Associations of Substance Use Behaviors With Suicidal Ideation and Suicide Attempts Among US and Chinese Adolescents

Suicide ideation and psychotropic recreational drug use by adolescents: a systematic review and meta-analysis

BACKGROUND

Adolescence is characterized by complex and dynamic changes, often involving experimentation, including the use of psychotropic substances. Although it is well-established that recreational psychotropic drugs are associated with suicide ideation in adults, evidence of this association in adolescents remains limited.

OBJECTIVE

To investigate the relationship between suicide ideation and psychotropic recreational drug use among adolescents.

DESIGN AND SETTING

Systematic review with meta-analysis developed at Universidade Federal de Uberlândia (UFU) and Universidade Estadual de Campinas (UNICAMP), Brazil.

METHODS

A search across eight electronic databases for observational studies, without language or publication year restrictions, was conducted. The Joanna Briggs Institute tool was used to assess the risk of bias. Random-effects meta-analyses and odds ratios were used to measure the effects.

RESULTS

The search yielded 19,732 studies, of which 78 were included in the qualitative synthesis and 32 in the meta-analysis. The findings indicated that suicidal ideation was 1.96 times more likely (95% confidence interval, CI = 1.47; 2.61) for adolescents who used some drug recurrently and 3.32 times more likely (95%CI = 1.86; 5.93) among those who abused drugs. Additionally, adolescents who used cannabis were 1.57 times more likely (95%CI = 1.34; 1.84) to experience suicide ideation compared with non-users, while cocaine users had 2.57 times higher odds (95%CI = 1.47; 4.50).

CONCLUSIONS

Psychotropic recreational drug use is associated with suicidal ideation among adolescents regardless of current or previous use, abuse, or type of substance used.

SYSTEMATIC REVIEW REGISTRATION

Registered in the PROSPERO database under the identification number CRD42021232360. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021232360.

Mobile phone addiction and suicide behaviors among Chinese adolescents: The mediation of poor sleep quality

Background and aims

Mobile phone addiction (MPA) is emerging among adolescents, especially during the COVID-19 pandemic. Nevertheless, there is a dearth of knowledge regarding the correlation between MPA and suicide behaviors and its mechanism. The objective of the current study is exploring the direct effect of MPA on suicide behaviors and the indirect effect through poor sleep quality.

Methods

A total of 18,900 Chinese adolescents aged 12 to 18 were recruited via a multi-stage cluster sampling method.

Results

The prevalence of MPA and poor sleep quality was 26.2 and 23.1%, respectively. During the past year, 24.4% participants were involved in suicide behaviors. Specifically, suicide ideators, suicide planners, and suicide attempters were 10.7, 8.4, and 5.3%, respectively. Particularly, rural females had the highest prevalence of suicide behaviors, MPA, and poor sleep quality. Logistic regression analysis showed that MPA was significantly associated with suicide ideators (OR = 1.22, 95% CI: 1.09-1.37, p < 0.001) and planners (OR = 1.18, 95% CI: 1.04-1.34, p < 0.05), but not for suicide attempters (p > 0.05). Structural equation modelling demonstrated that MPA had direct effect on suicide behaviors (β = 0.145, 95% CI = 0.127-0.160), and poor sleep quality partially mediated the relationship (the mediating ratio was 46.7%). The mediating ratio of poor sleep quality was the highest in urban males.

Conclusions

MPA has both direct and indirect effects on suicide behaviors. For suicide prevention, limited mobile phone use and improvement sleep quality may be practical for adolescents. Additionally, more efforts of intervention could give priority to rural girls.

Social anxiety and suicidal ideation among middle-school students in China: a mediation model of internet addiction

Background

Suicide is a fatal public health issue for adolescents, and it is of great significance to explore the precursors of suicidal behaviors, especially suicidal ideation. However, the relationship between social anxiety and suicidal ideation and its mechanism are still unclear. The study aims to examine the association between social anxiety and suicidal ideation and the mediating effect through Internet addiction.

Methods

A total of 2,278 middle-school students aged 12 to 16 years were recruited through a multistage cluster sampling method in this cross-sectional study. Logistical regression analysis and structural equation modeling (SEM) were conducted to examine the direct and indirect effects of social anxiety.

Results

During the past year, 262 (11.50%) participants reported suicidal ideation. Females had a higher prevalence of suicidal ideation than males (12.9% vs. 10.0%, p = 0.034), and urban adolescents reported a higher prevalence than their rural counterparts (13.4% vs. 9.6%, p = 0.006). In the total sample, social anxiety and Internet addiction were independently associated with suicidal ideation (p < 0.05). In the subgroup analysis, the association between social anxiety and suicidal ideation was significant only among rural females and urban males (p < 0.05). SEM demonstrated that social anxiety had direct and indirect effects on suicidal ideation, and Internet addiction partially mediated the relationship, with a mediating ratio of 30.53%. The partial mediating effect was also significant only in rural females and urban males.

Conclusion

Adolescents may overuse the Internet to cope with social anxiety and further have suicidal ideation. Limiting Internet use and improving interpersonal skills in real life may be efficient for suicide prevention. In addition, targeted interventions should be tailored by different sexes across urban and rural regions.

Relationships between Weight Perceptions and Suicidal Behaviors in Chinese Adolescents: Results from an Ongoing School-Based Survey in Zhejiang Province

BACKGROUND

Weight perception has been implicated in suicidal behaviors among children and adolescents, yet little is known about the relationships in China. We examined the associations of self-perceived weight status and weight misperception with suicidal behaviors among Chinese adolescents.

METHODS

Data used in this analysis were from the 2017 Zhejiang Youth Risk Behavior Survey, which included 17,359 middle and high school students aged 9 to 18 years. Information on perceived weight status, as well as the actual height, weight and other related traits, was extracted by a self-reported questionnaire. Multivariate logistic regression models were used to estimate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for suicidal behaviors associated with perceived weight status and weight misperception.

RESULTS

Overall, the mean (SD) age was 15.7 (1.6) years among the study participants. Students who perceived themselves as overweight were more likely to have increased suicidal ideation and attempts reports, with ORs of 1.22 (95% CI: 1.09-1.37) and 1.32 (1.06-1.34), compared to those who perceive themselves as having about the right weight. Overestimated weight was significantly associated with greater odds of suicidal ideation (OR: 1.15, 95% CI: 1.03-1.27) and attempts (1.35, 1.10-1.65) relative to accurate weight perception.

CONCLUSIONS

Controlling for potential confounders, we found that both self-perception of overweight and overestimated perception were significantly associated with suicidal ideation and attempts among Chinese adolescents.

Do associations between suicide ideation and its correlates (substance use, anxiety, and depression) differ according to victimization type among youth? A Smart platform study

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23% of the youth reported suicide ideation in the past year.

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Suicide ideation was higher among those victimized by bullying.

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Suicide ideation was also higher with reported anxiety, or poor subjective health.

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Poor health did not play a role between victimization and suicide ideation.

The issues associated with mental health, substance misuse, and suicide ideation are complex and sensitive among youth. We sought to investigate the role that subjective health, internalizing and externalizing risk factors play in the association between victimization and suicide ideation among youth in Canada via used a custom-built digital epidemiological smartphone application (Smart Platform) on their personal smartphones.

A sample of 818 youth citizen scientists in Saskatchewan, Canada downloaded the app to provide information on victimization, subjective health, internalizing problems (symptoms of stress, anxiety, and depression), externalizing behaviours (cannabis use, alcohol, smoking), and suicide ideation. Binary regression models were used to estimate associations and controlled for gender, age, perpetration, and ethnicity.

From our sample, 23% of youth reported suicide ideation (i.e., thoughts) in the past year. Three types of victimization (cyberbullied, made fun or teased, or bullied via being left out) are associated with a two-times higher risk of suicide ideation. Although certain risk factors (anxiety, poor subjective health, and cannabis use) were associated with higher suicide ideation risk, they did not moderate the association between victimization and suicide ideation. Symptoms of depression were found to be protective against suicide ideation.

Suicide ideation is high among this sample of youth in Canada. Certain types of victimization, internalizing and externalizing risk factors, and poor subjective health are associated with a higher risk of suicide ideation. However, our findings confirm that the pathway from victimization to suicide ideation is complex and is potentially moderated by factors other than the ones explored here.

The Role of Mindfulness in Mitigating the Detrimental Effects of Harsh Parenting among Chinese Adolescents: Testing a Moderated Mediation Model in a Three-Wave Study

Based on the conservation of resources theory, this study aimed to investigate the mediating role of depressive symptoms and the moderating role of mindfulness in the association between harsh parenting and adolescent suicidal ideation in the Chinese cultural context. Using a three-wave (i.e., three months apart) data collection among 371 Chinese adolescents, this study found that depressive symptoms mediated the relationship between harsh parenting and adolescent suicidal ideation. Moreover, adolescent mindfulness mitigated the effects of harsh parenting on suicidal ideation, as well as the indirect effect of harsh parenting on suicidal ideation via depressive symptoms. The theoretical and practical implications are discussed.

Parenting Styles as a Moderator of the Association between Pubertal Timing and Chinese Adolescents' Drinking Behavior

BACKGROUND

Previous work has indicated that pubertal timing and parenting styles are associated with adolescents' drinking behavior, but studies on the relationship between the above three variables are lacking.

METHODS

Participants were 1408 Chinese adolescents aged 11-16 years old (46.52% girls). The data emphasized pubertal timing, parenting styles, drinking behavior, and socioeconomic and demographic characteristics of the adolescent and his or her family.

RESULTS

Early pubertal timing was related to drinking behavior; however, parenting styles played a moderating role. For male adolescents, father emotional warmth, mother rejection, and mother emotional warmth moderated the relationship between early pubertal timing and drinking behavior. For female adolescents, mother rejection, mother emotional warmth, and mother over-protection moderated the relationship between pubertal timing and drinking behavior.

CONCLUSIONS

Parenting styles that include emotional warmth, rejection, and over-protection appear to influence the negative outcomes associated with early pubertal timing, and may be useful in reducing adolescents' drinking behavior.

Prediction of adolescent suicidal ideation after the COVID-19 pandemic: A nationwide survey of a representative sample of Korea

OBJECTIVE

This study developed a model to predict groups vulnerable to suicidal ideation after the declaration of the COVID-19 pandemic based on nomogram techniques targeting 54,948 adolescents who participated in a national survey in South Korea.

METHODS

This study developed a model to predict suicidal ideation by using logistic regression analysis. The model aimed to understand the relationship between predictors associated with the suicidal ideation of South Korean adolescents by using the top seven variables with the highest feature importance confirmed in XGBoost (extreme gradient boosting). The regression model was developed using a nomogram so that medical workers could easily interpret the probability of suicidal ideation and identify groups vulnerable to suicidal ideation.

RESULTS

This epidemiological study predicted that eighth graders who experienced depression in the past 12 months, had a lot of subjective stress, frequently felt lonely in the last 12 months, experienced much-worsened household economic status during the COVID-19 pandemic, and had poor academic performance were vulnerable to suicidal ideation. The results of 10-fold cross-validation revealed that the area under the curve (AUC) of the adolescent suicidal ideation prediction nomogram was 0.86, general accuracy was 0.89, precision was 0.87, recall was 0.89, and the F1-score was 0.88.

CONCLUSION

It is required to recognize the seriousness of adolescent suicide and mental health after the onset of the COVID-19 pandemic and prepare a customized support system that considers the characteristics of persons at risk of suicide at the school or community level.

Mediation of Internet addiction on association between childhood maltreatment and suicidal behaviours among Chinese adolescents

Aims

The associations between suicidal behaviours and childhood maltreatment (CM), as well as Internet addiction (IA) have been extensively examined. However, few studies pay attention to different types of CM and all stages of suicidality, including suicidal ideation (SI), suicidal plans (SP) and suicidal attempts (SA). Moreover, little is known regarding the mediation of IA on the relationship between CM and suicidal behaviours. The study aims to explore the direct effect of CM and IA on three stages of suicidal behaviours, and the indirect effect of CM on suicidality via IA.

Methods

A total of 16 130 high-school students aged 12–18 were recruited using a stratified cluster sampling strategy across five representative provinces in China. Relevant information was collected by a self-administered anonymous questionnaire. Multinomial logistic regression analysis and structural equation model were used to examine the associations.

Results

During the last year, 16.0% of participants reported suicidal behaviours. Specifically, 7.9% reported SI only, 4.6% reported SP but no SA, and 3.5% reported SA. The prevalence of neglect, physical abuse and IA in moderate to severe were 28.9, 19.9 and 33.1%, respectively. After controlling for demographic characteristics and confounding factors, such as loneliness, psychological resilience, and social support, moderate and severe neglect, physical abuse and IA were associated with an increased risk of SI, SP and SA (p < 0.01). The total effect of neglect and physical abuse on suicidal behaviours were 0.152 and 0.172, respectively (p < 0.001). The mediation proportion of IA on the association between neglect and suicidal behaviours, as well as physical abuse and suicidal behaviours were 22.4 and 18.0%, respectively.

Conclusions

CM and IA are independently associated with suicidal behaviours among Chinese adolescents. Moreover, IA plays a mediating role on the relationship between CM and suicidality. Targeted interventions for adolescents’ suicidal behaviours should focus on those who have experience of CM and IA.