Cocaine and alcohol use preceding suicide in African American and white adolescents

Characteristics and circumstances of cocaine-related completed suicide in Australia, 2000-2021

BACKGROUND

There has been a substantial global increase in cocaine use and associated harms. The current study aimed to: 1. Determine the case characteristics and circumstances of death of cocaine-related suicide in Australia 2000-2021; and 2. Determine the toxicological profiles of cases.

METHODS

Retrospective study of cocaine-related death in Australia, 2000-2021, retrieved from the National Coronial Information System (NCIS). Suicide intent was based upon the NCIS code for "Intentional Self-harm", derived from case circumstances and coroners' conclusions. Sex comparisons were made for all major variables.

RESULTS

A total of 157 cases were identified, 82.2% male, 79.5% employed, with a mean age of 32.3 years. Concerns for mental health were documented in 65.6%, a previous suicide attempt in 21.0%, a history of substance use treatment and/or negative consequences of substance use in 45.9% and injecting drug use in 14.6%. Manner of death amongst both sexes was predominantly by physical means (82.8%). Written intent was documented in 29.3%. Intense agitation prior to the incident was noted in 28.0% and conflict in 24.8%. The median blood cocaine concentration was 0.060 mg/L (range 0.007-5.500). Other drugs were present in 95.5%, most commonly alcohol (63.1%) with a median concentration of 0.140 g/100 ml. Psychostimulants other than cocaine were present in 31.2%.

CONCLUSIONS

The 'typical' cocaine-related suicide case was a male, aged in their early thirties, who was highly likely to be employed. The majority of cases used physical means, and a substantial minority were highly agitated and engaged in conflict prior to the fatal incident.

Suicide rates amongst individuals from ethnic minority backgrounds: A systematic review and meta-analysis

BACKGROUND

Existing evidence suggests that some individuals from ethnic minority backgrounds are at increased risk of suicide compared to their majority ethnic counterparts, whereas others are at decreased risk. We aimed to estimate the absolute and relative risk of suicide in individuals from ethnic minority backgrounds globally.

METHODS

Databases (Medline, Embase, and PsycInfo) were searched for epidemiological studies between 01/01/2000 and 3/07/2020, which provided data on absolute and relative rates of suicide amongst ethnic minority groups. Studies reporting on clinical or specific populations were excluded. Pairs of reviewers independently screened titles, abstracts, and full texts. We used random effects meta-analysis to estimate overall, sex, location, migrant status, and ancestral origin, stratified pooled estimates for absolute and rate ratios. PROSPERO registration: CRD42020197940.

FINDINGS

A total of 128 studies were included with 6,026,103 suicide deaths in individuals from an ethnic minority background across 31 countries. Using data from 42 moderate-high quality studies, we estimated a pooled suicide rate of 12·1 per 100,000 (95% CIs 8·4-17·6) in people from ethnic minority backgrounds with a broad range of estimates (1·2-139·7 per 100,000). There was weak statistical evidence from 51 moderate-high quality studies that individuals from ethnic minority groups were more likely to die by suicide (RR 1·3 95% CIs 0·9-1·7) with again a broad range amongst studies (RR 0·2-18·5). In our sub-group analysis we only found evidence of elevated risk for indigenous populations (RR: 2·8 95% CIs 1·9-4·0; pooled rate: 23·2 per 100,000 95% CIs 14·7-36·6). There was very substantial heterogeneity (I²  > 98%) between studies for all pooled estimates.

INTERPRETATION

The homogeneous grouping of individuals from ethnic minority backgrounds is inappropriate. To support suicide prevention in marginalised groups, further exploration of important contextual differences in risk is required. It is possible that some ethnic minority groups (for example those from indigenous backgrounds) have higher rates of suicide than majority populations.

FUNDING

No specific funding was provided to conduct this research. DK is funded by Wellcome Trust and Elizabeth Blackwell Institute Bristol. Matthew Spittal is a recipient of an Australian Research Council Future Fellowship (project number FT180100075) funded by the Australian Government. Rebecca Musgrove is funded by the NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC-2016-003).

Family and peer support moderates the relationship between distress tolerance and suicide risk in black college students

ObjectivesThe relationship between distress tolerance and suicide risk was examined in black college students, as well as the moderating role of family and peer support in this relationship. Parent and peer support were studied separately in their relationship to overall suicidality.MethodOne-hundred twenty-five Black undergraduate students completed self-report measures that assessed study variables.ResultsUsing moderation analyses, distress tolerance was significantly associated with overall suicidality, such that increased tolerance was associated with decreased risk. Higher family support was significantly associated with decreased suicide risk, while peer support was not. However, both family and peer support significantly moderated the relationship between distress tolerance and suicide risk. For both types of support, the relationship between distress tolerance and suicide risk was significant when support was low.ConclusionsSocial support appears to be an important protective factor for suicide risk in black college students.

Trends and instigators among young adolescent suicide in the United States

OBJECTIVES

The present investigation examined the role of factors involved in suicide ideation and suicide attempt using a nationally representative sample of US high school students.

METHODS

Data were collected from students in Grades 9-12 as part of the Youth Behavioral Survey (n = 11,328). Logistic regression models were used to examine factors associated with suicide ideation and suicide attempt. Variables included demographic characteristics (grade, sex, and race), psychosocial factors (physical fighting, sexual violence, sports participation, bullying, and electronic bullying), and substance use (cigarette usage, marijuana usage, and alcohol usage).

RESULTS

The factor most associated with suicide ideation was bullying (either electronic or physical), whereas the factor most associated with suicide attempt was sexual violence followed closely by physical bullying.

CONCLUSIONS

The multitude of instigators and commonality among gender, ethnicity, and socio-economic status give an indication of how to prevent suicide and who to target information regarding the hazards of suicide.

Alcohol and Cocaine Combined Substance Use on Adult Hypothalamic Neural Stem Cells and Neurogenesis

Many advancements have been made over the years looking at the individual and combined effects of drugs of abuse on the brain, with one key area of research focusing on the effects on neurogenesis. An integral part of fetal brain development and, later, maintenance in the adult brain, neurogenesis occurs in three main regions: subventricularzone of the lateral ventricles (SVZ), subgranularzone of the dentate gyrus (SGZ), and the tanycyte layer in the hypothalamus (TL). We will review current literature on combined drugs of abuse and their effect on adult neurogenesis. More specifically, this review will focus on the effect of combining cocaine and alcohol. Additionally, the tanycyte layer will be explored in more depth and probed to look at the neurogenic properties of tanycytes and their role in neurogenesis.

Physical and psychosocial factors associated with psychostimulant use in a nationally representative sample of French adolescents: Specificities of cocaine, amphetamine, and ecstasy use

PURPOSE

Patterns of psychostimulant (PST) use, psychological and physical factors, and family relationships were investigated in a nationally representative sample of adolescents. The differences between users of cocaine (Cc), ecstasy/MDMA, and amphetamine (EA) were analyzed, taking into account gender differences.

METHODS

Substance use, psychological factors (lifetime suicide attempts, suicidal thoughts in the previous year, visits to a mental health professional), physical factors (health and body shape perceptions (BSP), body mass index (BMI)), and family relationships (existence of disagreements with parents, relationships with mother and father) were investigated in 26,351 17-year-old French adolescents.

RESULTS

Lifetime suicidal behavior was strongly associated with EA use only. Suicidal ideation in the previous year was associated with Cc use among both boys and girls and associated with EA use among girls. Compared to Cc users, more EA users were overweight, while more Cc users were underweight compared to EA users. BSP, BMI, and EA use were related in girls only. Having a good or very good relationship with both mother and father was negatively associated with Cc use in boys and girls. Girls who had a good or very good relationship with their fathers seemed to be less prone to use EA. Boys with a good or very good relationship with their mothers seemed to be less prone to use EA.

CONCLUSION

The results of the present study could serve as a basis for prevention and harm reduction strategies/programs targeting youth use and for the adaptation of these strategies/programs according to substance and gender.

Examining the association between prescription opioid misuse and suicidal behaviors among adolescent high school students in the United States

Although some studies have examined the association between prescription opioid misuse and mental health outcomes, few studies have examined the effects of prescription opioid misuse on suicidal behaviors among adolescents. The objective of this study was to examine the association between prescription opioid misuse and suicidal ideation, suicide plan, and suicide attempt among adolescents. Data for this study came from the 2017 Youth Risk Behavior Surveillance System. A sample of 8830 adolescents aged 14-18 years (50.9% female) were analyzed using logistic regression with suicidal ideation, suicide plan, and suicide attempt as outcome variables and prescription opioid misuse as the main explanatory variable. Of the 8830 adolescents, 13.3% ever misused prescription opioids; 17.7% experienced suicidal ideation, 13.3% made a suicide plan, and 6.5% attempted suicide during the past 12 months. In the multivariate logistic regression models, adolescent students who misused prescription opioids were 1.50 times more likely to have experienced suicidal ideation, 1.44 times more likely to have made a suicide plan, and 1.58 times more likely to have attempted suicide during the past 12 months when compared to their counterparts who did not misuse prescription opioids. Other significant predictors of suicidal behaviors include sexual minority, history of sexual assault, traditional bullying and cyberbullying victimization, feeling sad or hopeless, cigarette smoking, and illicit drug use. The findings of the present study demonstrate the harmful effects of prescription opioid misuse and its association with suicidal behaviors among adolescents.

Factors Influencing Suicide Behaviours in Immigrant and Ethno-Cultural Minority Groups: A Systematic Review

This paper reviews recent literature on factors influencing suicide behaviours, including thoughts, plans, and attempts, in immigrant and ethno-cultural minority groups, to inform a more comprehensive understanding of suicide behaviours in increasingly culturally diverse populations. Thirty-three studies published between 2002 and 2013 were identified through digital databases searches and included in this review. Analysis of study findings focused on impacts of ethno-cultural identity and acculturation, other cultural and immigration influences, and family and community supports on suicide behaviours. Policy, practice, and research recommendations are identified, to inform relevant suicide prevention efforts and enhance mental health supports for immigrant and ethno-cultural minority populations.

How Illegal Drug Use, Alcohol Use, Tobacco Use, and Depressive Symptoms Affect Adolescent Suicidal Ideation: A Secondary Analysis of the 2011 Youth Risk Behavior Survey

The purpose of this study was to identify the major risk factors among adolescents who have either contemplated or attempted suicide. Along with successful suicides, suicide attempts and contemplation are coexisting factors that are prominent in the adolescent population and therefore warrant major concern. A secondary data analysis of the Youth Risk Behavior Survey (YRBS) was completed to explore the factors that may influence adolescents' thoughts or actions about suicidal behavior. The YRBS represents high-school students throughout 50 states. Nine questions from the YRBS were used to elicit information about the relationships among the risk factors: (1) Suicidal thoughts and attempts; (2) illegal drug use; (3) alcohol use; (4) tobacco use; and (5) depressive symptoms. Statistically significant relationships among the risk factors were found for adolescents. Adolescents considered suicide (15.8%); attempted suicide at least once (7.8%); were injured while attempting suicide (n = 2.7%). Our findings support the idea that illegal substance use can lead to suicidal thoughts and actions. Depression had a positive relationship with suicidal ideations, supporting similar studies suggesting that depression leads to suicidal action.

Suicidal ideation and sex differences in relation to 18 major psychiatric disorders in college and university students: anonymous web-based assessment

College/university students are at high risk for psychiatric disorder and suicide secondary to age, campus stressors, and social pressures. We therefore report frequencies of 18 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision disorders and suicidal ideation (SI) acquired anonymously from a Web site receiving 113,181 visits from more than 1,500 predominantly US colleges/universities. Depression was foremost, followed by social phobia and eating disorders. Substance-related disorders were less frequent than expected. SI occurred in 47.1% of students, with women evidencing somewhat stronger findings than men. SI was more associated with substance, bipolar, and panic disorders than depression. Self-reported emotional volatility exceeded thoughts of self-harm for all disorders. The results support two subtypes of suicide risk: dysphoric premeditators and those primarily angry and/or impulsive. Clinicians and researchers should therefore consider suicide as an independent psychopathological phenomenon that includes emotional volatility as a risk factor and thoroughly evaluate psychiatric disorders potentially conferring greater suicidal propensity than depression.

Perceived racism and suicide ideation: mediating role of depression but moderating role of religiosity among African American adults

Suicide is a public health problem for African Americans who are young and of working age. The purpose of this study was to examine mediated and moderated effects of perceived racism on suicide ideation in a community sample of 236 African American men and women. Measures of suicide ideation, depression symptoms, intrinsic/extrinsic religiosity, and perceived racism were administered. Perceived racial discrimination was directly and indirectly associated with suicide ideation. For participants who reported low levels of extrinsic religiosity, the mediated effect of perceived racism (via depression symptoms) was significant. These findings provide some insight into suicide vulnerability for specific subgroups of African Americans.

Implementing a mental health ministry committee in faith-based organizations: the promoting emotional wellness and spirituality program

Social workers have successfully collaborated with African-American faith-based organizations to improve health outcomes for numerous medical conditions. However, the literature on Faith-Based Health Promotion for major depression is sparse. Thus, the authors describe a program used to implement a Mental Health Ministry Committee in African-American churches. Program goals are to educate clergy, reduce stigma, and promote treatment seeking for depression. Key lessons learned are to initially form partnerships with church staff if there is not a preexisting relationship with the lead pastor, to utilize a community-based participatory approach, and to have flexibility in program implementation.

A complex interplay between personality domains, marital status and a variant in CHRNA5 on the risks of cocaine, nicotine dependences and cocaine-induced paranoia

Background

Personality correlates highly with both cocaine and nicotine dependencies (CD, ND), and their co-morbid psychopathologies. However, little is known about the nature of these relationships. This study examined if environment (marriage) or genetics (a single SNP, CHRNA5*rs16969968) would moderate the correlation of personality with CD, ND and cocaine-induced paranoia (CIP) in African and European Americans (AAs, EAs).

Methods

1432 EAs and 1513 AAs were examined using logistic regression. Personality was assessed by NEO-PI-R, while CD, ND and CIP were diagnosed according to DSM-IV. ND and CD were examined as binary traits and for the analysis of CIP, subjects were divided into 3 groups: (A) Controls with no CIP; (B) CD cases without CIP; and (C) CD cases with CIP. Multiple testing was Bonferroni-corrected.

Results

For CD and ND in the EA population, marital status proved to be a significant moderator in their relationship with openness only (OR = 1.90, 95%CI = 1.36–2.64, p = 1.54e-04 and OR = 2.12, 95%CI = 1.52–2.90, p = 4.65e-06 respectively). For CIP, marriage was observed to moderate its correlation with openness and neuroticism (OR = 1.39, 95%CI = 1.18–1.63, p = 7.64e-04 and OR = 1.26, 95%CI = 1.12–1.42, p = 1.27e-03 respectively). The correlations moderated by rs16969968 were those of conscientiousness and CD (OR = 1.62, 95%CI: 1.23–2.12, p = 8.94e-04) as well as CIP (OR = 1.21, 95%CI: 1.11–1.32, p = 4.93e-04 when comparing group A versus group C). No significant interactions were observed in AA population. The Bonferroni-corrected significance threshold was set to be 1.67e-03.

Conclusion

The role of personality in CD and CIP may be interceded by both environment and genetics, while in ND by environment only.

Risk Factors for Suicidal Ideation Among African American and European American College Women

Given that suicide is the second leading cause of death among college students, it is important to identify risk factors that may contribute to college students’ suicide. Our study examined the differences in risk factors of suicidal ideation between 99 African American and 529 European American college women (18–24 years old). The only significant difference that was reported between the two groups of women was on hopelessness, with African American women having lower hopelessness scores. In hierarchical regression analyses, reports of hopelessness, depression, and perceived burdensomeness, but not thwarted belongingness, significantly predicted suicidal ideation in college women. Furthermore, race moderated the relationship between hopelessness and suicidal ideation such that hopelessness was a stronger predictor for African American women than it was for European American women. Race also moderated the depression–suicidal ideation association, with depression emerging as a stronger predictor of suicidal ideation for European American than for African American women. When assessing risk for suicide, our results suggest that practitioners may need to focus more on hopelessness in African American women and more on depression in European American women while also considering perceived burdensomeness in college women regardless of race. In addition to assessment, prevention programs which target these identified risk factors for suicidality should be developed specifically for African American and European American college women.

Substance abuse and suicide risk among adolescents

The aim of this paper was to review the literature concerning the relationship between suicide and substance abuse behaviours among adolescents, focusing on epidemiology, comorbidity and preventive programmes. We performed a Pubmed/Medline, Scopus, PsycLit and PsycInfo search to identify all papers and book chapters during the period between 1980 and 2011. Adolescents with substance abuse disorder who attempt or complete suicide can be characterized as having mood disorders, stressful life events, interpersonal problems, poor social support, lonely lives and feelings of hopelessness. The research supports the existence of a strong relationship between suicide and substance abuse. Preventive programmes should be based on the detection of risk factors associated with both suicide and substance abuse disorder. Management programmes should combine different therapeutic strategies such as peer-to-peer education, school-based programmes, psychotherapy and pharmacological treatment. Evidence suggests that targeted suicide prevention programmes can be delivered which reduce the burden associated with substance abuse and suicide in youths.

A longitudinal study of risk factors for incident drug use in adults: findings from a representative sample of the US population

OBJECTIVE

To examine baseline mental disorders and other correlates among people who have not previously used drugs as potential risk factors for incident drug use at 3-years' follow-up.

METHOD

Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (commonly referred to as the NESARC) Wave 2 (2004 to 2005; n = 34 653), a longitudinal nationally representative survey of mental illness in community-dwelling adults. The study group consisted of people who reported no history of any illicit drug use or prescription drug misuse at Wave 1 (2001 to 2002). Logistic regression analyses were used to compare people with first-episode drug use at Wave 2 (n = 1145) to those who remained abstinent (n = 25 790) across various Wave 1 correlates, including sociodemographic factors, mental disorders (including alcohol use disorders and nicotine dependence), childhood adversity, and family history of substance use disorders.

RESULTS

All measures of childhood adversity were associated with an increased risk of incident drug use, as were alcohol or drug problems in first-degree relatives. In models adjusted for childhood adversity and a family history of addiction, a pre-existing mood disorder (AOR 1.31; 95% CI 1.04 to 1.64), personality disorder (AOR 1.82; 95% CI 1.50 to 2.20), previous nicotine dependence (AOR 1.41; 95% CI 1.09 to 1.83), and alcohol abuse or dependence (AOR 1.96; 95% CI 1.48 to 2.60) were independently associated with new-onset drug use at follow-up.

CONCLUSIONS

Specific mental disorders independently increase the risk of progression to incident drug use among people who were previously abstinent. Early-life adversities and addiction in family members accounts for some, but not all, of this observed relation.

Alcohol and drug use in suicidal behaviour

PURPOSE OF REVIEW

To present a summary of estimates of the risk of suicidal behaviour (ideation, plan and attempt) among those with substance use disorders in the general population and risk estimates for those with acute alcohol and drug consumption (intoxication) immediately prior to a suicide attempt.

RECENT FINDINGS

In Mexico and elsewhere studies have emerged on the risk of suicidal behaviour among those with substance use disorders that are not affected by treatment selection bias or by psychiatric comorbidity. In developed and developing groups of nations, alcohol use disorders were associated with increased odds ratio (OR) of ideation (range 2.0-2.5) and attempt (2.6-3.7), whereas drug use disorders were associated with increased risk of ideation (2.3-3.0) and attempt (2.0-4.0). Follow-up studies of general population samples reported an OR for drug use disorders from 1.9 to 3.7 for ideation, and an OR of 3.0 for attempt. Alcohol dependence increased suicide ideation with an OR of 1.5. Those drinking alcohol prior to the suicide attempt had ORs in the range of 6.2-9.6. This increase may have a dose-response relationship. We found no studies providing risk estimates for drug use prior to a suicide attempt.

SUMMARY

Current evidence points to a causal role of alcohol and drug use disorders exerting a distal effect on suicidal behaviour. Evidence for the proximal role of alcohol and drug use, as triggers of suicidal behaviour, are still very limited in number, analytical techniques and scope of substances other than alcohol.

Health consequences of illegal drug use

PURPOSE OF REVIEW

The aim of this article is to review recent research on the health consequences of illegal drug use and possible risk factors, with a particular focus on prospective evidence.

RECENT FINDINGS

Mortality studies have revealed qualitative and quantitative changes in causes of death among heroin and injecting drug users (IDUs), probably due to increasing exposure to harm reduction programs, the introduction of highly active antiretroviral therapy (HAART), the aging of drug users, and rising concurrent use of illegal drugs and prescription drugs. For morbidity, nonfatal overdose is still one of the most important concerns; likewise the higher prevalence of hepatitis C among non-IDUs and hepatitis A, B, C coinfection. Cannabis use has been consistently reported to be associated with the emergence of psychotic symptoms, yet that seems not to be the case for anxiety and depressive disorders. Use of 3,4 methylenedioxymethamphetamine (MDMA) has been linked with short-term negative effects on cognitive performance (i.e. visual memory). A series of longitudinal studies have shown enduring unfavorable effects of prenatal cocaine and marijuana exposure on children's physical, cognitive, and language development.

SUMMARY

Prospective evidence on illegal drug use in particular subpopulations may be needed to better understand health problems among users at different life stages and the possible long-term effects.

Depression, desperation, and suicidal ideation in college students: results from the American Foundation for Suicide Prevention College Screening Project at Emory University

The objective of this investigation was to examine suicidal ideation and depression in undergraduate college students who participated in the American Foundation for Suicide Prevention-sponsored College Screening Project at Emory University. The principal measure of depressive symptoms was the nine-item depression module from the Patient Health Questionnaire (PHQ-9). Additional questions were focused on current suicidal ideation, past suicide attempts, and episodes of deliberate self-harm and on symptoms of anxiety and distress. Seven hundred and twenty-nine students participated over a 3-school-year interval (2002-2005). Most notably, 11.1% of the students endorsed current (past 4 weeks) suicidal ideation and 16.5% had a lifetime suicide attempt or self-injurious episode. Students with current suicidal ideation had significantly higher depression symptom severity than those without suicidal ideation (t = -9.34, df = 706, P<.0001, d = 1.9), and 28.5% of the students with PHQ-9 scores of 15 or higher reported suicidal ideation compared to 5.7% of those with lower scores (chi(2) = 56.29, df = 1, P<.0001, two-tailed). Suicidal ideation was prominently associated with symptoms of desperation (odds ratio 2.6, 95% CI 1.5-4.6, P<.001). The vast majority of students with moderately severe to severe depression (85%) or current suicidal ideation (84%) were not receiving any psychiatric treatment at the time of assessment. These results suggest that there is a strong relationship between severity of depressive symptoms and suicidal ideation in college students, and that suicidal feelings and actions are relatively common in this group. This underscores the need to provide effective mental health outreach and treatment services to this vulnerable population. As this analysis was based on data collected at a single institution, the results may not be representative of all college students or young adults.