The role of drugs and alcohol in urban minority adolescent suicide attempts

Substance use-related suicide after release from correctional, behavioral health, and healthcare facilities using national violent death reporting system data

INTRODUCTION

Suicide and substance use are prevalent problems among persons discharged from facilities. This study (1) articulated rates of substance-related suicide deaths among those discharged correctional, behavioral health, and healthcare facilities, and (2) identified factors associated with substance-related suicide deaths unique to, or generalizing across, facility discharge.

METHODS

We used data from the National Violent Death Reporting System. Suicide deaths (N = 105,968) were aggregated from 2003 to 2017. Chi-square and independent samples t-tests were used to examine associations between drug/alcohol-related deaths and each correlate. Logistic regression was employed to identify the most robust substance-related suicide death-related factors.

RESULTS

Suicide deaths were commonly marked as being substance-related: 69% from correctional institutions, 54% from behavioral health facilities, 45% from those not released from a facility, and 39% from healthcare facilities. Regression models indicated housing interruptions and interpersonal stressors increased odds of the suicide death being marked as substance-related across discharge categories. Each discharge category also had unique predictors, underscoring the need for tailored prevention.

CONCLUSIONS

Substance-related suicide deaths are particularly common among adults discharged from correctional and behavioral health facilities. Findings are discussed with respect to community-focused, discharge planning, and clinical care suicide prevention strategies.

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

BACKGROUND

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

OBJECTIVE

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

PARTICIPANTS AND SETTING

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Suicidal Ideation among Youth Living in the Slums of Kampala, Uganda

The purpose of this study is to examine the factors associated with suicidal ideation among youth living in the slums of Kampala, Uganda. Analyses are based on cross-sectional survey data, collected in 2014, of a convenience sample (n = 1134) of urban service-seeking youth participating in a Uganda Youth Development Link drop-in center. Logistic regression analyses were computed to determine the psychosocial factors associated with suicidal ideation. Among youth participants, 23.54% (n = 266) reported suicidal ideation in the past year. In the multivariable analysis, suicidal ideation was associated with being female (OR: 1.61; 95% CI: 1.15, 2.25), reporting one (OR: 1.51; 95% CI: 1.05, 2.18) or two deceased parents (OR: 1.55; 95% CI: 1.03, 2.35), ever living on the streets (OR: 2.65; 95% CI: 1.86, 3.79), problem drinking (OR: 1.83; 95% CI: 1.19, 2.80), sexually transmitted infection (OR: 1.59; 95% CI: 1.14, 2.21), ever being raped (OR: 1.49; 95% CI: 1.01, 2.20), and experiencing physical child abuse (OR: 2.40; 95% CI: 1.75, 3.27). Our findings underscore many unmet needs in this vulnerable population. However, strategies that specifically seek to address problem drinking—a modifiable risk factor for suicidal ideation—may be particularly warranted in this low-resource setting.

Examining the Complexities of Suicidal Behavior in the African American Community

Once considered a “White thing,” suicide is now the third leading cause of death for African Americans, behind only homicide and unintentional injury. Although the rates of suicide for African American women remain low and relatively unchanged, the rates for African American men have increased dramatically during the past 20 years. The changes in the suicide rates for African American youth have motivated researchers to investigate protective and risk factors associated with suicide. In light of some of the current findings that identify religious participation as a protective factor against suicide for African Americans, an alternative perspective is provided that examines the contribution of spirituality and specific religious practices on gender differences in suicide risk.

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

The goal of this investigation was to determine whether cocaine and ethanol use was a differentiating factor between African American and white teenage suicide victims. This is a retrospective analysis of medical examiner's records of all completed suicides in Fulton County, GA from 01/1989 to 12/2003, and included 1296 cases. There were 79 suicide victims aged 19 and younger during the study interval, and of this group, 49 (62%) were African American, 26 (33%) were white, and 4 (5%) other race, compared to adults (20 years) where 28.5% were African American, 68.6% white and 2.9% other race (chi(2)=42.678, d.f.=2, p<0.0001). Of the black teenaged victims, 82.2% had no cocaine or alcohol detected at autopsy, while 41.7% of the white victims were positive for one or both substance (chi(2)=4.633, d.f.=1, p=0.04). Only 8.9% of the black teenage suicide victims had used cocaine prior to death compared to 28% of the whites (chi(2)=4.432; d.f.=1; p<0.04). The suicide rate (suicide/100,000/year) for black teens was 5.48 compared to 4.16 for whites, but the rate of cocaine positive teen suicides was 1.12 for whites and 0.45 for blacks. The pattern of cocaine use changes dramatically in the adult group, with 27% of African American suicide victims compared to 7.7% of whites being positive (chi(2)=73.272; d.f.=1; p<0.001). Use of intoxicating substances does differentiate teenage suicide victims, as only a small proportion of black teenagers had used cocaine or alcohol prior to death compared to almost half of all whites.

Impact of Familial Factors and Psychopathology on Suicidality Among African American Adolescents

Racial differences in familial factors, psychopathology, perceptions of social support, and socioeconomic status were examined in a matched sample of African American and White suicidal adolescents (N = 90) during a psychiatric hospitalization. Exploratory analyses suggest that significant differences were found in family support and its association with psychopathology, but most noteworthy were the many similarities between the two adolescent groups. The results presented in this study represent new knowledge on the characteristics of African-American adolescents at high risk of suicidal behavior, and replace conventional wisdom with empirical knowledge about an aspect of human behavior for this population. Implications for social work practice, suicide prevention, and future research are discussed.

Adolescent Substance Use and Suicidal Behavior: A Review With Implications for Treatment Research

Adolescent substance use (alcohol and other drugs) and suicidal behavior, independently, pose serious public health problems. Youths who report co-occurring substance use and suicidality are a particularly high-risk group. In this review, we explore four areas that are pertinent to research with substance-abusing and suicidal adolescent populations. First, we review epidemiological research that is relevant to the association between substance use and suicidal behavior. Results suggest that substance use heightens statistical risk for suicidal behavior in adolescent clinical and community populations. Alcohol intoxication may serve as a proximal risk factor for suicidal behavior among distressed youths through its psychopharmacological effects on the brain. Substance use may also serve as a distal risk factor for suicidal behavior by increasing stress and exacerbating co-occurring psychopathology. Second, we propose different theoretical models that might explain the high rates of co-occurring substance use and suicidal behavior among adolescents. Substance use may stem from an underlying syndrome of problem behavior among impulsive suicide attempters with predominant externalizing symptoms. In contrast, nonimpulsive suicide attempters with predominant internalizing symptoms may use substances to cope with negative affective states. Third, we explore the status of treatment research with substance abusing and suicidal adolescent populations. Studies of substance abuse treatment and suicidal behavior have neither adequately assessed nor incorporated treatment of the other co-occurring problem. Finally, we conclude with proposed directions for future research, including the development of integrated interventions tailored to adolescents with these co-occurring problems.

Substance use and suicidal conduct: a study of adolescents hospitalized for suicide attempt and ideation

AIM

To study the prevalence of psychoactive substance use disorder (PSUD) among suicidal adolescents, psychoactive substance intoxication at the moment of the attempt, and the association between PSUD at baseline and either occurrence of suicide or repetition of suicide attempt(s).

METHODS

186 adolescents aged 16 to 21 y hospitalized for suicide attempt or overwhelming suicidal ideation were included (T0); 148 of them were traced again for evaluations after 6 mo (T1) and/or 18 mo (T2). DSM-IV diagnoses were assessed each time using the Mini International Neuropsychiatric Interview.

RESULTS

At T0, 39.2% of the subjects were found to have a PSUD. Among them, a significantly higher proportion was intoxicated at the time of the attempt than those without PSUD (44.3% vs 25.4%). Among the 148 adolescents who could be traced at either T1 or T2, two died from suicide and 30 repeated suicide attempts once or more times. A marginally significant association was found between death by suicide/repetition of suicide attempt and alcohol abuse/dependence at baseline (OR=3.3, 95% CI 0.7-15.0; OR=2.6, 95% CI 0.7-9.3). More than one suicide attempt before admission to hospital at T0 (OR=3.2, 95% CI 1.1-10.0) and age over 19 y at T0 (OR=3.2, 95% CI 1.1-9.2) were independently associated with the likelihood of death by suicide or repetition of suicide attempt.

CONCLUSION

Among adolescents hospitalized for suicide attempt or overwhelming suicidal ideation, the risk of death or repetition of attempt is high and is associated with previous suicide attempts--especially among older adolescents--and also marginally associated with PSUD; these adolescents should be carefully evaluated for such risks and followed up once discharged from the hospital.

Negative life events associated with deliberate self-harm in an African population in Uganda

Negative life events associated with deliberate self-harm (DSH) were investigated in an African context in Uganda. Patients admitted at three general hospitals in Kampala, Uganda were interviewed using a Luganda version (predominant language in the study area) of the European Parasuicide Study Interview Schedule I. The results of the life events and histories module are reported in this paper. The categories of negative life events in childhood that were significantly associated with DSH included those related to parents, significant others, personal events, and the total negative life events load in childhood. For the later-life time period, the negative life events load in the partner category and the total negative life events in this time period were associated with DSH. In the last-year time period, the negative life events load related to personal events and the total number of negative life events in this time period were associated with DSH. A statistically significant difference between the cases and controls for the total number of negative life events reported over the entire lifetime of the respondents was also observed, which suggests a dose effect of negative life events on DSH. Gender differences were also observed among the cases. In conclusion, life events appear to be an important factor in DSH in this cultural environment. The implication of these results for treatment and the future development of suicide interventions in this country are discussed.

Social environment factors associated with suicide attempt among low-income African Americans: the protective role of family relationships and social support

BACKGROUND

Suicide and suicide attempts are important public health concerns, and recent decades have witnessed a rising rate of suicide among African Americans. A history of prior attempts is a leading risk factor for completed suicide. Further research is needed into the social environment risk factors for suicide attempt among African Americans. This study focused on two important dimensions of the social environment, family relationships and social support, as well as an important person-level risk factor--depressive symptoms.

METHOD

Data were obtained from a case-control study of 200 African American men and women aged 18-64 years, who sought services at a large, urban, public hospital. Odds ratios adjusted for significant sociodemographic differences between groups (aORs) were calculated for environment risk factors for suicide attempt among the cases and controls. The role of depressive symptoms was also studied.

RESULTS

Lower levels of family adaptability and family cohesion increased the relative rate of suicide attempt in the sample. The aOR associated with the lowest quartile of family adaptability was 3.90, and the aORs associated with the first and second quartiles of family cohesion were 8.91 and 5.51, respectively. Lower levels of social embeddedness and social support increased the relative rate of suicide attempt in our sample. The aOR associated with the first and second quartiles of social embeddedness were 5.67 and 4.93, respectively, and the aOR associated with the lowest quartile of social support was 6.29. A mediating role of depression was discovered when depressive symptoms were entered into the logistic regression models.

CONCLUSIONS

Our findings indicate that social environment factors including deficits in family functioning and social support are associated strongly with suicide attempts among low-income African American men and women seeking treatment in a large, urban hospital. Thus, better family functioning and social supports can be considered protective factors in this population. The presence of depressive symptoms, a well-known risk factor for suicide attempts and suicide, appears to mediate the association between social environment factors and suicide attempt.

Uncovering the mystery: factors of African American suicide

Traditionally, African Americans have registered lower rates of suicide than other ethnic groups. In the last 20 years this pattern has changed, particularly among young African Americans. To date, the research conducted regarding this phenomenon has been limited for a variety of reasons and previous research has been inconclusive in determining risk factors of African American suicide. The purpose of this paper is to identify risk and protective factors specific to African American suicide. To determine the factors, the 1993 National Mortality Follow-back Survey was analyzed. The risk factors identified include being under age 35, southern and northeastern residence, cocaine use, firearm presence in home, and threatening others with violence. Some of the protective factors associated with African American suicide include rural residence and educational attainment. These results provide valuable information about completed African American suicides in relation to Whites. Several of these factors are unique to African Americans.

Reducing Substance Use Among African American Adolescents: Effectiveness of School-Based Health Centers

This paper explores the impact of school-based heath centers (SBHCs) on the substance use behaviors of low-income, inner-city African American adolescents. Researchers surveyed 2,114 9th- and 11th-grade students from seven inner-city public high schools (three with SBHCs and four without SBHCs). Of the initial 2,114 students, 598 SBHC students and 598 non-SBHC students were successfully matched using ethnicity, grade, gender, and propensity scores. The results of separate grade × gender × SBHC ANOVAs indicated significant grade × SBHC interactions (i.e., such that substance use decreased in SBHC schools while increasing in non-SBHC schools) for cigarettes (p = .05) and marijuana (p< .001), but not for alcohol. These findings show that the SBHC intervention model is promising toward the prevention and reduction of substance use among high-risk African American adolescents and highlight the importance of accessible, holistic, and culturally appropriate health care.

Adolescent substance abuse and suicide

Rates of adolescent suicide have increased significantly in the last five decades as have rates of adolescent substance abuse. However, the relationship between substance abuse and adolescent suicide is unclear. To better understand this relationship, a literature review that focused on the role of substance abuse in adolescent suicide was performed. The results of this review are discussed in this article. The most important risk factors for completed and attempted suicide are mental disorders (mood disorders and disruptive behavior disorders) and substance abuse [Brent, 1995: Suicide Life-Threatening Behav 25:52-63]. Furthermore, family history, social factors, and the presence of firearms in the home may contribute significantly to the risk for suicide. More research is needed in this area particularly with regard to cultural issues, substance abuse, and suicide.