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Lalwani K, Whitehorne-Smith P, McLeary JG, Albarus N, Abel W. Investigating the associations of age of initiation and other psychosocial factors of singular alcohol, tobacco and marijuana usage on polysubstance use: analysis of a population-based survey in Jamaica. BMJ Open 2023; 13:e076111. [PMID: 37963690 PMCID: PMC10649390 DOI: 10.1136/bmjopen-2023-076111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES This study aimed to examine concurrent polysubstance use of alcohol, tobacco and marijuana and determine correlations with access to marijuana, friend and familial drug use habits, risk perception and the age of initiation associated with the singular use of these substances. DESIGN A secondary data analysis. SETTING Used the Jamaica National Drug Prevalence Survey 2016 dataset. PARTICIPANTS Involved the entire dataset comprising 4623 randomly selected respondents between 12 and 65 years old. OUTCOME MEASURES Primary outcome: concurrent polysubstance use recorded as using two or more of alcohol, tobacco and marijuana. Predictor variables include risk perception and age of initiation of singular alcohol, tobacco and marijuana use, ease of marijuana access and family and friend alcohol and illegal drug use. RESULTS Approximately 58%-66% of respondents commenced singular alcohol, tobacco or marijuana use under 17. Participants commencing marijuana use at 11 years and under and between 12 and 17 were 3.346 and 4.560 times more likely to report past month concurrent polysubstance use (p=0.030 and p<0.001). Respondents who did not believe that smoking tobacco sometimes (p=0.049), and smoking marijuana sometimes and often was harmful, had increased odds of concurrent polysubstance use (p=0.047 and p<0.001, respectively). Respondents who indicated access to marijuana as easy were significantly more likely to report past month concurrent polysubstance use compared with those who reported access as difficult (p=0.002). Participants who indicated that friends or family members get drunk and take illegal drugs were associated with 1.722 and 1.864 increased odds of reporting past month concurrent polysubstance use (p=0.004 and p=0.017, respectively). CONCLUSIONS Decreased perceived risk, childhood and adolescent age of initiation and easy access to marijuana were significantly associated with polysubstance use among Jamaicans. The influence of friends and family members' drug and alcohol use behaviours on individuals developing polysubstance use habits further endorses the need for interventions.
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Affiliation(s)
- Kunal Lalwani
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Saint Andrew, Jamaica
| | | | - Joni-Gaye McLeary
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Saint Andrew, Jamaica
| | - Neena Albarus
- School of Social Welfare, University of California, Berkeley, California, USA
| | - Wendel Abel
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Saint Andrew, Jamaica
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2
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Choi SH, Stommel M, Broman C, Raheb-Rauckis C. Age of Smoking Initiation in Relation to Multiple Health Risk Factors among US Adult Smokers: National Health Interview Survey (NHIS) Data (2006-2018). Behav Med 2023; 49:312-319. [PMID: 35465849 DOI: 10.1080/08964289.2022.2060930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 02/23/2022] [Accepted: 03/23/2022] [Indexed: 11/02/2022]
Abstract
The adverse effects of multiple health risk factors have been well-documented; however, still understudied are the effects of early smoking in the context of multiple health risk factors. This study aimed to examine the role of early smoking initiation in relation to several health risk factors, including heavy drinking, physical inactivity, and obesity in later life among ever smokers in the USA. The National Health Interview Survey (NHIS) data from 2006 through 2018 were analyzed. The primary dependent variables were presence of three other risk factors: heavy drinking, physical inactivity, and obesity. The independent variable was the age of smoking initiation. Logit regression models were constructed to evaluate the association between smoking initiation and multiple health risk factors. All analyses were done in 2022. Among US adult smokers, 18.2% started smoking before age 15 (early initiators), 55.9% at ages 15-18 (middle initiators), and 25.9% at age 20 or later (late initiators). Compared to late smoking initiators, the odds of engaging in additional health risk factors increased by 37.3% among early initiators (OR = 1.373, 95% CI = 1.316, 1.432) and 7.7% among middle initiators (OR = 1.077, 95% CI= 1.041, 1.116). Additionally, current smoking was associated with higher odds (OR = 1.369, 95% CI = 1.322, 1.417) of having additional health risk factors compared to former smoking, with one exception: current smokers had lower odds of obesity (OR = 0.566, 95% CI = 0.537, 0.597). Tobacco control programs to prevent adolescents from initiating smoking may have the potential to prevent other health risk factors in adulthood.
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Affiliation(s)
- Seung Hee Choi
- College of Nursing, Wayne State University, Detroit, MI, USA
| | - Manfred Stommel
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Clifford Broman
- Department of Sociology, Michigan State University, East Lansing, MI, USA
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3
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Peprah P, Asare BYA, Okwei R, Agyemang-Duah W, Osafo J, Kretchy IA, Gyasi RM. A moderated mediation analysis of the association between smoking and suicide attempts among adolescents in 28 countries. Sci Rep 2023; 13:5755. [PMID: 37031212 PMCID: PMC10082789 DOI: 10.1038/s41598-023-32610-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 03/30/2023] [Indexed: 04/10/2023] Open
Abstract
Globally, evidence has shown that many adolescents are victims of substance use, mainly cigarette smoking, and it has been associated with suicidal ideation. However, the mechanisms underlying this association are poorly understood. This study examines whether truancy mediates and gender moderates the association of cigarette smoking with suicide attempts among adolescents in 28 countries. Data from the Global School-Based Student Health Survey were used. Hierarchical multiple logistic regression analyses were used to estimate the effect-modification of gender on cigarette smoking and suicide attempt. The mediating effect of truancy on the association between cigarette smoking and suicidal attempt was assessed using the generalized decomposition method. Cigarette smoking was associated with suicide attempts after adjusting for several confounding variables (aOR = 1.21; 95% CI = 1.09-1.33). The bootstrap results from the generalized decomposition analysis indicated that truancy partially mediated the association of cigarette smoking with a suicide attempt, contributing 21% of the total effect among in-school adolescents. Hierarchical regression analyses suggested that gender moderated the effect of cigarette smoking on suicidal attempts: female adolescents who smoked had 36% higher odds of suicidal attempts compared to male adolescents. The findings suggest possible pathways for designing and implementing interventions to address adolescents' cigarette smoking and truancy to prevent suicidal attempts.
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Affiliation(s)
- Prince Peprah
- Social Policy Research Centre, University of New South Wales, Sydney, Australia.
- Centre for Primary Health Care and Equity, University New South Wales, Sydney, Australia.
| | - Bernard Yeboah-Asiamah Asare
- Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Reforce Okwei
- Department of Geography, Miami University, Oxford, USA
| | | | - Joseph Osafo
- Department of Psychology, University of Ghana, Legon, Ghana
- Centre for Suicide and Violence Research - CSVR, Accra, Ghana
| | - Irene A Kretchy
- Centre for Suicide and Violence Research - CSVR, Accra, Ghana
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Razak M Gyasi
- African Population and Health Research Center, Manga Close, Off-Kirawa Road, P.O. Box 10787, Nairobi, 00100, Kenya
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4
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Ball J, Crossin R, Boden J, Crengle S, Edwards R. Long-term trends in adolescent alcohol, tobacco and cannabis use and emerging substance use issues in Aotearoa New Zealand. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2060266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jude Ball
- Department of Public Health, University of Otago, Wellington
| | - Rose Crossin
- Department of Population Health, University of Otago, Christchurch
| | - Joseph Boden
- Department of Psychological Medicine, University of Otago, Christchurch
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington
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Frobel W, Grafe N, Meigen C, Vogel M, Hiemisch A, Kiess W, Poulain T. Substance use in childhood and adolescence and its associations with quality of life and behavioral strengths and difficulties. BMC Public Health 2022; 22:275. [PMID: 35144574 PMCID: PMC8831000 DOI: 10.1186/s12889-022-12586-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substance use in childhood and adolescence continues to be a current health concern. The aims of the present study were to identify trends in the use of alcohol, cigarettes, and cannabis in children and adolescents in the last 10 years and to assess associations between substance use and quality of life and behavioral strengths and difficulties. METHODS Substance use was examined in 1829 9- to 18-year-old German children and adolescents participating in the LIFE Child cohort study between 2011 and 2020. Quality of life was investigated using the KIDSCREEN-27 questionnaire. The Strength and Difficulties Questionnaire was used to assess behavioral strengths and difficulties. Associations were assessed using linear regression analyses. All effects were adjusted for age, gender, and family socio-economic status. RESULTS 38.44% of participants reported drinking alcohol at least sometimes. Smoking (6.23%) and the use of cannabis (3.94%) were less frequent. While we observed no significant changes in smoking between 2011 and 2021, the consumption of cannabis and the frequent consumption of alcohol has increased in this time period. Cigarette and cannabis use were associated with additional symptoms of hyperactivity/inattention and reduced prosocial behavior. For all three substances, usage was associated with more conduct problems. We also found significant associations between substance use and a lower quality of life in the areas of physical wellbeing, psychological wellbeing, parent relation and autonomy, and school environment. One noteworthy finding was that cigarette consumption and frequent alcohol use were associated with higher quality of life in terms of social support/peer group relations. Some significant interactions between substance use and child age indicated that associations between substance use and quality of life or behavioral difficulties were stronger in younger than in older children. CONCLUSIONS The results show that quality of life and behavioral difficulties are associated with substance use and should be considered when developing or implementing preventive measures to counter substance use. Furthermore, the findings indicate that substance use can be accompanied by improved peer relations. Therefore, the influence of peers, especially of peers who use these substances, should not be underestimated.
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Affiliation(s)
- Wiebke Frobel
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany. .,Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research, Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany.
| | - Nico Grafe
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Christof Meigen
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Mandy Vogel
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.,Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research, Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Andreas Hiemisch
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.,Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research, Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Wieland Kiess
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.,Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research, Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Tanja Poulain
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.,Department of Women and Child Health, University Hospital for Children and Adolescents and Center for Pediatric Research, Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany
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6
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Lawrence D, Johnson SE, Mitrou F, Lawn S, Sawyer M. Tobacco smoking and mental disorders in Australian adolescents. Aust N Z J Psychiatry 2022; 56:164-177. [PMID: 33908298 DOI: 10.1177/00048674211009617] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study aimed to (1) examine the strength of the association between mental disorders/mental health problems, risk behaviours and tobacco smoking among Australian adolescents, (2) compare rates of tobacco smoking among Australian adolescents with major depressive disorder, attention-deficit/hyperactivity disorder and/or conduct disorder in 2013/14 vs 1998, and (3) identify the extent to which an association between tobacco smoking and mental health problems among adolescents can be attributed to non-mental health risk factors. METHODS The study utilised data from the first (1998) and second (2013/14) child and adolescent components of the National Surveys of Mental Health and Wellbeing. Both surveys identified nationally representative samples of Australian young people aged 4-17 years, living in private dwellings. Information was collected from parents and 13- to 17-year-olds about mental disorders, mental health problems, risk behaviours and tobacco smoking. RESULTS In the 2013/14 survey, the rate of current tobacco smoking among those with a mental disorder was 20% compared to 5% in those without a mental disorder. Rates were highest for young people with conduct disorder (50%), major depressive disorder (24%) and anxiety disorders (19%). In 2013/14, 38% of current tobacco smokers had a mental disorder and 32% reported self-harm and/or suicidal ideation vs 10% and 5%, respectively, among adolescents who had never smoked. Females with mental disorders or reporting self-harm or suicidal ideation had higher rates of current smoking than males. Other significant factors associated with current smoking included school-related problems, binge eating and having had more than one sexual partner. CONCLUSION While smoking rates in 13- to 17-year-olds with mental disorders had declined since 1998, the strength of the association between mental disorders and smoking had increased, especially among females. Our findings highlight the need to address the tobacco smoking among adolescents with mental disorders, particularly females.
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Affiliation(s)
- David Lawrence
- Graduate School of Education, The University of Western Australia, Perth, WA, Australia
| | - Sarah E Johnson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Francis Mitrou
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, College of Medicine & Public Health, Margaret Tobin Centre, Adelaide, SA, Australia
| | - Michael Sawyer
- School of Psychology and Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
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7
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Ahuja M, Awasthi M, Gim S, Records K, Cimilluca J, Al-Ksir K, Tremblay J, Doshi RP, Sathiyasaleen T, Fernandopulle P. Early Age of Cannabis Initiation and Its Association With Suicidal Behaviors. Subst Abuse 2022; 16:11782218221116731. [PMID: 35966616 PMCID: PMC9373116 DOI: 10.1177/11782218221116731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022]
Abstract
Background: Suicide rates in the U.S. have continued to rise over the last 2 decades. The increased availability and broader legalization of cannabis is a public health concern, particularly among adolescents. The objective of this study was to examine the association between the age of cannabis initiation and lifetime suicidal ideations and attempts in a sample of adults aged 18 or older. Methods: Data are from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001 to 2003 (N = 15 238). The primary objective of the CPES was to collect data about the prevalence of mental disorders, impairments associated with these disorders, and their treatment patterns from representative samples of majority and minority adult populations in the U.S. Logistic regression analyses were conducted to test the association between cannabis initiation age (early ⩽14 years old; later >14 years old) and outcomes of lifetime suicide ideation and attempts. Cigarette use, cannabis use, gender, income, race, education, and age were controlled for the analyses. Results: Overall, 12.5% of participants reported suicide ideation, while 4.2% reported attempt. Early cannabis use was associated with a higher risk of suicide ideation (AOR = 3.32, 95% CI [2.75, 3.80]) than later cannabis use (AOR = 2.15, 95% CI [1.92, 2.39]). Early cannabis use was associated with a higher risk of suicide attempt (AOR = 4.38, 95% CI [3.48, 5.52]) than later cannabis use (AOR = 2.56, 95% CI [2.14, 3.06]). Wald chi-squared tests revealed significant differences between the early and late initiation for both ideation (χ2 = 26.99; P < .001) and attempts (χ2 = 26.02; P < .001). Conclusions: Significant associations were found between early initiation of cannabis and suicide behaviors. As suicide rates continue to rise, it is recommended that clinicians, treatment providers, and other professionals consider the use of cannabis at an early age as a risk for subsequent suicide behaviors.
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Affiliation(s)
- Manik Ahuja
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Manul Awasthi
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Suzanna Gim
- LUI Pharmacy, Long Island University, Brooklyn, NY, USA
| | - Kathie Records
- School of Nursing, College of Natural and Health Sciences, University of Northern Colorado, Greeley, CO, USA
| | - Johanna Cimilluca
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Kawther Al-Ksir
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Johnathan Tremblay
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Riddhi P Doshi
- Center for Population Health, UConn Health, Farmington, CT, USA
| | | | - Praveen Fernandopulle
- Department of Psychiatry and Behavioral Sciences, East Tennessee State University, Johnson City, TN, USA
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8
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Dual-harm in adolescence and associated clinical and parenting factors. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1615-1626. [PMID: 35352132 PMCID: PMC9288948 DOI: 10.1007/s00127-022-02258-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE Both aggression toward others and self peak in adolescence and interpersonal violence and suicide are among the leading causes of death in young people worldwide. Individuals who show both aggression toward others and self, i.e. dual-harm, may experience the worst outcomes. The current study investigates clinical and parenting factors associated with dual-harming in adolescence, to provide new insights for prevention and treatment. METHODS In a prospective cohort of adolescents, oversampled on emotional and behavioral problems (n = 1022; aged 12-17 years), we investigated co-occurrence in harm toward others and self and presented findings in an area-proportional Euler diagram. Four harm groups (no harm, other-harm, self-harm, and dual-harm) were compared on intelligence scores, general functioning, emotional and behavioral problems, substance use, parental hostility, and harsh parenting with ANCOVAs and logistic regressions. RESULTS In adolescents that other-harmed, the risk of self-harm was 1.9 times higher than for those who did not harm others. Dual-harm adolescents reported worse overall functioning, more emotional and behavioral problems, more parental hostility and harshness, and were more likely to use substances than those who did not engage in aggressive behaviors. No evidence of differences in intelligence scores between groups were found. CONCLUSION These findings highlight a vulnerable group of adolescents, at risk of future suicide, violent offending, and the development of severe psychopathology. Dual-harm is a promising marker for early intervention and referral to specialized mental health professionals. Further research is needed to examine underlying pathways and risk factors associated with persistent dual-harm trajectories into adulthood.
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9
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Waters AF, Peltier MR, Roys MR, Stewart SA, Copeland AL. Smoking and suicidal ideation among college students: Smoking expectancies as potential moderators. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:951-958. [PMID: 32027235 DOI: 10.1080/07448481.2020.1719112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Objective: In the present study, we sought to establish a link between suicidal ideation (SI) and smoking in college students, determine whether psychopathology accounted for the association, and determine whether smoking expectancies were moderators. Participants: Participants (N = 607) were identified as nonsmokers, exsmokers, infrequent smokers, or daily smokers. Methods: Participants were assessed for smoking patterns, smoking expectancies, psychopathology, SI, and past suicide attempts. Results: Daily smokers had the highest level of SI. There was a dose-response relationship between smoking and SI, such that the higher the daily smoking rate, the greater the SI, even when controlling for depression, alcohol use, and drug use. Trend-level results indicated that at lower smoking rates, elevated smoking-related negative affect reduction (NAR) expectancies were associated with lower SI, while elevated NAR expectancies in combination with higher smoking rates were associated with greater SI. Conclusion: Smoking cessation programs for college students should screen for SI.
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Affiliation(s)
- Aaron F Waters
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - MacKenzie R Peltier
- Psychology Service, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Melanie R Roys
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Shelby A Stewart
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Amy L Copeland
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
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10
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A genetically informed study on the association of cannabis, alcohol, and tobacco smoking with suicide attempt. Mol Psychiatry 2021; 26:5061-5070. [PMID: 32507850 DOI: 10.1038/s41380-020-0785-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 12/17/2022]
Abstract
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.
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11
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Rissanen ML, Kekkonen V, Kraav SL, Kivimäki P, Laukkanen E, Hintikka J, Tolmunen T. Social support may prevent self-cutting in adolescence: A 5-year follow-up study. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2021; 34:343-351. [PMID: 34164876 DOI: 10.1111/jcap.12341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/22/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Abstract
Self-cutting is common among adolescents. However, studies examining protective factors are rare. It has been suggested that social support may protect against self-cutting in adolescence. The aim of this study was to investigate the possible association of social relationships with the initiation of self-cutting. METHODS The participants were community-dwelling Finnish adolescents (N = 4171) aged 13-18 years at baseline. The follow-up assessment was conducted 5 years later (N = 794). Those adolescents who had self-cut before the baseline assessment (N = 134) were excluded from the analysis, leaving a total of 660 participants to be analyzed. In this group, 37 adolescents initiated self-cutting during the 5-year follow-up period and 623 did not. Cox's proportional hazards models were used with several adjustments for possible confounding factors. FINDINGS A higher age, male gender, good relationships with siblings, weekly meetings with friends, and personal experience of not being lonely associated with the noninitiation of self-cutting during the follow-up period. Good relationships with parents or peers had no association with the initiation of self-cutting. Depressive symptoms mediated the effect of subjective loneliness on initiating self-cutting. CONCLUSIONS Social support produced by friends may have a protective effect against self-cutting.
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Affiliation(s)
- Marja-Liisa Rissanen
- Unit of Health Care, Savonia University of Applied Sciences, Kuopio, Finland.,Department of Adolescent Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Virve Kekkonen
- Department of Adolescent Psychiatry, Kuopio University Hospital, Kuopio, Finland.,Department of Psychiatry, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Siiri-Liisi Kraav
- Faculty of Social Sciences, University of Eastern Finland, Joensuu, Finland
| | - Petri Kivimäki
- Department of Adolescent Psychiatry, Kuopio University Hospital, Kuopio, Finland.,City of Helsinki, Pitäjänmäki Health Station, Helsinki, Finland
| | - Eila Laukkanen
- Department of Adolescent Psychiatry, Kuopio University Hospital, Kuopio, Finland.,Department of Psychiatry, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jukka Hintikka
- Department of Psychiatry, Päijät-Häme Central Hospital, Lahti, Finland.,Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Tommi Tolmunen
- Department of Adolescent Psychiatry, Kuopio University Hospital, Kuopio, Finland.,Department of Psychiatry, School of Medicine, University of Eastern Finland, Kuopio, Finland
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12
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Swann AC, Graham DP, Wilkinson AV, Kosten TR. Nicotine Inhalation and Suicide: Clinical Correlates and Behavioral Mechanisms. Am J Addict 2021; 30:316-329. [PMID: 34109688 DOI: 10.1111/ajad.13171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/26/2021] [Accepted: 03/06/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Extensive evidence links smoking and suicide independently of psychiatric diagnoses, but there are questions about the pathophysiology and specificity of this relationship. We examined characteristics of this linkage to identify potential transdiagnostic mechanisms in suicide and its prevention. METHODS We reviewed literature that associated suicide with smoking and e-cigarettes, including the temporal sequence of smoking and suicide risk and their shared behavioral risk factors of sensitization and impulsivity. RESULTS Smoking is associated with increased suicide across psychiatric diagnoses and in the general population, proportionately to the number of cigarettes smoked per day. Rapid nicotine uptake into the brain through inhalation of conventional cigarettes, electronic cigarettes (e-cigarette), or even second-hand smoke can facilitate long-term sensitization and short-term impulsivity. Both impair action regulation and predispose to negative affect, continued smoking, and suicidal behavior. Intermittent hypoxia, induced by cigarettes or e-cigarettes, synergistically promotes impulsivity and sensitization, exacerbating suicidality. Two other shared behavioral risks also develop negative urgency (combined impulsivity and negative affect) and cross-sensitization to stressors or to other addictive stimuli. Finally, early smoking onset, promoted by e-cigarettes in never-smokers, increases subsequent suicide risk. CONCLUSION AND SCIENTIFIC SIGNIFICANCE Prevention or cessation of nicotine inhalation can strategically prevent suicidality and other potentially lethal behavior regardless of psychiatric diagnoses. Medications for reducing smoking and suicidality, especially in younger smokers, should consider the neurobehavioral mechanisms for acute impulsivity and longer-term sensitization, potentially modulated more effectively through glutamate antagonism rather than nicotine substitution. (Am J Addict 2021;30:316-329).
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Affiliation(s)
- Alan C Swann
- Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - David P Graham
- Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | | | - Thomas R Kosten
- Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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13
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Omotoso AB, Makanjuola AB, Abiodun OA. Recreational use of psychoactive substances among secondary school students in North-Central Nigeria. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2020.1779361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ayotunde B. Omotoso
- Child and Adolescent Psychiatry Unit, Department of Behavioural Sciences, University of Ilorin Teaching Hospital Ilorin, Ilorin, Nigeria
| | - Alfred B. Makanjuola
- Drug Abuse Treatment, Research & Rehabilitation Centre, Department of Behavioural Sciences, University of Ilorin Teaching Hospital Ilorin, Ilorin, Nigeria
| | - Olatunji A. Abiodun
- Department of Behavioural Sciences, University of Ilorin Teaching Hospital Ilorin, Ilorin, Nigeria
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14
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Lange S, Koyanagi A, Rehm J, Roerecke M, Carvalho AF. Association of Tobacco Use and Exposure to Secondhand Smoke With Suicide Attempts Among Adolescents: Findings From 33 Countries. Nicotine Tob Res 2020; 22:1322-1329. [PMID: 31504808 DOI: 10.1093/ntr/ntz172] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/03/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION There is evidence to suggest that tobacco use is associated with suicide attempts. However, it is unclear whether such an association can be extended to include secondhand smoke exposure. Using nationally representative data of school-attending adolescents from 33 countries, we examined the association of tobacco use and exposure to secondhand smoke with suicide attempts. METHODS We used data from the Global School-based Student Health Survey, a cross-sectional survey conducted among adolescents 12-15 years of age. We used logistic regression to estimate the country-specific associations. We then conducted random effect meta-analyses to obtain overall and country-income level pooled estimates. Lastly, we used logistic regression analyses to investigate a dose-response association of cigarette smoking and exposure to secondhand smoke with suicide attempts. RESULTS A positive association between tobacco use and suicide attempts among adolescents was present regardless of country-income level (low income: odds ratio 4.98, 95% CI: 3.11-7.96; lower middle income: 3.47, 2.91-4.15; upper middle income: 3.09, 2.75-3.47; and high income: 3.18, 2.63-3.84) and gender (boys: 3.28, 2.86-3.76; girls: 3.86, 3.30-4.51). Exposure to secondhand smoke was associated with suicide attempts, albeit weakly, among girls only (1.26, 1.14-1.39; boys: 1.00, 0.87-1.15). There was some evidence that a dose-response association of cigarette smoking and exposure to secondhand smoke with suicide attempts may only exist among girls. CONCLUSIONS Adolescents who use tobacco, and adolescent girls exposed to secondhand smoke were found to be more likely to attempt suicide; however, future longitudinal studies are warranted to assess causality. IMPLICATIONS Our findings indicate that routine screening of adolescents for tobacco use should be implemented globally, especially when assessing suicidal behaviors and risk. Future longitudinal and intervention studies are warranted to assess causality and whether prevention efforts such as tobacco control interventions and programmes targeting tobacco use and exposure to secondhand smoke among adolescents could ultimately lead to a reduction in the occurrence of suicide attempts.
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Affiliation(s)
- Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute of Clinical Psychology and Psychotherapy and Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
| | - Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - André F Carvalho
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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15
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Wojciechowski TW. The Development of Cigarette Smoking Behavior Among Juvenile Offenders in Adolescence and Early Adulthood: ADHD Symptomatology as a Risk Factor. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2020. [DOI: 10.1080/1067828x.2020.1782795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Fekih-Romdhane F, ElKhouni C, Sassi H, Cheour M. The Role of Personal Factors and Learning Environment in Suicidal Ideation Among Tunisian Medical Students. CRISIS 2020; 42:20-31. [PMID: 32343167 DOI: 10.1027/0227-5910/a000678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: Little is known about specific professional factors influencing medical students' suicidal ideation and behavior. We aimed to evaluate the prevalence and correlates of suicidal ideation in Tunisian medical students. Method: This was a cross-sectional study; 390 second-cycle medical students were enrolled at the Faculty of Medicine of Tunis. Participants responded to an anonymous questionnaire containing sociodemographic data, educational factors, the Suicidal Ideation Questionnaire (SIQ), and the Depression, Anxiety and Stress scales (DASS-21). Results: Eleven students (2.8%) had made one or more suicide attempts in their lifetime. For a threshold value of 41 based on the SIQ scale, 7.9% of students were considered to have a potential risk of suicide. The multiple hierarchical linear regression analysis identified as main factors independently associated with suicidal ideation: tobacco consumption, perceived sleep quality, depression symptoms, the personal history of suicide attempt, the satisfaction with student-supervisor relationship, and choosing to study medicine. Conclusion: Suicide prevention efforts should target high-risk students with prior personal or family history of suicidal behavior. Moreover, medical school authorities should put in place effective strategies to optimize the learning environment at their institutions.
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Affiliation(s)
- Feten Fekih-Romdhane
- Tunis El Manar University, Faculty of Medicine of Tunis, Tunisia.,Razi Hospital, Mannouba, Tunisia
| | - Chams ElKhouni
- Tunis El Manar University, Faculty of Medicine of Tunis, Tunisia.,Razi Hospital, Mannouba, Tunisia
| | - Hadhami Sassi
- Tunis El Manar University, Faculty of Medicine of Tunis, Tunisia.,Razi Hospital, Mannouba, Tunisia
| | - Majda Cheour
- Tunis El Manar University, Faculty of Medicine of Tunis, Tunisia.,Razi Hospital, Mannouba, Tunisia
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17
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Zhou H, Xian W, Zhang Y, Yang Y, Fang W, Liu J, Shen J, Zhang Z, Hong S, Huang Y, Zhang L. Suicide among cancer patients: adolescents and young adult (AYA) versus all-age patients. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:658. [PMID: 31930059 DOI: 10.21037/atm.2019.10.51] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Many researchers have studied suicide risk factors of patients with one specific cancer. But there is no comprehensive study to compare suicide issues between adolescents and young adult (AYA) group and all-age groups in a pan-cancer view. Methods Patients diagnosed with 20 solid malignancies were identified from SEER database. Multivariable logistic regression was operated to find out risk factors of suicide. Results Male sex has less impact on AYA than all-age patients (OR 2.72, 95% CI: 2.23-3.31, P<0.001 vs. OR 4.64, 95% CI: 4.37-4.94, P<0.001), while white race (OR 3.28, 95% CI: 2.02-5.77, P<0.001 vs. OR 3.40, 95% CI: 3.02-3.84, P<0.001) and unmarried status (OR 1.51, 95% CI: 1.24-1.83, P<0.001 vs. OR 1.39, 95% CI: 1.33-1.46, P<0.001) have similar impact on AYA and all-age groups. Localized cancer stage may have stronger impact on AYA than all-age (OR 2.90, 95% CI: 1.83-4.84; P<0.001 vs. OR 1.76, 95% CI: 1.61-1.92; P<0.001), while surgery only influence all-age (OR 1.14, P=0.451 vs. 1.24, P<0.001). Within 5 years from cancer diagnosis, longer survival time is associated with higher suicide risk of both all-age and AYA patients. Conclusions Male sex, white race and unmarried status, earlier cancer stage and longer survival time within 5 years are similar prevalent risk factors for both AYA group patients and all-age patients. It is not necessary to pick AYA cancer patients out when considering suicide risk of cancer patients.
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Affiliation(s)
- Huaqiang Zhou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Wei Xian
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Yaxiong Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yunpeng Yang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Wenfeng Fang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Jiaqing Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Jiayi Shen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Zhonghan Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Shaodong Hong
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yan Huang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
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18
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Rose RJ, Salvatore JE, Aaltonen S, Barr PB, Bogl LH, Byers HA, Heikkilä K, Korhonen T, Latvala A, Palviainen T, Ranjit A, Whipp AM, Pulkkinen L, Dick DM, Kaprio J. FinnTwin12 Cohort: An Updated Review. Twin Res Hum Genet 2019; 22:302-311. [PMID: 31640839 PMCID: PMC7108792 DOI: 10.1017/thg.2019.83] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This review offers an update on research conducted with FinnTwin12 (FT12), the youngest of the three Finnish Twin Cohorts. FT12 was designed as a two-stage study. In the first stage, we conducted multiwave questionnaire research enrolling all eligible twins born in Finland during 1983-1987 along with their biological parents. In stage 2, we intensively studied a subset of these twins with in-school assessments at age 12 and semistructured poly-diagnostic interviews at age 14. At baseline, parents of intensively studied twins were administered the adult version of the interview. Laboratory studies with repeat interviews, neuropsychological tests, and collection of DNA were made of intensively studied twins during follow-up in early adulthood. The basic aim of the FT12 study design was to obtain information on individual, familial and school/neighborhood risks for substance use/abuse prior to the onset of regular tobacco and alcohol use and then track trajectories of use and abuse and their consequences into adulthood. But the longitudinal assessments were not narrowly limited to this basic aim, and with multiwave, multirater assessments from ages 11 to 12, the study has created a richly informative data set for analyses of gene-environment interactions of both candidate genes and genomewide measures with measured risk-relevant environments. Because 25 years have elapsed since the start of the study, we are planning a fifth-wave follow-up assessment.
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Affiliation(s)
- Richard J. Rose
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | | | - Sari Aaltonen
- Institute for Molecular Medicine FIMM, Helsinki, Finland
| | - Peter B. Barr
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Leonie H. Bogl
- Institute for Molecular Medicine FIMM, Helsinki, Finland
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Holly A. Byers
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kauko Heikkilä
- Institute for Molecular Medicine FIMM, Helsinki, Finland
| | | | - Antti Latvala
- Institute for Molecular Medicine FIMM, Helsinki, Finland
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
| | | | - Anu Ranjit
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Alyce M. Whipp
- Institute for Molecular Medicine FIMM, Helsinki, Finland
| | - Lea Pulkkinen
- Department of Psychology, University of Jyvaskyla, Jyvaskyla, Finland
| | - Danielle M. Dick
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Jaakko Kaprio
- Institute for Molecular Medicine FIMM, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
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19
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Osipova NN, Dmitrieva EV, Beglyankin NI, Bardenshteyn LM. [Predictors of suicidal behaviour in adolescents with depressive disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:28-33. [PMID: 31006788 DOI: 10.17116/jnevro20191191228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A review of recent publications is devoted to risk factors for suicidal behavior in adolescents with depressive disorders. The authors summarized Russian and international studies on the clinical course of affective disorders, in particular bipolar disorders, their clinical heterogeneity and incompleteness in adolescence. Particular attention is given to the complexity of early identification of predictors of suicidal behavior in depressive disorders due to comprehensiveness of exogenous and endogenous effects characteristic of adolescence. The role of genetic loading for affective disorders, problems of children having parents with affective disorders, social and psychological factors (violence in families, school bullying etc.) and risks of suicidal behavior are described. It is of great significance to investigate premorbid adjustment, subaffective manifestations of disorders in adolescence to predict the trajectory of the disease, its complications in the form of suicidal behavior and opportunities for early intervention.
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Affiliation(s)
- N N Osipova
- Smolensk State University of Medicine of the Ministry of Healthcare of RF, Moscow, Russia
| | - E V Dmitrieva
- Smolensk State University of Medicine of the Ministry of Healthcare of RF, Moscow, Russia
| | - N I Beglyankin
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - L M Bardenshteyn
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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20
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The role of substance use, smoking, and inflammation in risk for suicidal behavior. J Affect Disord 2019; 243:33-41. [PMID: 30223137 PMCID: PMC6241516 DOI: 10.1016/j.jad.2018.09.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/09/2018] [Accepted: 09/06/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Alcohol and substance use disorders are important predictors for suicidal behavior. However, the role of individual substances as proximal risk factors for suicidal behavior and the mechanisms through which substance use affect risk are not entirely clear. We examine whether the frequency of substance use and whether biological markers in the HPA axis and inflammatory pathways are associated with clinical risk factors of suicidal behavior of aggression, impulsivity, hopelessness, and poor sleep. METHODS The sample consisted of psychiatric inpatients, aged 15-30 years, admitted for suicide attempt (n = 38), suicidal ideation (n = 40); and healthy controls (n = 37). We measured hair cortisol concentrations, glucocorticoid receptor (GR) sensitivity, stimulated production of interleukin- or IL-6, C-reactive protein, and mRNA expression of GR, SKA2, FKBP5, TNF-α, and IL-1β. RESULTS Smoking was associated with increased aggression [β = 2.9, 95% CI (-0.03, 6), p = 0.05], impulsivity [β = 3.1, 95% CI (1.6, 4.6), p < 0.001], and poor sleep [β = 0.5, 95% CI (0.03, 0.95), p = 0.04] even after controlling for demographics and group. Similarly, TNF-α mRNA was associated with impulsivity [β = 0.07, 95% CI (0.01, 0.1), p = 0.02] and hopelessness [β = 0.03, 95% CI (0.004, 0.05), p = 0.03]. Smoking tobacco (r = 0.32, p < 0.001) was positively associated with TNF-α mRNA. LIMITATIONS Study limitations include the cross-sectional design, retrospective assessment, and relatively small sample size. CONCLUSIONS Future longitudinal studies are needed to test whether inflammatory markers mediate the relationships between smoking, clinical risk factors, and suicidal behavior; and to examine whether smoking cessation could reduce the risk for suicidal behavior in at-risk patients.
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