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Brewer K, Mantey DS, Thomas PB, Romm KF, Kong AY, Alexander AC. Identifying disparities in suicidal thoughts and behaviors among US adolescents during the COVID-19 pandemic. Prev Med 2023; 177:107791. [PMID: 38035944 PMCID: PMC10842713 DOI: 10.1016/j.ypmed.2023.107791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Suicidal thoughts and behaviors (STBs) became more common among racial and ethnic minorities and sexual and gender minorities (SGM) during the COVID-19 pandemic relative to White and non-SGM adolescents. This study examines associations between pandemic-related stressors and STBs among a nationally representative sample of adolescents to identify vulnerable subpopulations. METHODS We analyzed data from 6769 high school students using the 2021 Adolescent Behaviors and Experiences Survey. Pandemic-related stressors were assessed via seven items related to negative experiences (e.g., parent job loss; food insecurity) during the COVID-19 pandemic. Logistic regression analyses estimated the association between pandemic-related stressors and four outcomes: (1) sadness/hopelessness; (2) suicidal ideation; (3) suicide planning; and (4) recent suicide attempt (i.e., past 12 months). Interactions were modeled by sex, race/ethnicity, and sexual identity. RESULTS A greater number of pandemic-related stressors was associated with higher odds for sadness and hopelessness (aOR: 1.55; 95% CI:1.44-1.67), suicidal ideation (aOR: 1.48; 95% CI:1.39-1.57), suicide planning (aOR:1.47; 95% CI: 1.36-1.59), and recent suicide attempt (aOR: 1.64; 95% CI:1.42-1.88). Pandemic-related stressors were also more strongly associated with some types of STBs in males (relative to females) and SGM females (relative to heterosexual females). CONCLUSION Study findings indicate that pandemic-related stressors are associated with STBs within the US adolescent population, particularly among male and SGM female adolescents. Researchers are encouraged to use this knowledge to ensure nationwide suicide prevention efforts adequately address inequities in suicide risk.
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Affiliation(s)
- Khandis Brewer
- TSET Health Promotion Research Center, Stephenson Cancer Center, the University of Oklahoma Health Science Centers, Oklahoma City, OK, USA
| | - Dale S Mantey
- Department of Health Promotion & Behavioral Sciences, the University of Texas Health Science Center, School of Public Health, Austin, TX, USA; Department of Epidemiology, Human Genetics, & Environmental Sciences, the University of Texas Health Science Center, School of Public Health, Austin, TX, USA; Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health Austin Campus, Austin, TX, USA
| | - Priya B Thomas
- Department of Epidemiology, Human Genetics, & Environmental Sciences, the University of Texas Health Science Center, School of Public Health, Austin, TX, USA
| | - Katelyn F Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center, the University of Oklahoma Health Science Centers, Oklahoma City, OK, USA; Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Amanda Y Kong
- TSET Health Promotion Research Center, Stephenson Cancer Center, the University of Oklahoma Health Science Centers, Oklahoma City, OK, USA; Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Adam C Alexander
- TSET Health Promotion Research Center, Stephenson Cancer Center, the University of Oklahoma Health Science Centers, Oklahoma City, OK, USA; Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Kahn GD, Wilcox HC. Marijuana Use Is Associated With Suicidal Ideation and Behavior Among US Adolescents at Rates Similar to Tobacco and Alcohol. Arch Suicide Res 2022; 26:520-533. [PMID: 32780674 PMCID: PMC7876158 DOI: 10.1080/13811118.2020.1804025] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study used data from the National Youth Risk Behavior Survey to examine the association between adolescent marijuana, tobacco, and alcohol use and suicidal ideation and attempts over a period of six years (2011-2017), as attitudes and laws became more permissive of marijuana use. We used logistic regression to control for possible confounders, estimate marginal prevalence ratios (PR's), and assess changes over time. Marijuana was more strongly associated with suicide attempts than ideation, and more frequent use was associated with significantly greater risk. The effect has not changed substantively since 2011, despite changing attitudes toward marijuana. Marijuana is broadly comparable to other substances: results for tobacco were similar, though frequent alcohol use had a significantly stronger association than other substances.
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Gilreath TD, Dangerfield DT, Montiel Ishino FA, Hill AV, Johnson RM. Polytobacco use among a nationally-representative sample of black high school students. BMC Public Health 2021; 21:206. [PMID: 33485321 PMCID: PMC7824955 DOI: 10.1186/s12889-021-10228-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background Studies of the patterns of polytobacco use have increased. However, understanding the patterns of using multiple tobacco products among Black adolescents is minimal. This study identified the patterns of polytobacco use among U.S. Black adolescents. Methods Latent class analysis (LCA) was used to identify patterns of adolescent polytobacco use among a representative sample of Black youth from the 2017 Youth Risk Behavior Survey (n = 2782). Ever and recent (past 30 day) use of cigarettes, electronic cigarettes, cigars, and dip or chewing tobacco were used as latent class indicators. Multinomial regression was conducted to identify the association if smoking adjusting for sex, age, grade, and marijuana use. Results Most students were in the 9th grade (29%), e-cigarette users (21%) and were current marijuana users (25%). Three profiles of tobacco use were identified: Class 1: Non-smokers (81%), Class 2: E-cigarette Users (14%), and Class 3: Polytobacco Users (5%). Black adolescent Polytobacco users were the smallest class, but had the highest conditional probabilities of recent cigarette use, e-cigarette use, ever smoking cigars or chewing tobacco. Ever and current use of marijuana were associated with increased odds of being in the e-cigarette user versus non-smoker group, and current marijuana use was associated with increased odds of polytobacco use (aOR = 24.61, CI = 6.95–87.11). Conclusions Findings suggests the need for targeted interventions for reducing tobacco use and examining the unique effects of polytobacco use on Black adolescents. Findings confirm a significant association of marijuana use with tobacco use.
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Affiliation(s)
- Tamika D Gilreath
- Department of Health & Kinesiology, College Station, Texas A & M University, 267 Gilchrist, 4243 TAMU, College station, TX, 77843-4243, USA.
| | | | - Francisco A Montiel Ishino
- Division of Intramural Research, National Institute for Minority Health Disparities, Bethesda, MD, 20892, USA
| | - Ashley V Hill
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Xiao Y, Romanelli M, Lindsey MA. A latent class analysis of health lifestyles and suicidal behaviors among US adolescents. J Affect Disord 2019; 255:116-126. [PMID: 31150941 DOI: 10.1016/j.jad.2019.05.031] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/31/2019] [Accepted: 05/18/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Previous studies have documented the link between individual health behaviors and suicide, but little is known about the influence of health lifestyles on suicide among adolescents. This study aims to identify the unobserved patterns of health behaviors and to examine their associations with adolescent suicidal behaviors to inform screening of suicidality. METHODS Data were derived from a nationally representative sample of adolescents (n = 14,506, ages 12-18, 50.9% female) in the national school-based 2017 Youth Risk Behavior Survey. Latent class analysis was performed based on 13 health behaviors related to diet (e.g., frequency of consuming breakfast, fruits/vegetables, soda), physical activity (frequencies of physical activity, sports team participation), sleep, and media use (TV/computers). Suicidal behaviors were measured by three dichotomized variables, including suicidal ideation, plan, and attempts. Multivariate logistic regressions were used to examine associations between identified classes and suicidal behaviors. RESULTS Four classes of health lifestyles were identified. Class 1 (23.6%) consistently engaged in health-promoting behaviors, including eating breakfast daily, high intake of fruits/vegetables, physically active, and infrequent use of TV/computers. Class 2 (37.7%) had an irregular diet, moderate exercise, and high computer use. Class 3 (31.8%) had moderate diet, frequent exercise, and moderate sleep. Class 4 (6.9%) had the lowest engagement in health-promoting behaviors. Class 4 had higher odds of suicide plan than Class 1 (OR = 1.50, 95% CI = 1.10-2.05). Notably, Class 2 and 3 were less likely to attempt suicide than Class 1 (OR = 0.74, 95% CI = 0.57-0.95 for Class 2; OR = 0.65, 95% CI = 0.48-0.89 for Class 3). LIMITATIONS Due to the cross-sectional design, no causal inference can be drawn. CONCLUSIONS Both Class 1 (consistent) and Class 4 (lowest) engagement in health-promoting behaviors were associated with increased suicidal behaviors. Suicide prevention efforts that examine both lifestyles are keys to early detection of suicidal ideation and plans, and prevention of suicide attempts.
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Affiliation(s)
- Yunyu Xiao
- Silver School of Social Work, New York University, New York, USA; McSilver Institute for Poverty Policy and Research, New York, USA.
| | - Meghan Romanelli
- Silver School of Social Work, New York University, New York, USA; McSilver Institute for Poverty Policy and Research, New York, USA
| | - Michael A Lindsey
- Silver School of Social Work, New York University, New York, USA; McSilver Institute for Poverty Policy and Research, New York, USA
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Hajebi A, Abbasi-Ghahramanloo A, Hashemian SS, Khatibi SR, Ghasemzade M, Khodadost M. Risk-taking behaviors and subgrouping of suicide in Iran: A latent class analysis of national registries data. Psychiatry Res 2017; 255:355-359. [PMID: 28609673 DOI: 10.1016/j.psychres.2017.05.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 04/14/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Abstract
Suicide is one the most important public health problem which is rapidly growing concerns. The aim of this study was to subgroup suicide using LCA method. This cross-sectional study was conducted in Iran based on 66990 records registered in Ministry of Health in 2014. A case report questionnaire in the form of software was used for case registries. Latent class analysis was used to achieve the research objectives. Four latent classes were identified; (a) Non-lethal attempters without a history of psychiatric disorders, (b) Non-lethal attempters with a history of psychiatric disorders, (c) Lethal attempters without a history of psychiatric disorders, (d) Lethal attempters with a history of psychiatric disorders. The probability of completed/an achieved suicide is high in lethal attempter classes. Being male increases the risk of inclusion in lethal attempters' classes (OR = 4.93). Also, being single (OR = 1.16), having an age lower than 25 years (OR = 1.14) and being a rural citizen (OR = 2.36) associate with lethal attempters classes. The males tend to use more violent methods and have more completed suicide. Majority of the individuals are non-lethal attempters who need to be addressed by implementing preventive interventions and mental support provision.
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Affiliation(s)
- Ahmad Hajebi
- Research Center for Addiction & Risky Behaviors (ReCARB), Psychiatric Department, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Abbasi-Ghahramanloo
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran; Department of Epidemiology, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran
| | | | - Seyed Reza Khatibi
- Department of Epidemiology, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran; Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Masomeh Ghasemzade
- Mental & Social Health and Addiction Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Mahmoud Khodadost
- Department of Epidemiology, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran; Department of Epidemiology, Faculty of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Abstract
Although Black Americans have lower prevalence of depression compared to non-Hispanic Whites (10% vs. 17%), they are nearly twice as likely to have worse outcomes. One contributor to poor depression outcomes involves the ways in which Black Americans seek help for depression. However, little is known about depression help-seeking behavior, and the use of multiple sources of help, among Black Americans. This study used latent class analysis to identify unique constellations of depression help seeking, from multiple sources, among African American and Black Caribbeans. Results indicated four profiles of depression help seeking including Informal/Primary Care Utilizers (41.4%), Formal Mental Health Utilizers (40.6%), All Support Utilizers (9.8%), and Mixed Source Utilizers (8.2%). The constellation of each profile and demographic differences in class assignment are discussed. Results have implications for tailored depression interventions for Black Americans including community-based psychoeducation and cultural competence training for mental health providers.
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Tempier R, Guérin E. Tobacco smoking and suicidal thoughts and attempts: Relationships from a general population survey. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2015. [DOI: 10.1016/j.cegh.2014.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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School victimization and substance use among adolescents in California. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2015; 15:897-906. [PMID: 24482139 DOI: 10.1007/s11121-013-0449-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Substance use and violence co-occur among adolescents. However, the extant literature focuses on the substance use behaviors of perpetrators of violence and not on victims. This study identifies patterns of school victimization and substance use and how they co-occur. The California Healthy Kids Survey was used to identify latent classes/clusters of school victimization patterns and lifetime and frequency of recent (past month) alcohol, tobacco, and marijuana use (N = 419,698). Demographic characteristics (age, gender, and race/ethnicity) were included as predictors of latent class membership. Analyses revealed four latent classes of school victimization: low victimization (44.4 %), moderate victimization (22.3 %), verbal/relational victimization (20.8 %), and high victimization (with physical threats; 12.5 %). There were also four classes of substance use: non-users (58.5 %), alcohol experimenters (some recent alcohol use; 25.8 %), mild poly-substance users (lifetime use of all substances with few days of recent use; 9.1 %), and frequent poly-substance users (used all substances several times in the past month; 6.5 %). Those in the high victimization class were twice as likely to be frequent poly-substance users, and mild poly-substance use was most salient for those in the verbal victimization class. Few studies have explored latent patterns of substance use and violence victimization concurrently. The findings indicate substantial heterogeneity in victimization and substance use among youth in California schools with implications for targeted and tailored interventions. Understanding how certain types of victimization are associated with particular patterns of substance use will provide schools with opportunities to screen for concurrent behavioral health problems among youth.
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Donath C, Graessel E, Baier D, Bleich S, Hillemacher T. Is parenting style a predictor of suicide attempts in a representative sample of adolescents? BMC Pediatr 2014; 14:113. [PMID: 24766881 PMCID: PMC4011834 DOI: 10.1186/1471-2431-14-113] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 04/09/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Suicidal ideation and suicide attempts are serious but not rare conditions in adolescents. However, there are several research and practical suicide-prevention initiatives that discuss the possibility of preventing serious self-harm. Profound knowledge about risk and protective factors is therefore necessary. The aim of this study is a) to clarify the role of parenting behavior and parenting styles in adolescents' suicide attempts and b) to identify other statistically significant and clinically relevant risk and protective factors for suicide attempts in a representative sample of German adolescents. METHODS In the years 2007/2008, a representative written survey of N = 44,610 students in the 9th grade of different school types in Germany was conducted. In this survey, the lifetime prevalence of suicide attempts was investigated as well as potential predictors including parenting behavior. A three-step statistical analysis was carried out: I) As basic model, the association between parenting and suicide attempts was explored via binary logistic regression controlled for age and sex. II) The predictive values of 13 additional potential risk/protective factors were analyzed with single binary logistic regression analyses for each predictor alone. Non-significant predictors were excluded in Step III. III) In a multivariate binary logistic regression analysis, all significant predictor variables from Step II and the parenting styles were included after testing for multicollinearity. RESULTS Three parental variables showed a relevant association with suicide attempts in adolescents - (all protective): mother's warmth and father's warmth in childhood and mother's control in adolescence (Step I). In the full model (Step III), Authoritative parenting (protective: OR: .79) and Rejecting-Neglecting parenting (risk: OR: 1.63) were identified as significant predictors (p < .001) for suicidal attempts. Seven further variables were interpreted to be statistically significant and clinically relevant: ADHD, female sex, smoking, Binge Drinking, absenteeism/truancy, migration background, and parental separation events. CONCLUSIONS Parenting style does matter. While children of Authoritative parents profit, children of Rejecting-Neglecting parents are put at risk - as we were able to show for suicide attempts in adolescence. Some of the identified risk factors contribute new knowledge and potential areas of intervention for special groups such as migrants or children diagnosed with ADHD.
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Affiliation(s)
- Carolin Donath
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, Erlangen, 91054, Germany
| | - Elmar Graessel
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, Erlangen, 91054, Germany
| | - Dirk Baier
- Criminological Research Institute of Lower Saxony, Lützerodestr 9, Hannover, 30161, Germany
| | - Stefan Bleich
- Center for Addiction Research, Clinic for Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany
| | - Thomas Hillemacher
- Center for Addiction Research, Clinic for Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany
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Gilreath TD, Astor RA, Estrada JN, Johnson RM, Benbenishty R, Unger JB. Substance Use Among Adolescents in California: A Latent Class Analysis. Subst Use Misuse 2014; 49:116-123. [PMID: 23971853 PMCID: PMC3842372 DOI: 10.3109/10826084.2013.824468] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Data from the California Healthy Kids Survey of 7th, 9th, and 11th graders were used to identify latent classes/clusters of alcohol, tobacco, and marijuana use (N = 418,702). Analyses revealed four latent classes of substance use, which included nonusers (61.1%), alcohol experimenters (some recent alcohol use; 22.8%), mild polysubstance users (lifetime use of all substances with less than 3 days of recent use; 9.2%), and frequent polysubstance users (used all substances three or more times in the past month; 6.9%). The results revealed that alcohol and marijuana use are salient to California adolescents. This information can be used to target and tailor school-based prevention efforts.
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Affiliation(s)
- Tamika D Gilreath
- a 1 School of Social Work, University of Southern California , Los Angeles, California, USA
| | - Ron A Astor
- a 1 School of Social Work, University of Southern California , Los Angeles, California, USA
| | - Joey N Estrada
- b 2 Department of Counseling and School Psychology, San Diego State University , San Diego, California, USA
| | - Renee M Johnson
- c 3 Department of Community Health Sciences, Boston University , Boston, Massachusetts, USA
| | - Rami Benbenishty
- d 4 School of Social Work, Bar Ilan University , Ramat Gan, Israel
| | - Jennifer Beth Unger
- e 5 Department of Preventive Medicine, Keck School of Medicine, University of Southern California , Los Angeles, California, USA
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Dome P, Gonda X, Rihmer Z. Effects of smoking on health outcomes in bipolar disorder with a special focus on suicidal behavior. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/npy.12.51] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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