) and externalizing symptoms (conduct, hyperactivity problems) were the mediators; and alcohol use, the outcome. Results indicated significant between, within, and lagged effects on alcohol use through internalizing and externalizing symptoms. There were significant between and within effects on alcohol use through internalizing symptoms for adolescents with high anxiety sensitivity and hopelessness, and significant between, within, and lagged effects on alcohol use through externalizing symptoms for adolescents with high impulsivity and sensation seeking. These findings implicate two risk pathways that account for how bullying victimization enhances alcohol use risk and emphasize the importance of personality profiles that can shape the immediate and long-term consequences of victimization.

Associations between tobacco and alcohol use and aggressive behavior among adolescents in 55 Low- and Middle-Income countries

BACKGROUND

Aggressive behavior has become a serious public health problem among adolescents worldwide. We aimed to assess the associations between tobacco and alcohol use and aggressive behavior among adolescents in 55 Low- and Middle-Income countries (LMICs).

METHODS

Data from 55 LMICs that had done a Global School-based Student Health Survey (GSHS) between 2009 and 2017, comprising 187,787 adolescents aged 12-17 years, were used to examine the associations between tobacco and alcohol use and aggressive behavior.

RESULTS

Among adolescents in the 55 LMICs, the proportion of aggressive behavior was 5.7 %. Compared with none tobacco users, those who used tobacco on 1-5 days (odds ratio [OR] = 2.00, 95 % confidence interval [CI] = 1.89-2.11), 6-9 days (2.76, 2.48-3.08), 10-19 days (3.20, 2.88-3.55), and ≥20 days (3.88, 3.62-4.17) during the past 30 days were positively associated with aggressive behavior. Compared with none alcohol users, those who used alcohol on 1-5 days (1.44, 1.37-1.51), 6-9 days (2.38, 2.18-2.60), 10-19 days (3.04, 2.75-3.36), and ≥20 days (3.25, 2.93-3.60) during the past 30 days were positively associated with aggressive behavior.

LIMITATIONS

Aggressive behavior, tobacco use and alcohol use were assessed by self-reported questionnaires, which might be prone to recall bias.

CONCLUSIONS

Higher amounts of tobacco and alcohol use are associated with aggressive behavior among adolescents. These findings emphasize the need to strengthen tobacco and alcohol control efforts to reduce tobacco and alcohol use targeting adolescents in LMICs.

Examining Racial/Ethnic Differences in the Association of Victimization and Suicidal Thoughts and Behaviors with Alcohol Use Among Sexual Minority Youth

Purpose: Integrating Minority Stress Theory and Bagge and Sher's Theoretical Framework of the Alcohol-Suicide Attempt Relation, this study aimed to test whether experiencing both minority stress and suicidal thoughts and behaviors (STBs) had a greater strength of association with Latinx and Black sexual minority youth (SMY)'s alcohol use compared with that of White SMY. Methods: Using data on 2341 non-Latinx Black, Latinx, and non-Latinx White SMY from the 2015 and 2017 Youth Risk Behavior Surveys, we tested the prevalence of STBs, victimization, and alcohol use for Black and Latinx participants compared with White participants. Multivariate logistic regression analyses tested the main effects of STBs, victimization, and race/ethnicity on alcohol use. Finally, interaction terms assessed the interaction among STBs, victimization, and race/ethnicity on alcohol use. Results: The results supported our hypothesis, based on Minority Stress Theory, that experiencing victimization would be associated with greater alcohol use. Results also supported Bagge and Sher's theoretical framework showing that suicide plan and attempts were associated with greater alcohol use. When taking all of these stressors into account, results showed that Latinx SMY who experienced victimization had greater current prevalence of alcohol use than their White counterparts. However, Latinx SMY who were victimized and experienced suicidal ideation reported lower alcohol use than White SMY. Conclusion: These findings support the double jeopardy and resiliency hypotheses, which suggest that minority stressors have differing associations for each racial/ethnic SMY group's alcohol use. More research is needed that helps to disentangle the protective and risk factors for alcohol use among Black and Latinx SMY.

What factors matter in the amount of alcohol consumed? An analysis among Brazilian adolescents

Alcohol consumption in the under-18 age group has been growing in recent years, leading to various health risks. Considering the problems this habit brings, the present study contributes to the literature dedicated to categorizing different types of drinkers. The study objective is to verify the factors associated with the intensity of alcohol use among elementary school students in the year 2015. The dataset came from the National Adolescent School-based Health Survey (PeNSE). The applied methodology was a logit model of sequential response (continuation ratio). The main results are as follows. It was found that being female is associated with a lesser chance of having consumed alcohol in the reference period, however, with a greater chance of consuming five or more doses. Economic condition and formal paid employment are positively associated with alcohol consumption, which increases with the progression of the student's age. The number of friends who drink alcohol and consumption of products originating from tobacco and illicit drugs, are good predictors of alcohol use by students. The time spent practicing physical activities increased the chance of male students consuming alcohol. The results showed that, in general, the characteristics associated with different alcohol consumption profiles remain similar but differ between genders. Intervention strategies aimed at preventing alcohol consumption by minors are suggested in order to reduce the negative effects of substance use and abuse.

Peer sexual harassment, affect, and substance use: Daily level associations among adolescents

INTRODUCTION

Peer sexual harassment is associated with adolescent substance use at the global level; however, it is unknown whether substance use occurs proximal in time to the sexual harassment experience. This study used daily reports to examine the proximal relations between sexual harassment victimization and affect and substance use. Based on theories of self-medication, we hypothesized that negative affect and substance use (cigarettes, electronic cigarettes, alcohol, and marijuana) would be higher than typical on days when sexual harassment occurred relative to nonvictimization days.

METHOD

A community sample of 13-16-year-old adolescents (N = 204, 55.4% female) from a metropolitan area in the northeastern United States completed 56 days of online reports assessing experiences with peer sexual harassment, substance use (cigarettes, electronic cigarettes, alcohol, and marijuana), and positive and negative affect.

RESULTS

Multilevel modeling revealed that experiencing sexual harassment on a given day was associated with higher than typical negative affect on that day, relative to nonvictimization days. The likelihood of cigarette and alcohol use (but not electronic cigarettes, marijuana, or positive affect) was greater on days when sexual harassment occurred.

CONCLUSION

Sexual harassment victimization is proximally associated with negative affect and alcohol and cigarette use, suggesting that adolescents may be using substances to cope with sexual harassment victimization. The co-occurrence of sexual harassment with negative affect and substance use points to the need for prevention efforts that conjointly address sexual harassment victimization, coping, and substance use.

Developmental Relations Between Bullying Victimization and Suicidal Ideation in Middle Adolescence and Emerging Adulthood: Do Internalizing Problems and Substance Use Mediate Their Links?

Previous research has suggested that bullying victimization is associated with higher suicidal risk among young people; however, the mechanisms underlying this relation have not been well examined. The current study aimed to illuminate the developmental links between bullying victimization and suicidal ideation by examining the mediating roles of depressive symptoms, anxiety symptoms, and substance use. The study sample consisted of n = 1465 participants (51.7% male) from the normative z-proso study. Using random intercept cross-lagged panel models and three waves of longitudinal data (ages 15, 17, and 20), the hypothesized mediation effects at the within-person level were tested while partialling out between-person confounds. The results suggested that, at the within-person level, bullying victimization did not predict subsequent suicidal ideation via depressive symptoms, anxiety symptoms, or substance use. However, age 15 bullying victimization predicted within-person increases in age 17 depressive symptoms and suicidal ideation. In addition, depressive symptoms at age 15 and tobacco and cannabis use at age 17 were associated with within-person increases in bullying victimization at ages 17 and 20, respectively. The results also indicated that cannabis use and suicidal ideation were positively and reciprocally related over time. Future studies collecting data at multiple timescales are needed to understand proximal and longer-term mechanisms underlying the relation between bullying victimization and suicidality.

Correlates of suicidality in young people with depressive disorders: A systematic review

OBJECTIVE

Depression is one of the most prevalent and disabling mental health conditions among young people worldwide. The health and economic burdens associated with depressive illness are substantial. Suicide and depression are closely intertwined, yet a diagnosis of depression itself lacks predictive specificity for suicidal behaviour. To better inform suicide prevention and early intervention strategies for young people, improved identification of modifiable intervention targets is needed. The objective of this review was to identify clinical, psychosocial and biological correlates of suicidality in young people diagnosed with a broad range of unipolar and bipolar depressive disorders.

METHOD

Systematic searches were conducted across MEDLINE, Embase and PsycINFO to identify studies of young people aged 15-25 years diagnosed with unipolar or bipolar depressive disorders. An assessment of suicidality was required for inclusion. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Synthesis Without Meta-analysis guidelines.

RESULTS

We integrated findings from 71 studies including approximately 24,670 young people with clinically diagnosed depression. We identified 26 clinical, psychosocial and biological correlates of suicidality. Depression characteristics (type and severity), psychiatric comorbidity (particularly anxiety and substance use disorders) and neurological characteristics emerged as having the most evidence for being associated with suicidal outcomes. Our ability to pool data and conduct meaningful quantitative synthesis was hampered by substantial heterogeneity across studies and incomplete reporting; thus, meta-analysis was not possible.

CONCLUSION

Findings of this review reinforce the notion that suicidality is a complex phenomenon arising from the interplay of multiple contributing factors. Our findings question the utility of considering a diagnosis of depression as a specific risk factor for suicidality in young people. Suicidality itself is transdiagnostic; adoption of a transdiagnostic approach to investigating its aetiology and treatment is perhaps warranted. Future research investigating specific symptoms, or symptom networks, might help to further our understanding of suicidality among young people experiencing mental illness.

Developmental associations between bullying victimization and suicidal ideation and direct self-injurious behavior in adolescence and emerging adulthood

BACKGROUND

Bullying, suicide, and self-injury are significant issues among young people. Extensive research has documented bullying victimization associations with suicidal ideation and self-injury; however, the modeling approaches used have mostly not addressed the relations between these constructs at the within-person level, and it is these links that are critical for testing developmental theories and guiding intervention efforts. This examined the within-person, bidirectional relations between these constructs in adolescence and emerging adulthood.

METHODS

Participants were from the Zurich Project on Social Development from Childhood to Adulthood (z-proso). Random intercept cross-lagged panel models (RI-CLPMs) were fit to general and sexual bullying victimization and suicidal ideation data at ages 15, 17, and 20 (n = 1465), and general and sexual victimization and direct self-injurious behavior data at ages 13, 15, 17, and 20 (n = 1482).

RESULTS

There was a positive within-person effect of age 15 general bullying victimization on age 17 suicidal ideation (β = .10) and age 17 suicidal ideation on age 20 general bullying victimization (β = .14).

CONCLUSIONS

General bullying victimization and suicidal ideation may have detrimental effects on each other over development but at different stages.

Suicidal ideation, plans, and attempts and the use of psychoactive substances by adolescents

Introduction: Suicidal behavior and substance abuse constitute a serious public health problem.

Aim: The study was to analyze the relationships between suicidal behaviors (ideation, plans, attempts) and substance abuse in adolescents. The authors also took into account the respondents’ motivation to attempt suicide and use psychoactive substances, as well as some demographic variables.

Participants: The study involved 3493 secondary school students aged 16-17 years. The group included 69.41% girls and 30.59% boys.

Methods: The participants were surveyed with a self-report questionnaire designed by one of the authors.

Results: Statistically significant relationships were found between the respondents’ suicidal behaviors and the risky use of alcohol, cannabis, amphetamine, and designer drugs.

Conclusions: 1. The use of psychoactive substances increases the risk of suicidal ideation and plans, as well as suicidal attempts in adolescents and young adults.

2. Significantly more respondents who report suicidal ideation, plans and attempts, in comparison to those who do not report such thoughts and behaviours, abuse alcohol and consumer cannabis, amphetamine and designer drugs to cope with problems and olster self-confidence.

3. In the group of respondents who report suicidal behaviour, psychoactive substances are consumed by significantly more men than women and by significantly more city inhabitants than people living in the country.

4. Young people, who report suicidal thoughts, plans, and attempts, are initiated into alcohol consumption at an earlier age than their non-suicidal peers.

Predicting the severity of peer victimization and bullying perpetration among youth with interpersonal problems: A 6-month prospective study

INTRODUCTION

Peer victimization is prevalent and associated with adverse outcomes. In this prospective study of youth who self-reported interpersonal problems, we examined school connectedness, school behavioral difficulties, academic difficulties, and internalizing problems (social anxiety, self-esteem, depression) as predictors of peer victimization and bullying perpetration severity. We also examined the moderating effects of gender.

METHODS

Participants were 218 youth (66.5% female), ages 12-15 years (M = 13.5, SD = 1.1), who screened positive for peer victimization, bullying perpetration, and/or low social connectedness using self-report measures. Youth were recruited from an emergency department in the United States as part of an intervention trial. Youth identified primarily as African American (53.7%) and Caucasian (31.7%). Youth completed a 6-month follow-up assessment (75% retention). Separate Bayesian regression models were used to examine the effects of baseline school connectedness, school behavioral difficulties, academic difficulties, and internalizing problems on the severity of 6-month peer victimization and bullying perpetration.

RESULTS

Baseline depression was positively related to both peer victimization and bullying perpetration severity. Baseline behavioral problems were positively related to bullying perpetration severity. Interactions indicated that gender moderated the relationship between school connectedness and peer victimization.

CONCLUSIONS

Given the adverse outcomes linked with peer victimization and bullying perpetration, an improved understanding of factors that predict victimization and perpetration severity may be helpful in defining intervention targets.

A genetically informed study on the association of cannabis, alcohol, and tobacco smoking with suicide attempt

Use of substances such as cannabis, alcohol, and tobacco, has been associated with increased risk of suicide attempt in several observational studies. However, establishing whether these associations are causal is challenging when using observational designs. To evaluate the potential causal contributions of cannabis use, alcohol use, and tobacco smoking to suicide attempt, we applied two-sample Mendelian randomization, an instrumental variable approach using single-nucleotide polymorphisms (SNPs) as instrumental variables for three exposures: lifetime cannabis use (yes/no; 42 instrument SNPs; GWAS sample size [N] = 162,082), alcohol use (drinks-per-week; 53 instrument SNPs; N = 941,280), and tobacco smoking (initiation, yes/no; 156 instrument SNPs; N = 1,232,091; heaviness; 27 instrument SNPs; N = 337,334). The main outcome was suicide attempt measured from hospital records (N = 50,264). All data come from publicly available summary statistics of genome-wide association studies of participants of European ancestry. We found evidence supporting a possible causal role of cannabis (OR = 1.18; 95% CI = 1.01-1.37, P = 0.032), alcohol (OR = 1.95; 95% CI = 1.15-3.32, P = 0.013), and smoking (initiation, OR = 1.90; 95% CI = 1.54-2.34, P < 0.001; heaviness, OR = 2.13; 95% CI = 1.13-3.99; P = 0.019) on suicide attempt. Using multivariable Mendelian randomization, we found that only cannabis showed a direct pathway to suicide attempt (P = 0.001), suggesting that the effect of alcohol and smoking was mediated by the other substance use phenotypes. No evidence was found for reverse causation, i.e., associations of suicide attempt on cannabis (P = 0.483), alcohol (P = 0.234), smoking initiation (P = 0.144), and heaviness (P = 0.601). In conclusion, evidence from this quasi-experimental study based on genetic data from large-scale GWASs are consistent with a causal role of cannabis, alcohol, and tobacco smoking on suicide attempt.

Substance use disorders and suicidality in youth: A systematic review and meta-analysis with a focus on the direction of the association

BACKGROUND

Reviews and meta-analyses suggest that substance use and suicidality (i.e., suicidal ideations and attempts) are associated in youth, but the direction of this association remains unclear. Theoretically, the secondary psychiatric disorder hypothesis (SPDH) posits that substance use leads to suicidality, while the secondary substance use disorder hypothesis (SSUDH) posits that suicidality leads to substance use. To clarify these associations, this meta-analysis systematically reviewed studies that examined the prospective associations between SUDs and suicidality in youth (age 25 and younger) and compared results according to the direction of the association.

METHODS

Web of Science, Embase, PsycINFO, PubMed, Medline and ProQuest Dissertations & Theses Global were searched from inception to March 8, 2020, and 55 effect sizes from 23 samples were included and analyzed using a three-level meta-analysis.

RESULTS

SUDs significantly predicted subsequent suicidality (OR = 2.16, 95%CI 1.57-2.97), suicidality significantly predicted subsequent SUDs (OR = 2.16, 95%CI 1.53-3.04), and these effect sizes did not differ (p = 0.49).

CONCLUSIONS

Considering that 65% of reviewed studies only examined the SPDH, this review highlights that more attention should be given to the SSUDH, and that studies should examine bidirectional associations between SUDs and suicidality across time. Clinically, because SUDs and suicidality were found to influence each other, results suggest that mental health and SUDs should ideally be detected and treated early, and that co-occurring disorders should be assessed and treated concomitantly.

Targets for intervention to prevent substance use in young people exposed to childhood adversity: A systematic review

Background and aims

Childhood adversity is a strong, and concerningly prevalent, risk factor for the later development of substance misuse. Yet despite substantial accumulating evidence for causal mechanisms, there has been little attempt to synthesize the strength of the evidence. Importantly, these mechanisms may be amenable to intervention, providing targets for substance use prevention among those exposed to childhood adversity. The present review aimed to systematically identify mediating and moderating mechanisms operating between childhood adversity and substance use.

Methods

A systematic review was conducted. Electronic databases (PubMed, MEDLINE, PsycINFO, Web of Science and CINAHL) were searched from 1998 to 2020 for modifiable mediators and moderators of the relationship between childhood adversity and substance use in people aged 10–24. Data was qualitatively synthesised, using a socio-ecological perspective to group mediators/moderators into individual, interpersonal, community, and public policy/cultural levels of behaviour.

Results

After screening against eligibility criteria, 50 studies were included in the current review. The mediators at the individual level of behaviour showing the largest and most consistent effect sizes included externalising behaviour, anger, coping motives for substance use, and post-traumatic stress symptoms. Among individual-level moderators, religiosity, future orientation and depressive symptoms all attenuated the relationship between childhood adversity and substance use. At the interpersonal level, peer relationships and mother-child relationships mediated the effect of adversity on substance use. Moderators included family cohesion and relationship quality. Community factors were less commonly studied, though school mobility and educational achievement mediated 14% and 28% of the total effect of childhood adversity on substance use respectively. No mediators or moderators were identified for public policy/culture.

Conclusions

A substantial proportion of the relationship between childhood adversity and substance use in youth is mediated through individual, interpersonal and community factors. Coupled with the knowledge that existing, evidence-based programs effectively address many of the identified mediators and moderators, this review advances knowledge on optimal targets to prevent substance misuse among those exposed to childhood adversity.

Comparative Analysis of Lifetime Suicide Attempts among Mexican Adolescents, over the Past 12 Years

OBJECTIVE

To compare the occurrence of suicide attempts across nationally representative samples of the Mexican adolescent population over the past 12 years, and to analyze its association with sociodemographic, lifestyle and mental-health indicators.

METHODOLOGY

Data were drawn from the 2006, 2012 and 2018 National Health and Nutrition Surveys (n = 25,056; 21,509; and 17,925 adolescents, respectively). Estimates were based on standardized measurements.

RESULTS

The estimated lifetime prevalence rates of suicide attempts were 1.1% in 2006, 2.7% in 2012, and 3.9% in 2018, indicating a 3.4-fold increase. Across the three survey periods, women yielded rates nearly three times higher than men. Lifetime prevalence grew the most among adolescents aged 13-15 years. Compared to the other respondents, the odds of lifetime suicide attempts proved seven times as high for those who had been sexually abused during their childhood, five times as high for those who had been diagnosed with a depressive disorder, three times as high for those who had suffered physical aggression and twice as high for those who had smoked 100+ cigarettes in their lifetimes and those who consumed alcohol.

CONCLUSION

The sharp increase in suicide attempts in Mexico calls for an urgent public-health response via universal and targeted interventions supported by national policy and sustained federal funding.

The interrelationships of child maltreatment, alcohol use, and suicidal ideation among youth living in the slums of Kampala, Uganda

BACKGROUND

Youth living in the slums of Kampala face many adversities, such as dire environmental conditions, poverty, and lack of government infrastructure.

OBJECTIVE

The purpose of this study is to examine the interplay of alcohol use and child maltreatment on suicidal ideation among youth living in the slums of Kampala, Uganda.

PARTICIPANTS AND SETTING

The study sample includes service-seeking youth who were attending Uganda Youth Development Link (UYDEL) drop-in centers in spring 2014 (n = 1134).

METHODS

Indicators of child maltreatment included parental physical abuse, parental neglect, and sexual abuse. Problematic alcohol use was specified using a hybrid structural equation mixture model that distinguished current drinking status with the frequency and intensity of use among current drinkers. This novel approach is more flexible than restricting our analysis to only drinkers or analyzing only current drinking status. The primary outcome of interest was suicidal ideation. All associations controlled for gender and age, and all associations were estimated simultaneously. All analyses were conducted in SAS 9.4 and Mplus 7.4.

RESULTS

The overall prevalence of suicidal ideation was 23.5 % (n = 266). Overall, current drinking status (OR: 1.80; 95 % CI: 1.31, 2.46), the child maltreatment sum score (OR: 1.88; 95 % CI: 1.48, 2.39), and sexual abuse (OR: 2.88; 95 % CI: 1.52, 5.47) were statistically significantly associated with reporting suicidal ideation.

CONCLUSIONS

This study highlights a population that would potentially benefit from prevention efforts not only aimed at suicide prevention but also harm reduction in terms of alcohol use and experiences of child maltreatment.

Genotype-environment correlation by intervention effects underlying middle childhood peer rejection and associations with adolescent marijuana use

Aggressive behavior in middle childhood can contribute to peer rejection, subsequently increasing risk for substance use in adolescence. However, the quality of peer relationships a child experiences can be associated with his or her genetic predisposition, a genotype-environment correlation (rGE). In addition, recent evidence indicates that psychosocial preventive interventions can buffer genetic predispositions for negative behavior. The current study examined associations between polygenic risk for aggression, aggressive behavior, and peer rejection from 8.5 to 10.5 years, and the subsequent influence of peer rejection on marijuana use in adolescence (n = 515; 256 control, 259 intervention). Associations were examined separately in control and intervention groups for children of families who participated in a randomized controlled trial of the family-based preventive intervention, the Family Check-Up . Using time-varying effect modeling (TVEM), polygenic risk for aggression was associated with peer rejection from approximately age 8.50 to 9.50 in the control group but no associations were present in the intervention group. Subsequent analyses showed peer rejection mediated the association between polygenic risk for aggression and adolescent marijuana use in the control group. The role of rGEs in middle childhood peer processes and implications for preventive intervention programs for adolescent substance use are discussed.

Social rejection, popularity, peer victimization, and self-injurious thoughts and behaviors among adolescents: A systematic review and meta-analysis

Self-injurious thoughts and behaviors (SITBs) are significant public health problems in adolescence. The current article provides a comprehensive systematic review examining the relationship between events leading to perceived low relational evaluation (e.g. social rejection) and SITBs among adolescents. Theoretical work posits that low relational evaluation is experienced as psychologically painful, a known correlate of SITBs. Therefore, events leading to low relational evaluation may be particularly informative in understanding the context of SITBs. The current review examines how experiences of low relational evaluation that are hypothesized to elicit psychological pain, such as social rejection, low popularity, and peer victimization are related to engagement in SITBs in adolescence. A total of 56 articles meeting inclusion criteria were identified. The hypothesis of an association between indicators of low relational evaluation and SITBs was generally supported throughout the literature, with more consistency found among studies examining suicidal ideation specifically. However, interpretation of the findings is constrained by various methodological limitations of studies. The present review concludes with a theoretical conceptualization of the relationship between perceived relational value and SITBs, leveraging social and evolutionary psychological theory, to guide future research into this topic.

Cannabis use, depression and suicidal ideation in adolescence: direction of associations in a population based cohort

BACKGROUND

To clarify the direction of the association between frequency of cannabis use, depressive symptoms and suicidal ideation from 15 to 20 years using cross-lagged analyses.

METHOD

We included 1606 adolescents from the province of Québec followed since 1997 with information on frequency of cannabis use (none/monthly/weekly), depression (defined as being in the top 10% symptoms) and serious suicidal ideation at ages 15, 17 and 20 years.

RESULTS

The prevalence of weekly cannabis use increased from 7.0% at age 15 years to 15.6% by age 20 years. Adolescents who reported using cannabis weekly at one age were 11 to 15 times more likely to continue using cannabis over time. In longitudinal cross-lagged analyses, weekly cannabis use at age 15 was associated with greater odds (OR=2.19, 95% CI=1.04-4.58) of suicidal ideation two years later. However, other substance use (alcohol, tobacco, other drugs) fully explained this association. Further, depression predicted subsequent weekly cannabis use, even after adjusting for comorbid other substance use (eg, for depression at 15 years predicting cannabis use at 17 years: OR=2.30, 95% CI=1.19-4.43).

LIMITATIONS

Quantity of cannabis consumed was not measured.

CONCLUSION

Findings suggest that depressive symptoms in adolescence may represent a risk factor for weekly cannabis consumption, which once initiated is likely to remain chronic. Weekly cannabis use increased risk for suicidal ideation, but not independently from other substance use including alcohol, tobacco and other drugs.

Depression and alcohol use disorders as precursors to death by suicide

The combined presence of depression with alcohol abuse can increase suicide risk. We used psychological autopsy to evaluate 101 individuals who died by suicide, to understand relationships between stressful life events, alcohol abuse, and depression. As compared to suicidal adults with depression only, individuals meeting criteria for both a depressive disorder and alcohol use disorder tended to be younger and experienced higher rates of stressful life events during the six months prior to death. Alcohol abuse likely influences interpersonal conflict, financial distress, and legal problems. Interventions focusing on managing life problems may help to reduce suicide risk.

Proximal Associations among Bullying, Mood, and Substance Use: A Daily Report Study

Adolescent involvement in bullying as a victim or perpetrator has been associated with negative health outcomes, including emotional distress and substance use. Whether negative affect and substance use are acute responses to bullying involvement or whether they develop over time is unknown. Such knowledge is needed to understand the conditions under which bullying contributes to adverse outcomes, as well as to inform the development of appropriate interventions. This study examined the daily-level associations among bullying, negative affect, and substance use (i.e., alcohol, cigarettes, electronic-cigarettes, marijuana) among a community sample of adolescents (N = 204) ages 13 - 16 years (55% female, 81% European American, 13% African-American) who had reported bully victimization or perpetration in the past six months. Participants completed a brief on-line survey every day for 56 consecutive days, reporting on their experiences with bully victimization, bully perpetration, mood, and substance use for that day. Consistent with hypotheses, being bullied on a given day was associated with reporting greater than average levels of sadness (b = 0.279, 95% CI = [0.172, 0.387]), anger (b = 0.354, 95% CI = [0.242, 0.466]), and cigarette use (OR = 1.453, 95% CI = [1.006, 2.099]) on that day; however, it was not associated with alcohol, electronic-cigarette, or marijuana use. Perpetration was not associated with same day negative affect or substance use. Results of the current study suggest that negative affect and cigarette use may be acute responses to bully victimization. Bully perpetration does not appear to be proximally linked to mood or substance use after accounting for victimization.

Cyber victimization, cyber aggression, and adolescent alcohol use: Short-term prospective and reciprocal associations

INTRODUCTION

Cyber victimization is a significant public health concern. We examined prospective and reciprocal associations between cyber victimization, cyber aggression, and adolescents' drinking and binge drinking. Gender, Hispanic ethnicity, and age were examined as moderators.

METHODS

Adolescents (N = 1140; 58% girls; 13-19 years; 80% Hispanic) from two US high schools completed the Cyber Peer Experiences Questionnaire and alcohol use items from the Youth Risk Behavior Survey at two time points, three months apart. Perceived social support was assessed at Time 1 and controlled for. Cross-lagged panel analyses using structural equation modeling were conducted, using zero-inflated negative binomial regressions for alcohol use outcomes.

RESULTS

Adolescents who experienced more cyber victimization were more likely to abstain from drinking over time; however, they reported more frequent drinking if they were a drinker, a relationship that was stronger for older adolescents. Cyber victimization was unrelated to binge drinking, and alcohol use was unrelated to cyber victimization over time. Adolescents who engaged in more cyber aggression were more likely to use alcohol over time; conversely, adolescents who used alcohol more frequently engaged in more cyber aggression over time. Gender and ethnicity did not moderate these associations.

CONCLUSIONS

A complex relationship between cyber victimization and alcohol use emerged; findings support the self-medication hypothesis among drinkers only and especially older adolescents. Reciprocal associations between cyber aggression and alcohol use fit with problem behavior theory Adolescent alcohol use prevention programs might play an important role in addressing cyber aggression. Drinking behaviors may be important to target in anti-cyberbullying interventions.

An mHealth approach to extend a brief intervention for adolescent alcohol use and suicidal behavior: Qualitative analyses of adolescent and parent feedback

Mobile health (mHealth) tools that supplement inpatient psychiatric care can maintain and enhance intervention effects following hospitalization. Adolescents hospitalized following a suicidal event represent a vulnerable population who could greatly benefit from such an mHealth intervention. In specific, suicidal adolescents who drink alcohol are in need of robust interventions that address the bidirectional relationship between alcohol use and suicidal thoughts and behaviors, because it puts them at especially high risk for suicide upon discharge. The purpose of this study was to conduct qualitative interviews to gather feedback to improve a brief alcohol intervention provided to suicidal adolescents during psychiatric hospitalization, and to develop a mHealth tool to extend care after discharge. Participants, eight adolescents and their parents, identified the need for a smartphone application to deliver intervention content to adolescents and parents during the post-hospitalization period. Adolescents sought support in meeting alcohol- and mood-related goals, while parents desired general resources as well as tips for conversations with their adolescent about mood and alcohol use.

The association between school bullying victimization and substance use among adolescents in Malawi: the mediating effect of loneliness

Background and objectives Research has shown an increased prevalence of substance use among adolescents in countries in Sub-Saharan Africa. Peer affiliation, bullying, and psychological stress are significantly associated with substance use. This study empirically tested theoretical frameworks linking peer affiliation, bullying victimization, loneliness and substance use (specifically tobacco or alcohol use) among adolescents. Materials and methods Data were obtained from the 2009 Malawi Global School-based Health Survey (GSHS) with a representative sample of 2359 students aged 13-17 years in Malawi, Sub-Saharan Africa. Missing data were handled using multiple imputation. The study conducted path analyses using Mplus to test the conceptual models of tobacco use and alcohol use. Results The results showed that loneliness partially mediated the association between bullying victimization and tobacco use in the first model, as well as the relationship between bullying victimization and alcohol use in the second model. Results indicated statistically significant indirect paths from bullying victimization to tobacco use and alcohol use through the mediation of loneliness. However, peer affiliation did not directly predict bullying victimization in the two path models; it directly predicted tobacco use only. Conclusions These findings have important implications in early intervention for health practitioners in school and mental health settings to prevent feelings of loneliness and substance use among adolescents who have experience with bullying victimization but no experience with depression, alcohol use or tobacco use.

Overprotective Parenting and Peer Victimization in Extremely Low Birth Weight Survivors

Extremely low birth weight (ELBW; <1000g) survivors are at increased risk for experiencing both peer victimization and overprotective parenting. This study investigated if overprotective parenting moderated associations between peer victimization and psychopathology among ELBW adult survivors who have been followed since birth. Participants included 81 (31 male, 50 female) adults born with an extremely low birth weight from Ontario, Canada. The participants were predominately Caucasian. The experience of peer victimization and overprotective parenting prior to age 16 was self-reported at age 22-26 years. Peer victimization was reported using the Childhood Experiences of Violence Questionnaire and overprotective parenting was reported using the Parental Bonding Instrument. Current anxiety disorder and alcohol or substance use disorder was assessed using the MINI International Neuropsychiatric Interview at age 29-36 years. The experience of overprotective parenting moderated the association between peer victimization and risk for an anxiety disorder in adulthood (OR=2.35, 95%CI, 1.01-5.50). If the ELBW survivor reported having an overprotective parent, peer victimization was associated with increased risk for having an anxiety disorder in adulthood (OR=2.45, 95%CI, 1.13-5.30). In contrast, this association was not significant in the absence of an overprotective parent (OR=1.04, 95%CI, 0.73-1.49). Future research should further investigate if parental support and encouragement of children's independence may be important for reducing the negative effects of peer victimization among ELBW survivors.