Co-occurring risk factors among U.S. high school students at risk for suicidal thoughts and behaviors

Lifetime use of multiple substances and youth suicide risk: assessing the role of depressive symptoms using structural equation modeling

OBJECTIVES

This study assessed the direct and indirect effects (via depressive symptoms) of lifetime use of a broad range of substances on suicide risk among US adolescents.

STUDY DESIGN

This was a cross-sectional study.

METHODS

Data from the 2021 Youth Risk Behavior Survey were used (N = 12,303, 48.7% female). Associations between five types of substance use (cigarette, e-cigarette, alcohol, marijuana, and prescription pain medicine) and three dimensions of suicide risk (suicidal ideation, suicide plan, and suicide attempt) were measured by multivariate logistic regression models. The role of depressive symptoms was further examined by structural equation modeling.

RESULTS

Almost three in five (57.5%) adolescents had used one or more substances in their lifetime (18.1% one type, 12.2% two types, 13.1% three types, 10.2% four types, and 3.8% five types). Adolescents using five substances were up to 16 times more likely to experience suicidal ideation and behaviors. Depressive symptoms significantly linked the pathway from substance use to suicide risk, resulting in much stronger indirect effects than the direct effects. Collectively, the five substance use behaviors and depressive symptoms explained about 60.4% of variance in suicidal ideation, 53.6% of variance in suicide plan, and 55.0% of variance in suicide attempt.

CONCLUSIONS

Lifetime use of multiple substances is significantly correlated with suicidal ideation and behaviors among adolescents via the pathway of depressive symptoms. Routine screening for a broad range of substance use behaviors is needed to identify adolescents at risk for suicide and accessible mental health services could potentially attenuate the linkage between substance use and suicide risk.

Suicidal Thoughts and Behaviors Among US Adolescents: The Cumulative Effects of Polysubstance Use Behaviors

Background: The linkage between substance use and youth suicidality is less developed due to the predominant focus on certain types of substances (e.g., alcohol consumption, prescription opioid misuse). This study examines polysubstance use and its mutual impact on suicidal thoughts and behaviors among US adolescents. Methods: Data from 2019 Youth Risk Behavior Survey were utilized. Associations between the concurrent use of five substances (cigarette, e-cigarette, alcohol, marijuana, and prescription opioid) and suicidality (suicidal thoughts, suicide plans, and suicide attempts) were measured by logistic regression models. The combined effect of polysubstance use on suicidality was further assessed by structural equation modeling. Results: About two in five (42.1%) adolescents used at least one type of substances in the past month and one in seven (13.5%) used three or more types concurrently (polysubstance use). Adolescents with polysubstance use behaviors were three to five times more likely to experience suicidal thoughts (OR=3.8, p < 0.05), make a suicide plan (OR=3.5, p < 0.05), or attempt suicide (OR=4.6, p < 0.05) than non-users. In the final structural model, polysubstance use and suicidality were significantly correlated with each other (β=0.37, p < 0.05). Collectively, polysubstance use explained about 14% of variance in youth suicidality. Conclusions: Polysubstance use shows a significant impact on youth suicidality. School-based health centers and educational programs are recommended to reduce substance use and suicidal behaviors among adolescents. Accessible mental health services and targeted treatments are needed for polysubstance users to mitigate their risk of suicide.

Examining the relationship between adversity and suicidality and self-harm in Irish adolescents from 2020 to 2022

BACKGROUND

Research indicates that there is a strong association between childhood adversity and youth suicide and self-harm. However, there is currently a lack of understanding about the patterns of adversity most frequently experienced by youth across social settings, and whether these typologies differently predict youth engagement in suicide and self-harm. This study examines the dominant patterns of adversity experienced by adolescents across home, peer, and school contexts, and explores the relationship between youth's adversity profiles and their suicide and self-harm outcomes, across a two year period (2020-2022).

METHODS

Secondary analyses were performed on data collected from 10,281 (50 % male) adolescents who participated in the Irish Planet Youth questionnaire in 2020 (n = 5004) or 2022 (n = 5277).

RESULTS

Findings from clustered latent class analyses indicated that there are four dominant profiles of adversity experienced by adolescents. Class 1 (Multiple Adversity) was characterised by a high probability of experiencing adversity across multiple social settings. Class 2 (Parent Adversity) had a strong likelihood of experiencing adversity with parents. Class 3 (Peer Adversity) were likely to experience adversity within the peer/friend domain. Class 4 was characterised by a low probability of experiencing adversity. Findings from logistic regression models with BCH training weights indicated that there were significant differences in self-harm and suicidality across the adversity classes. In comparison to the low adversity group, adolescents in the multiple adversity group were more likely to self-harm and attempt suicide.

LIMITATIONS

These findings are based on cross-sectional data and rely on the use of single-item measurements, which may limit the generalisability of findings.

DISCUSSION

Results indicate that youth who experience adversity across home, peer and school contexts are at the greatest risk of engaging in suicide and self-harm. These findings have important implications for policy and practice, and suggest that youth experiencing adversity across multiple settings should be priority targets for intervention.

Precipitating Circumstances Associated With Intimate Partner Problem-Related Suicides

INTRODUCTION

In 2020, suicide was the 12th leading cause of death among adults in the U.S. Previous research has shown that one common precipitating circumstance among adult suicide decedents is experiencing intimate partner problems (IPPs), such as divorce, separation, romantic break-ups, arguments, conflicts, and intimate partner violence. This study examines how precipitating factors differ between IPP- and non-IPP-related suicides.

METHODS

In 2022, this study analyzed National Violent Death Reporting System data from adult suicide decedents in 48 states and 2 territories between 2003 and 2020. Multivariable logistic regression models were used to compare precipitating circumstances between IPP- and non-IPP-related suicides, controlling for sociodemographic characteristics.

RESULTS

Of the 402,391 suicides, 20% (n=80,717) were known to be IPP-related. Circumstances that significantly increased the odds of IPP-related suicides included a history of suicidal thoughts and attempts and mental health problems (depressed mood, alcohol problem, mental health diagnosis), life stressors (interpersonal violence perpetration and victimization, arguments, financial problems, job problems, family problems), and recent legal problems. Non-IPP-related suicides were more likely to occur among older individuals and to be precipitated by a physical health problem or crime.

CONCLUSIONS

The findings can inform prevention strategies that build resiliency and problem-solving skills, strengthen economic support, and identify and assist people at risk for IPP-related suicides. The Centers for Disease Control and Prevention's Suicide Resource for Action and Intimate Partner Violence Prevention resource packages highlight the best available evidence for policies, programs, and practices related to preventing suicides and IPP.

Youth Suicide and Self-Harm: Latent Class Profiles of Adversity and the Moderating Roles of Perceived Support and Sense of Safety

Research suggests that exposure to adversity can lead to an increased risk of experiencing suicidal and self-injurious thoughts or behaviours, but few studies have examined whether different patterns of adversity are differentially associated with youth suicide/self-harm. The current study aims to explore the relationship between exposure to adversity across various social domains and youth self-harm and suicidality, using a person centred approach, and examines whether access to social support and a sense of safety across home, peer or school settings buffer the relationship between adversity and self-harm/suicidality. Secondary data analyses were carried out on cross-sectional self-report data collected from 4848 (M_age=15.78, SD = 0.59; 50% female) adolescents who participated in the Irish Planet Youth survey. Latent Class Analyses identified four distinct profiles of adversity; low-adversity (n = 2043, 42%); peer-adversity (n = 972, 20%); parental-adversity (n = 1189, 25%); and multiple-adversity (n = 644, 13%). Findings from logistic moderated regressions indicated that there were significant differences in self-harm and suicidality across the adversity classes. Although parental support and perceived safety at school were negatively associated with suicidality and self-harm outcomes, no significant moderation effects were observed. These findings suggest that youth who experience adversity across multiple social domains are more likely to report suicidal and self-harm thoughts and behaviours, and should be key targets for intervention/prevention efforts. While parental support and school safety may act as significant compensatory factors, further work is needed to identify the social resources that can offset the risk imposed by youth's adverse experiences.

Sports- and physical activity-related concussion and mental health among adolescents: Findings from the 2017 and 2019 Youth Risk Behavior Survey

This study examined the association between self-reported sports- or physical activity-related concussion and symptoms of depression and suicidal behaviors (suicidal ideation, having a suicide plan, and suicide attempts). This study used data from the 2017 and 2019 Youth Risk Behavior Survey (YRBS), a biennial, school-based, nationally representative survey of U.S. students in grade levels 9 to 12 (N = 14,496). Multivariate logistical regression models assessed the association between self-reported sports-or physical activity-related concussions and suicidal behaviors among students, controlling for a range of demographic and psychosocial variables. Altogether, 13.6% of students reported a sports-or physical activity related concussion in the past 12 months. Among youth, sports-or physical activity related concussions were significantly associated with greater odds of symptoms of depression, suicidal ideation, making a suicide plan, and suicide attempts compared to other youth who did not experience sports- or physical activity-related concussion. Findings highlight increased risk for adverse mental health outcomes among students with sports-or physical activity related concussions. Providing resources for students to engage in physical activity and sports teams may help prevent the onset of depression and suicidal behaviors; however, resources must also be available to monitor any concussions related to these activities to provide support for student emotional well-being.

Risk and Protective Factors Associated with Suicidal Thoughts and Behaviors Among Maryland Middle School Students

The aim of this study was to identify independent risk and protective factors associated with self-reported suicidal thoughts and behaviors (STB) among young adolescents by examining self-report data on mental health, substance abuse, violence involvement, social and economic challenges and supports, physical health and demographics in relation to STB. Data from nearly 27,000 students who completed the 2018-19 Maryland Middle School Youth Risk Behavior Survey/Youth Tobacco Survey (YRBS/YTS) were used to identify independent risk and protective factors associated with STB among middle school students (grades 6–8; ages 11-14). Twenty-three percent of students reported lifetime suicidal ideation and nine percent reported lifetime attempt(s). Independent risk factors associated with STB include depression, substance abuse or misuse, violence involvement, bullying victimization at school or electronically, sexual activity, and sleep deprivation. Protective factors include having an adult outside of school to confide in and feeling that teachers care and provide encouragement. Interactive effects by gender and/or race/ethnicity were observed for some factors in relation to STB. These results suggest that evidence-based programs and policies at the universal and selective/indicated levels in school settings are needed and should be introduced earlier on to address the widespread prevalence of STB in young adolescents. Program planners should take into consideration social, cultural and language needs when implementing and developing intervention strategies.

Suicidal behavior in Mexican adolescents: A test of a latent class model using two independent probability samples

Suicidal behavior is a serious health issue that affects the adolescent population and that may be prevented through evidence-based approaches. There are many risk factors involved in suicidal behavior, but there are few studies encompassing the complex relationships between them. This study tested the similarity between two latent class models from two different epidemiological samples of middle-school students and evaluated if the multinomial regression model replicated the associations between the classes and the psychosocial variables. Data of 4013 adolescents from the Mexican states of Campeche and Querétaro were included in LCA to characterize suicide behavior and associated factors. The most likely latent class membership was used as the outcome in multinomial regression models. The model with data from Querétaro was consistent with the previous LC model from Campeche. The four latent classes were nearly identical for both populations and can be defined as follows: 1) "No Problems," included 73% of the adolescents; 2) "Drug Use Only," comprised 7% of the adolescents; 3) "Suicidal Behavior, No Depression," captured 8% of the adolescents (25% reported binge drinking in the past month, 50% self-inflicted injuries, and 43% low-lethality suicide attempt); 4) "Depression and Suicidal Behavior," comprised 12% of the sample (66% met criteria for Major Depressive Episode, 28% reported binge drinking in the past month, and 11% had a high-lethality suicide attempt). The congruence between the models and the consistency with identified factors highlight the need for appropriate and effective prevention strategies to minimize risk factors and reinforce protective factors in the adolescent population.

Associations between depression subtype and functional impairment and treatment utilization in a national sample of adolescents

BACKGROUND

Prior studies have characterized distinct major depressive episode (MDE) subtypes among adults, yet limited evidence exists regarding variation in MDE during adolescence.

METHODS

Using 2008-2016 National Survey of Drug Use and Health data, latent class analysis (LCA) was used to characterize depression subtypes (based on symptom presentation) among 9,896 youth ages 12-17 with recent first-onset MDE. Logistic regression was used to estimate associations of MDE subtype with functional outcomes and treatment utilization, adjusting for demographic characteristics and depression severity (i.e., number of MDE diagnostic criteria and recurrence status) RESULTS: A 5-class LCA model provided optimal fit. Three distinct categories of MDE symptoms generally clustered together, which we termed "somatic," "cognitive," and "self-worth;" classes were differentiated by distinct combinations of symptoms across these 3 categories. Subtypes were characterized as: Highly Symptomatic (39% of youth); Somatic & Cognitive (24%), Somatic (22%), Diffuse Symptoms (8%), and Somatic & Self-Worth (6%). The majority of youth reported at least moderate impairment across multiple domains; subtype was a significant predictor of functional impairment. Only 34% of youth received any past-year depression-related treatment; treatment utilization was significantly higher for MDE subtypes with the highest prevalences of suicidal ideation.

LIMITATIONS

Due to cross-sectional data, we cannot establish causal directionality.

CONCLUSIONS

Subtype was significantly predictive of functional impairment and treatment utilization, above and beyond number of MDE diagnostic criteria or recurrence status. Understanding distinct profiles of adolescent depression, as well as potential differential associations with impairment, can inform prevention, diagnosis, and treatment of depression among youth.