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

Abstract

Background: Adolescence has been described as a period of increased health risk-taking behaviors. Given the variety of cultural contexts, healthcare systems, and public health policies in different regions, the present study aimed to determine whether there are similar or different associations of substance use behaviors with suicidal ideation and suicide attempts among US and Chinese adolescents.Methods: This study included a total of 14,765 US adolescents from the 2017 National Youth Risk Behavior Surveillance System (YRBSS) and 24,345 Chinese adolescents from the 2017 School-based Chinese Adolescents Health Survey (SCAHS).Results: The proportions of suicidal ideation and suicide attempts were 17.4 and 5.7% among US adolescents, which were higher than those among Chinese adolescents (suicidal ideation: 13.7% and suicide attempts: 2.7%). Among Chinese adolescents, the most common substance use behavior was “alcohol use (55.4%),” followed by “cigarette use (11.6%).” Among US adolescents, the most popular substance was alcohol (ever used: 55.9%), followed by marijuana (ever used: 34.6%). Moreover, alcohol use was significantly related to suicidal ideation/suicide attempts only in Chinese adolescents [suicidal ideation: Adjusted odds ratio (AOR) = 1.88, 95% CI = 1.71~2.06; suicide attempts: AOR = 2.12, 95% CI = 1.71~2.63], and marijuana use was associated with suicidal ideation and suicide attempts only in the US adolescent group (suicidal ideation: AOR = 1.23, 95% CI = 1.06~1.44; suicide attempts: AOR = 1.51, 95% CI = 1.21~1.87). Moreover, although the associations of prescription pain medication use with suicide attempts were significant in both Chinese and US adolescent groups, the adjusted associations were stronger in Chinese adolescents than in US adolescents (Chinese adolescents: AOR = 3.97, 95% CI = 2.76~5.72; US adolescents: AOR = 1.76, 95% CI = 1.43~2.16; P < 0.05).Conclusions: The associations of alcohol use with suicidal ideation and suicide attempts were only significant in Chinese adolescents. Marijuana use was associated with suicidal ideation and suicide attempts only in the US adolescent group. Although the associations of prescription pain medication use with suicide attempts were significant in both Chinese and US adolescent groups, the adjusted associations were significantly stronger for Chinese adolescents. These findings might be related to the differences in cultural contexts, healthcare systems, and public health policies in the two different countries.

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

“…In particular, three stages of suicidal behaviours were assessed with single items instead of dedicated interviews or psychometric instruments. Although the measurement of this study is practical and efficient in a large-size sample study (Guo et al ., 2021 ), we will adopt more rigorous assessment in future studies. Third, we only included two core subtypes of CM in the analysis, including neglect and physical abuse, while the direct and indirect influence of emotional abuse and sexual abuse on suicidal risk was ignored.…”

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

“…Alcohol use is a direct threat to adolescent health, and it creates risks of around 230 different identified health outcomes in the form of disease, injury, or mental health problems [ 14 , 15 , 16 ]. Recent studies found that adolescence alcohol use is linked to suicidal ideation and suicide attempts [ 17 , 18 ], gambling, abnormal fear-related behavior, and alcohol use disorders [ 19 , 20 ]. Alcohol use and abuse among young people (under 21 years of age) is a pervasive problem worldwide [ 21 ].…”

“…Alcohol use and abuse among young people (under 21 years of age) is a pervasive problem worldwide [ 21 ]. In China, alcohol drinking is more common than other substance use behavior among adolescents [ 18 ], given the fact that alcohol drinking is more culturally acceptable in China. Existing studies indicate that teenagers’ drinking behavior is becoming increasingly serious, and teenagers’ heavy drinking and drunken behavior has also increased.…”

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

“…In the suicidal process of adolescents, suicidal ideation has been considered one of the major factors causing the suicide of adolescents [ 8 , 12 ]. Through a survey of 24,345 Chinese adolescents, Guo et al found that 13.7% of adolescents experience suicidal ideation [ 13 ]. Therefore, society must pay more attention to the Chinese adolescent suicidal ideation problem [ 8 , 13 ].…”

“…Through a survey of 24,345 Chinese adolescents, Guo et al found that 13.7% of adolescents experience suicidal ideation [ 13 ]. Therefore, society must pay more attention to the Chinese adolescent suicidal ideation problem [ 8 , 13 ]. Existing studies have revealed that risk factors such as an unsupportive family environment [ 2 ], drug abuse [ 14 ], and bullying may affect the suicidal ideation of adolescents, of which an unsupportive family environment plays a crucial role in its formation [ 15 , 16 ].…”