Adolescent Suicidal Behavior and Substance Use: Developmental Mechanisms

Abstract

Adolescent suicidal behaviors and substance use are disturbingly common. Research suggests overlap of some of the etiological mechanisms for both adolescent suicidal behavior and substance use, yet clear understanding of the complex relations between these behaviors and their causal underpinnings is lacking. A growing body of evidence and a diathesis model (Mann et al. 1999;Mann, 2003) highlight the importance of impulse control as a proximal risk factor for adolescent suicidal and substance use behaviors. This literature review extends current theory on the relationships between adolescent suicidal behavior and substance use by: (1) examining how, when, and to what extent adolescent development is affected by poor impulse control, stressful life events, substance use behavior, and biological factors; (2) presenting proposed causal mechanisms by which these risk factors interact to increase risk for suicidal behaviors and substance use; and (3) proposing specifi c new hypotheses to extend the diathesis model to adolescents at risk for suicide and substance use. More specifi cally, new hypotheses are presented that predict bidirectional relationships between stressful life events and genetic markers of 5-HT dysregulation; substance use behavior and impulsivity; and substance use behavior and suicide attempts. The importance of distinguishing between different developmental trajectories of suicidal and substance use behaviors, and the effects of specifi c risk and protective mechanisms are discussed. Use of new statistical approaches that provide for the comparison of latent growth curves and latent class models is recommended to identify differences in developmental trajectories of suicidal behavior and substance use. Knowledge gained from these prospective longitudinal methods should lead to greater understanding on the timing, duration, and extent to which specifi c risk and protective factors infl uence the outcomes of suicidal behavior and substance use. In turn, fi ndings from these studies should inform researchers who conduct future treatment and prevention studies.Keywords: adolescence, development, suicide, substance abuse, behavior, risk and protective factors Epidemiological Findings of Adolescent Suicidal Behavior and Substance UseAdolescent suicidal behaviors are widespread and produce a signifi cant burden on healthcare systems. In the United States, suicide is the 4th most common cause of death among 10-14 year olds, and the 3rd most common cause of death among 15-24 year olds (Anderson and Smith, 2003). Suicide attempts are the primary reason for referral to child and adolescent psychiatric emergency services (Peterson et al. 1996). The incidence rates of suicide attempts among older adolescents range from 7% to 9% (CDC, 2004). Prospective fi ndings show that: (1) adolescents who attempt suicide are at risk of future non-lethal suicide attempts, and the risk increases with multiple suicide attempts (Goldston et al. 1999;Wingate et al. 2004); (2) adolescents who die by suicide have histo...

Gang Membership, Violence, and Psychiatric Morbidity

“…Associations with lifetime suicide attempts may partly reflect other psychiatric morbidity, including anxiety disorders and depression. However, they also correspond to the notion that impulsive violence may be directed both outward and inward (24). The relationship between alcohol misuse and violence is highly complex (25).…”

Understanding the Relationship between Substance Use and Self-Injury in American Indian Youth

“…Thus, it appears the more lethal the behavior among the Apaches, the greater the cooccurrence with alcohol and drug use. While explanations from the literature could attribute this fact to the loss of impulse control that comes with substance use (2,9), Apache collaborators seek more culturally relevant explanatory models that posit substance abuse as a co-occurring form of adolescent self-injury that amplifies results of intentional self-harm. This idea is in contrast to dominant Western models of suicide, such as Joiner's (10) and Mann et al's (11), that do not include binge substance use in the spectrum of self-injury.…”

“…A broad literature supports that suicide and substance use co-occur (1). However, the relationship and possible shared causes are unknown (2).…”

“…Three dominant Western hypotheses about the cooccurrence of suicidal behavior and substance abuse include the following: (1) both behaviors are motivated by a single cause such as unbearable stresses, a sense of inadequacy or unmet expectations, or an attempt to "escape" life's difficulties; (2) both behaviors are an expression of a third factor, such as other psychiatric conditions (i.e., depression or disruptive behavior disorders), poor impulse control, or negative life experiences (abuse or trauma); and (3) chronic or episodic substance abuse has biological, legal, emotional, and physical consequences that increase risk for suicide in vulnerable populations (1).…”

Suicidal ideation and substance use among adolescents and young adults: A bidirectional relation?

“…That is, suicidal ideation and substance use may affect each other (Dawes et al, 2008). Findings from three longitudinal studies found earlier substance use predicting later suicidal ideation, but did not support the reverse relations (van Ours et al, 2013; Pederson and von Soest, 2008; Bronisch et al, 2008).…”