Adolescent Suicidal Behavior and Substance Use: Developmental Mechanisms

Hidden Wounds: Exploring Racial and Gender Disparities in the Impact of Mass Shooting Events on Suicide Risk Among U.S. High School Students

This study examines the impact of mass shooting events (MSEs) on youth suicide-related behaviors in schools, focusing on heterogeneity across age, race, and gender. Suicide is the second leading cause of death among adolescents and has increased by 63% in the last two decades. Using individual-level data from the Youth Risk Behavior Surveillance System (YRBS) and state-level data from the Gun Violence Archive (GVA) from 2013 to 2019, a difference-in-differences approach is employed to analyze the impact of MSEs on suicide consideration, suicide planning, suicide attempt, and injury from attempted suicide among high school students. Our findings indicate that MSEs lead to a significant increase in the likelihood of suicide attempts (5.1 pp) and injury from suicide (1.9 pp). We particularly observe NH-Black students show a dramatic increase in all measured behaviors, indicating a heightened vulnerability. Notable variations by race and gender suggest that targeted strategies and policies are necessary in addressing students' suicide risk following MSEs. Our findings also reveal lagged effects, demonstrating that the behavioral impacts of MSEs persist over a year, highlighting the importance of investigating longer-term consequences. Strategies targeting the progression from suicide ideation to suicide attempts are particularly crucial to effectively mitigate the long-lasting and detrimental impact that exposure to MSEs can have on youth mental health and well-being.

Addiction profile is associated with suicidal behavior and repetition of non-suicidal self injury: a latent profile analysis study in a schooled adolescents

Adolescence is a critical period for the development of self-regulatory behaviors, with emotional dysregulation, impulsivity, and substance use emerging as significant factors associated with self-injury and suicidal thoughts and behaviors. This study aims to investigate the prevalence and patterns of non-suicidal self-injury (NSSI), suicidal ideation, and suicide attempts in a community-based sample of adolescents. A sample of 1526 adolescents aged 12-16 was analyzed using Latent Profile Analysis (LPA), identifying two distinct behavioral profiles: the Substance Use with Non-Problematic Gaming (37.4%) profile, characterized by alcohol, cannabis, and nicotine use, and the Moderate Problematic Gaming with Minimal Substance Use (62.6%) profile, associated with problematic video game use and minimal substance use. Overall, 36% of participants reported engaging in NSSI, 27.2% reported suicidal ideation, and 3.21% reported suicide attempts within the past year. Ordinal regression analysis indicated that adolescents in the SUP group exhibited higher levels of emotional dysregulation, impulsivity, and behavioral difficulties, significantly increasing their odds of suicide attempts (OR 2.24, p < 0.02). Additionally, emotional dysregulation independently doubled the risk of suicide attempts (OR 2.01, p < 0.001). This study provides a detailed risk profile for adolescent self-injury and suicide-related behaviors in school settings. Despite the limitations of a non-clinical sample, the findings underscore the importance of early prevention efforts targeting emotional dysregulation and impulsivity. Future research should consider longitudinal approaches to better understand the developmental trajectories of NSSI and suicidal behaviors in adolescents, particularly in high-risk, marginalized populations.

Predictors of Suicidal Thoughts and Attempts among School-Going Thai Adolescents: A Sex-Specific Structural Equation Modelling Analysis

Adolescent suicide is a growing public health concern in Thailand. Identifying predictors of suicidal behaviors is essential for targeted prevention strategies. Using Structural Equation Modeling, this study explores the predictors of suicidal thoughts and attempts among a sample of 5657 Thai adolescents in grades 7-12, typically representing the age group 13-17 years, with nearly equal proportions of males (47%) and females (53%) participants. Data from the Thailand Global School-based Student Health Survey (GSHS) 2021 were analyzed. Explanatory Factor Analysis (EFA) identified key constructs, followed by SEM stratified by sex to examine relationships between constructs and suicidal behaviors. Reliability and validity were assessed using Cronbach's α and SEM fit indices. EFA identified five constructs: current substance use, history of violence, experiences of bullying, parental awareness, and poor mental health. SEM revealed poor mental health as a significant predictor for both sexes. Substance use, experiences of bullying, and a history of violence predicted suicidal behaviors in females. Parental vigilance was only a protective factor for males. The findings underscore the importance of gender-specific interventions and comprehensive mental health support to address the unique vulnerabilities of Thai adolescents, reducing suicidal thoughts and attempts.

Testing the modifiability of episodic future thinking and episodic memory among suicidal and nonsuicidal adolescents

Background

Despite increased attention on treatment and prevention for suicidal adolescents, we know little about potential intervention targets. Episodic future thinking-the ability to imagine detailed, personal, and future-oriented events-is a modifiable cognitive process that has been linked with suicidal ideation (SI) in adolescents. However, until now its modifiability has only been tested in adults.

Method

Adolescents (N = 176, ages 15-19; 71% SI) completed performance-based measures of episodic future thinking (i.e., Experimental Recombination Paradigm) and memory immediately before and after an Episodic Specificity Induction (ESI).

Results

Adolescents produced a greater number of future episodic details after (vs. before) the ESI but showed no change in non-episodic details (e.g., semantic information). Patterns of change in episodic future thinking were not moderated by SI history. Adolescents overall did not demonstrate change in past episodic detail counts after the ESI. However, there were select moderating effects of SI history on this effect.

Conclusion

Results show that episodic future thinking can change immediately following an episodic specificity induction among adolescents, regardless of whether they have previously experienced SI. This demonstration of within-person change constitutes a foundational first step in examining malleability of episodic future thinking in adolescents and offers preliminary evidence of a cognitive mechanism that may be leveraged in service of reducing adolescents' SI.

Predictors of Suicidal Ideation and Continued Substance Use Problems Among Patients Receiving Methadone Maintenance Treatment Who Have Co-Occurring Cocaine Use Disorder

BACKGROUND

Persons with polysubstance use problems are at high suicide risk, which may complicate substance use treatment. The purpose of this study was to a) examine cross-sectional and longitudinal risk factors for suicidality among persons in methadone maintenance treatment who present with co-occurring cocaine use disorder and b) evaluate whether suicidality impacts substance use outcomes independently and differentially depending on treatment type (i.e. standard methadone care [SC] vs. contingency management plus standard care [CM + SC]).

METHODS

Data come from five randomized controlled trials of CM conducted within methadone clinics (N = 562). Participants were categorized (mutually exclusive) as no history of suicidality (56.4%, n=317), past suicidal ideation (SI; 11%, n=62), recent SI (3.6%, n=20), or lifetime suicide attempt (29%, n=163).

RESULTS

Suicidality groups differed by sex and baseline employment, income, trauma history, and psychosocial functioning. Suicide attempt history was positively associated with years of polysubstance use, prior drug treatments, and unintentional overdose history. Baseline psychological problem severity and emotional abuse history were associated with SI likelihood 12 weeks later. Past SI was associated with longer durations of abstinence than no suicidality. Unexpectedly, those with recent SI reported lower drug use severity at 12 week if they received SC compared to CM + SC. Effects were small to medium.

CONCLUSIONS

Despite greater polysubstance use history, patients with suicide attempts did not show worse substance use outcomes than persons without suicidality. Patients with past SI fared better than those without suicidality on abstinence over 12 wk. Methadone clinics could be key points of entrance and continued services for suicide prevention.

Interactive effect of adverse child experiences and suicidal thoughts and behaviors on adolescent alcohol and cannabis use frequency

OBJECTIVE

Adolescents with adverse childhood experiences (ACEs) and suicidality may engage in high levels of substance use to alleviate distress. Most studies of associations among ACEs, suicidality, and substance use rely on retrospective reports by adults. Comparatively less is known about concurrent relationships between ACEs, suicide risk, and substance use in adolescents, which is important for prevention. This study tested if the associations between ACEs and drinking and between ACEs and cannabis use would be even stronger among youth with suicidal ideation or attempt, relative to youth without suicidal ideation or attempt.

METHOD

High schoolers (N = 1,625; 50.8% male; 47.1% female; 2% nonbinary) from western New York completed the Youth Risk Behavior Survey. Ordinal regressions tested main effects and interactions of the number of ACEs and suicidal ideation/behavior (i.e., none, ideation/plan, attempt) on categories of past-month drinking and cannabis days of use, controlling for age, gender, and race/ethnicity.

RESULTS

Significant ACEs by suicide interactions on adolescent drinking indicate that the association between ACEs and drinking was stronger for adolescents with suicide attempt adjusted odds ratio (AOR = 2.63) compared to youth with no ideation or attempt (AOR = 1.56) and suicidal ideation/planning only (AOR = 1.58). Main effects of ACEs (AORs = 1.95-2.08) and suicide attempt (vs. no suicidal ideation/attempt [AOR = 2.11] and suicidal ideation/plan [AOR = 2.11]) were associated with greater cannabis use; interactions were not significant.

CONCLUSIONS

Associations between ACEs and drinking were particularly strong for adolescents with suicide attempt. Conversely, ACEs and suicide attempt were independently associated with cannabis use. Mitigating against ACEs may reduce both adolescent alcohol and cannabis use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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.

Substance Use Frequency Relates to Suicidal Ideation Through Perceived Burdensomeness and to Suicide Attempts Through Capability for Suicide

BACKGROUND

Although substance use has been linked to both suicidal ideation and suicide attempts, the factors underlying these relations remain unclear. The Interpersonal-Psychological Theory of Suicide (ITS) provides a framework for understanding how substance use may increase suicide risk. The purpose of the current study was to examine if frequency of substance use is indirectly related to suicidal ideation and suicide attempts through core ITS variables (i.e., burdensomeness, thwarted belongingness, and suicide capability).

METHODS

An online sample of Mechanical Turk workers (N = 365) completed measures assessing substance use frequency, burdensomeness, thwarted belongingness, suicide capability, suicidal ideation, and suicide attempts.

RESULTS

After controlling for relevant clinical and demographic covariates, substance use frequency was indirectly related to suicidal ideation through burdensomeness but not thwarted belongingness. Substance use frequency was indirectly related to suicide attempts through suicide capability only.

LIMITATIONS

The cross-sectional design precludes conclusions about the precise nature and direction of the relations examined. The use of a community sample limits generalizability to more severe substance using samples.

CONCLUSIONS

Results highlight the relevance of distinct ITS factors in the relation between substance use frequency and both suicidal ideation and suicide attempts. Results may inform specific targets for novel interventions aimed at reducing suicide risk among substance-using individuals.HighlightsSubstance use frequency was indirectly related to SI through burdensomeness.Substance use frequency was not indirectly related to SI through thwarted belongingness.Substance use frequency was indirectly related to SA only through suicide capability.

Suicide Attempt and Risk of Substance Use Disorders Among Female Youths

IMPORTANCE

Suicide attempts are prevalent among female youths, yet little is known about the subsequent development of substance use disorders.

OBJECTIVE

To assess the association between suicide attempts among females before 20 years of age and future risk of substance use disorders.

DESIGN, SETTING, AND PARTICIPANTS

In this longitudinal cohort study, females aged 8 to 19 years (hereafter referred to as youths) who attempted suicide were matched with female youths with no attempt between April 1, 1989, and March 31, 2019, in Quebec, Canada. The cohort was followed up for 31 years, for a total of 2 409 396 person-years, to identify subsequent substance use disorders.

EXPOSURES

Confirmed suicide attempts among females 8 to 19 years of age.

MAIN OUTCOMES AND MEASURES

The main outcome measure was hospitalization for a substance use disorder later in life. Hazard ratios (HRs) and 95% CIs for the association of suicide attempt with substance use disorders were estimated using Cox proportional hazards regression models adjusted for baseline age, mental illness, resource-limited socioeconomic status, and year at start of follow-up.

RESULTS

Among 122 234 female youths (mean [SD] age, 15.6 [1.9] years), 5840 (4.8%) attempted suicide and 4341 (3.6%) developed a substance use disorder. Compared with the 116 394 matched female youths who did not attempt suicide (95.2%), those who attempted suicide had a greater risk of hospitalization for any substance use disorder during the follow-up period (HR, 6.03; 95% CI, 5.39-6.77), especially sedative or hypnotic use disorders (HR, 32.24; 95% CI, 23.29-44.64). Suicide attempt was associated with the development of sedative or hypnotic use disorders up to 5 years (HR, 66.69; 95% CI, 34.72-128.09), although risks remained elevated up to 3 decades later for all substances. Compared with those without suicide attempt, female youths with 3 or more suicide attempts had 21.20 (95% CI, 13.53-32.90) times the risk of substance use disorders, whereas female youths with 1 attempt had 5.70 (95% CI, 5.08-6.41) times the risk of these disorders.

CONCLUSIONS AND RELEVANCE

In this cohort study, female youths who attempted suicide had increased risk of subsequent substance use disorders compared with female youths who did not attempt suicide. These findings suggest that closer management and prevention of substance use among female youths who attempt suicide may be beneficial.

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

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.

Use of Alcohol, Tobacco, and Caffeine and Suicide Attempts: Findings From a Nationally Representative Cross-sectional Study

In this study, the association between students' substance use and suicide attempts in the past 1 year was examined using secondary data from the 13th Korea Risk Behavior Web-based Survey. Participants were 7th- to 12th-grade students and 50.9% were male. A binominal logistic regression analysis was used to investigate the association between past experience of substance use (alcohol, tobacco, and caffeine) and suicide attempts after controlling for sociodemographic and psychological factors. Compared with no use, daily use of alcohol (odds ratio [OR] = 8.00), caffeine (OR = 2.13), and tobacco (OR = 1.41) was associated with increased odds of suicide attempts. These results indicate that school-based suicide prevention programs should cover awareness, surveillance, and treatment referral for these 3 substances. Moreover, mental health professionals should monitor intake of these substances when evaluating risk of suicide attempts in youth.

Age of onset of substance use in patients with dual diagnosis and its association with clinical characteristics, risk behaviors, course, and outcome: A retrospective study

RESEARCH QUESTION

Do patients with dual diagnosis (DD) with an early initiation of substance use and subsequent early onset substance use disorder (EOS) differ from those with late onset substance use disorder (LOS) regarding characteristics, sex-related risk behaviors, course, and outcome?

OBJECTIVES

The aim is to study EOS and LOS groups of patients with DD attending a treatment center with regard to clinical characteristics, type of psychiatric disorders, risk behaviors, and short-term outcome.

MATERIALS AND METHODS

Retrospective chart review of patients diagnosed with DD (n = 307) with regard to the above variables. Diagnoses of both substance use disorders (SUDs) and psychiatric disorders were made by qualified psychiatrists as per the International Classification of Diseases, 10^th revision.

RESULTS

Among 307 participants with DD, 100 were in EOS group (onset of SUD before 18 years of age as assessed clinically) and 207 in LOS group. Cannabis as the primary substance was more prevalent in the EOS (30%) than that of the LOS group (12%). Psychotic disorders were more prevalent in the EOS group (41%) followed by mood disorders (30%), while the reverse was true in the LOS group (27.5% and 56.5%, respectively). When compared to the LOS group, the EOS group had higher number of psychiatric admissions, reported higher prevalence of risky sexual behaviors (unprotected sexual intercourse, multiple sexual partners, and history of sexual intercourse with commercial sex workers), showed poorer treatment adherence, and worse outcome regarding both psychiatric disorder and SUD (all differences significant at P < 0.05).

CONCLUSIONS

DD patients differ significantly based on the age of onset of substance use. These may have therapeutic and management implications.

Reciprocal relationships between substance use and disorders and suicidal ideation and suicide attempts in the Collaborative Study of the Genetics of Alcoholism

BACKGROUND

Substance use and misuse and suicidal thoughts and behaviors tend to co-occur. The purpose of this study was to examine whether (a) suicidal ideation and attempt are related to onset of alcohol, nicotine and cannabis use and dependence; (b) early use of alcohol, nicotine and cannabis is associated with onset of suicidal ideation and attempt; and (c) whether these associations persist while controlling for covariates, such as family history of alcohol problems, major depression and other internalizing and externalizing disorders.

METHODS

The prospective cohort of the Collaborative Study of the Genetics of Alcoholism (COGA; N=3277) was used. Cross-sectional and discrete time logistic regression (i.e. survival) analyses examined associations between suicidal ideation and attempt and onset of alcohol, nicotine and cannabis use and dependence. Survival models also examined whether individual early substance use was related to onset of ideation and attempt.

RESULTS

Ideation was related to 0.71-0.77 odds of onset of subsequent alcohol, nicotine and cannabis use. Attempt was associated with 1.44-1.61 odds of later alcohol, nicotine and cannabis dependence, even after accounting for covariates. Evidence for early substance use being related to subsequent onset of ideation or attempt was limited. Several sex and race differences emerged.

LIMITATIONS

The sample was ascertained for family history of alcoholism; not all participants had been followed up allowing for censored observations; reporting bias.

CONCLUSION

Suicide attempts are associated with increased likelihood of onset of substance dependence.

High-risk behaviors related to intentional and unintentional harm in adolescents of zahedan, iran

Background:

Adolescence and youth are life-threatening stages of development when a range of unsafe behaviors can harmfully affect a person’s health and their social and educational performance.

Objectives:

The present study aimed to determine the incidence and prevalence of high-risk behaviors related to intentional and unintentional harm in adolescents of Zahedan (Iran).

Patients and Methods:

This cross-sectional study included 1000 randomly selected male and female high school students of Zahedan, Iran. The Persian version of High Risk Behavior Questionnaire and Goldberg’s 28-item General Health Questionnaire were used to collect data. Descriptive statistics (frequency and percentage) was used to analyze data.

Results:

The most prevalent behaviors were not wearing seat belt (48%), riding a motorcycle without a helmet (42.3%) and involvement in physical conflicts (38.7%). Both the incidence and prevalence of the studied behaviors were higher in boys than girls. Moreover, greater prevalence of behaviors related to intentional and unintentional harm was observed in subjects with a drug abusing friend or family member.

Conclusions:

The incidence and prevalence of high-risk behaviors in the studied population were slightly lower compared to several other parts of the country and some other countries. Nevertheless, since the rates and trend are alarming, sectoral and intersectoral cooperation is indispensable to the implementation of preventive interventions at different levels of society. Such efforts would obviously require the help of experts in various fields and necessitate the assessment of sociocultural features of the population.

High school suicide in South Africa: teachers' knowledge, views and training needs

BACKGROUND

Suicidal ideation and attempted suicide are a huge problem in South Africa, especially in the rural areas. Previous research has emphasized the importance of the ability of school professionals to identify young people who are at risk of committing suicide. The objectives of this study were to assess the knowledge of teachers with regard to identifying the warning signs of suicidal behaviour, assessing the type of information they give to students in the class after a suicide of one of their class mates, and assessing their views and training needs on the prevention of suicidal behaviour in students.

METHODS

Five focus group discussions were conducted with 50 high school teachers in Limpopo Province, South Africa. All focus group discussions were audio-taped, transcribed verbatim, and then analysed using an inductive approach.

RESULTS

The results demonstrate that teachers lack knowledge of the warning signs of suicidal behaviour among students. They also report that they do not know how to support students in the event of attempted or completed suicide of another student. The school curriculum is perceived as lacking information on suicide and suicidal behaviour.

CONCLUSIONS

Teachers in Limpopo Province need to be trained to identify students at risk, and to respond to situations by referring individuals at risk to appropriate mental health professionals. School-based suicide prevention programmes that are based on theory and evidence should be developed. These programmes should include teacher training to help teachers to identify symptoms of psychosocial problems that might lead to suicide, develop their skills in handling such problems, and help students to cope with their emotions after a suicide incident in the class or at school.

High school students' knowledge and experience with a peer who committed or attempted suicide: a focus group study

BACKGROUND

Suicide is a major public health problem for adolescents in South Africa, and also affects those associated with them. Peers become more important during adolescence and can be a significant source of social support. Because peers may be the first to notice psychological problems among each other, the present study's objectives were to assess students' knowledge about suicide, perceived risk factors, signs of poor mental health in adolescents who committed suicide, students' awareness of available mental health care and resources, and beliefs about prevention.

METHODS

This qualitative study used focus group discussions to elicit the thoughts and feelings of high school students who had a peer who committed or attempted suicide. Peers and class mates of suicide attempters and suicide completers were identified with the help of a social worker and school management and were invited to participate. All focus group discussions were audio taped and analyzed. A total of 56 adolescents (13-19 years of age) from Limpopo schools in South Africa participated in six focus group discussions. The data were analyzed by NVivo version 8, using an inductive approach.

RESULTS

Participants reported to be affected by the suicide attempt or completed suicide. They felt guilty about their failure to identify and prevent the suicide and displayed little knowledge of warning signs for suicidal behaviour. They identified several risk factors for the suicide of their peers, such as poor relationship issues, teenage pregnancy, punishment, and attention seeking behaviour. Resources for students with mental health problems and survivors of suicide attempts were not perceived to be available at schools and elsewhere.

CONCLUSION

School-based suicide prevention programs based on theory and evidence are necessary. Such interventions should also focus on detection of mental health problems by peers. Counseling services for students with mental health problems and suicide survivors should be available and made known to students at risk and peers.

Suicidal ideation and substance use among adolescents and young adults: a bidirectional relation?

OBJECTIVE

To examine reciprocal associations between substance use (cigarette smoking, use of alcohol, marijuana, and other illegal drugs) and suicidal ideation among adolescents and young adults (aged 11-21 at wave 1; aged 24-32 at wave 4).

METHODS

Four waves public-use Add Health data were used in the analysis (N=3342). Respondents were surveyed in 1995, 1996, 2001-2002, and 2008-2009. Current regular smoking, past-year alcohol use, past-year marijuana use, and ever use of other illegal drugs as well as past-year suicidal ideation were measured at the four waves (1995, 1996, 2001-2002, and 2008-2009). Fixed effects models with lagged dependent variables were modeled to test unidirectional associations between substance use and suicidal ideation, and nonrecursive models with feedback loops combining correlated fixed factors were conducted to examine reciprocal relations between each substance use and suicidal ideation, respectively.

RESULTS

After adjusting for the latent time-invariant effects and lagged effects of dependent variables, the unidirectional associations from substance use to suicidal ideation were consistently significant, and vice versa. Nonrecursive model results showed that use of cigarette or alcohol increased risk of suicidal ideation, while suicidal ideation was not associated with cigarette or alcohol use. Reversely, drug use (marijuana and other drugs) did not increase risk of suicidal ideation, but suicidal ideation increased risk of illicit drug use.

CONCLUSION

The results suggest that relations between substance use and suicidal ideation are unidirectional, with cigarette or alcohol use increasing risk of suicidal ideation and suicidal ideation increasing risk of illicit drug use.

Multiple substance use and self-reported suicide attempts by adolescents in 16 European countries

Substance use and suicide attempts are high-risk behaviors in adolescents, with serious impacts on health and well-being. Although multiple substance use among young people has become a common phenomenon, studies of its association with suicide attempts are scarce. The present study examines the association between multiple substance use and self-reported suicide attempts in a large multinational sample of adolescent students in Europe. Data on multiple substance use (tobacco, alcohol, tranquillizers/sedatives, cannabis, other illegal drugs) and self-reported suicide attempts were drawn from the 2007 European School Survey Project on Alcohol and Other Drugs (ESPAD). The ESPAD survey follows a standardized methodology in all participating countries. The present study is based on 45,086 16-year-old adolescents from 16 countries that had used the optional "psychosocial module" of the questionnaire, thereby including the question on suicide attempts. Logistic regression analyses were performed to examine the associations of any self-reported suicide attempt (dependent variable) with substance use controlling for country and gender. The strongest association with self-reported suicide attempts was for any lifetime tranquillizer or sedative use (odds ratio 3.34, 95 % confidence interval 3.00-3.71) followed by any lifetime use of illegal drugs other than cannabis (2.41, 2.14-2.70), 30-day regular tobacco use (2.02, 1.84-2.21), 30-day frequent alcohol use (1.47, 1.32-1.63) and any 30-day cannabis use (1.37, 1.18-1.58). The odds ratio of reporting a suicide attempt approximately doubled for every additional substance used. These findings on the association between multiple substance use, including legal drugs (tranquillizers or sedatives and tobacco), and the life-threatening behavior of suicide attempts provide important cues for shaping prevention policies.

Co-occurring risk behaviors among White, Black, and Hispanic US high school adolescents with suicide attempts requiring medical attention, 1999-2007: implications for future prevention initiatives

PURPOSE

To identify subtypes of adolescent suicide attempters by examining risk profiles related to substance use, violent behavior, and depressive symptoms. To examine the relationship between these subtypes and having had two or more suicide attempts during the past year. To explore race and gender differences across subtypes of suicide attempters.

METHODS

Data were combined from five nationally representative cohorts of the US Youth Risk Behavior Surveillance System (YRBSS) and focused on a subpopulation of youth who reported a suicide attempt requiring medical attention. Latent class analysis was used to identify subtypes of suicide attempters.

RESULTS

Analysis yielded three classes of youth who attempted suicide, distinguishable by their levels of substance use and violent behaviors: low substance use and violent behaviors, high substance use and violent behaviors, and extreme substance use and violent behaviors. All three classes had a high propensity for endorsing depressive symptoms. The proportion of youth with two or more suicide attempts during the past year increased across subgroup of attempters with higher levels of substance use and violent behaviors. Racial and gender differences were found across subtypes of suicide attempters.

CONCLUSIONS

Preventing and treating the co-occurrence of substance use and violent behaviors may serve as essential strategies for reducing suicide attempts, especially among male youth. The use of public health strategies for suicide prevention should take into account the different needs of youth at risk for suicide.

Intolerance to delayed reward in girls with multiple suicide attempts

Impulsivity has been conceptualized as influencing the expression of suicidal behavior. Adolescence is a developmental period characterized both by a relatively high rate of suicide attempts and a high level of impulsivity. The current study examined two behavioral measures (delay reward and disinhibition) and one self-report measure of impulsivity among girls with suicide attempt histories. Girls with multiple suicide attempts performed more impulsively on measures of delayed reward, and had higher self-ratings of depression and aggression than girls with either one or no suicide attempts. The multiple attempter girls' preference for immediate gratification may directly increase vulnerability to suicidal acts in the context of distressing states or indirectly increase risk by creating poor life experience over time.

Young men's intimate partner violence and relationship functioning: long-term outcomes associated with suicide attempt and aggression in adolescence

BACKGROUND

Longitudinal research supports that suicidal thoughts and behaviors in adolescence predict maladjustment in young adulthood. Prior research supports links between suicide attempt and aggression, perhaps because of a propensity for impulsive behavior in states of high negative affect that underlies both problems. Such vulnerability may increase risk for intimate partner violence and generally poor young adulthood relational adjustment.

METHOD

A total of 153 men participated in annual assessments from ages 10-32 years and with a romantic partner at three assessments from ages 18-25 years. Multi-method/multi-informant constructs were formed for parent/family risk factors, adolescent psychopathology (e.g. suicide-attempt history, mother-, father-, teacher- and self-reported physical aggression) and young adulthood relational distress (jealousy and low relationship satisfaction) and maladaptive relationship behavior (observed, self- and partner-reported physical and psychological aggression toward a partner, partner-reported injury, official domestic violence arrest records and relationship instability).

RESULTS

Across informants, adolescent aggression was correlated with suicide-attempt history. With few exceptions, aggression and a suicide attempt in adolescence each predicted negative romantic relationship outcomes after controlling for measured confounds. Adolescent aggression predicted young adulthood aggression toward a partner, in part, via relationship dissatisfaction.

CONCLUSIONS

Boys' aggression and suicide-attempt history in adolescence each predict poor relationship outcomes, including partner violence, in young adulthood. Findings are consistent with the theory of a trait-like vulnerability, such as impulsive aggression, that undermines adaptation across multiple domains in adolescence and young adulthood. Prevention and intervention approaches can target common causes of diverse public health problems.