Evaluating Adolescent Substance Use and Suicide in the Pediatric Emergency Department.

OBJECTIVES: This study evaluates the relationship between substance use and impairment and current suicidal thoughts or behaviors in adolescent patients screened in a pediatric emergency department (ED). METHODS: Data were collected between June 2013 and February 2018 from adolescent patients who presented to a single, urban, pediatric ED. Adolescents completed a computerized, self-administered assessment that evaluates depression, suicide, posttraumatic stress, violence, traumatic exposure, bullying, and substance use. Assessments are administered as standard care to all ED patients aged 14 to 18 years. We used binary logistic regression to estimate the odds of reporting current suicidal thoughts or behaviors associated with patient demographics (ie, age, sex, and race), substance use in the past month, and substance-related impairment. RESULTS: A total of 11,623 adolescent patients (65.4% female and 52.9% African American) completed the assessment. Participants were, on average, 15.7 years old (SD = 1.27). Younger age (odds ratio [OR], 0.79; 95% confidence interval [CI], 0.74-0.84) and substance use impairment (OR, 0.44; 95% CI, 0.33-0.58) decreased the odds of reporting current suicidal thoughts or behaviors, whereas male sex (OR, 1.51; 95% CI, 1.28-1.79) and those with past-month substance use (OR, 1.85; 95% CI, 1.51-2.26) increased the odds. CONCLUSIONS: Recent substance use and male sex are associated with a higher likelihood of adolescents reporting current suicidal thoughts or behaviors during an ED visit. Standardized screening during pediatric ED visits may allow for more efficient evaluation of patients in higher-risk groups.

Cross sectional analysis of Chicago vs suburban Cook County suicide deaths among 10-24-year-olds in the Illinois violent death reporting system.

BACKGROUND: In 2014, suicide was the second leading cause of death among 10- to 24-year-olds in the US. Studies note disparities in youth suicide based on sex, race/ethnicity, and urban vs rural settings. This study investigates demographics, mental health indicators, and other circumstances surrounding youth/young adult deaths by suicide, comparing Chicago and suburban Cook County from 2005 to 2010. METHODS: Using the Illinois Violent Death Reporting System (IVDRS), we employed a cross-sectional design to provide descriptive analysis of decedents in three age groups (10-14, 15-19, and 20-24 years) in two geographic areas: urban (city of Chicago) and suburban (suburban Cook County) between January 1, 2005 and December 31, 2010. We used chi-square testing to test for significant differences in each age group by demographics, mental health indicators, and suicide markers in each area. RESULTS: Between 2005 and 2010, the IVDRS reported 299 deaths by suicide among 10-24-year-olds, 52% in Chicago, and 48% in suburban Cook County. Of these deaths, 5.7%, 33.4% and 60.9% were ages 10-14, 15-19, and 20-24 years, respectively. Non-Hispanic (NH) whites comprised 50.7% of the totals, NH Blacks 26.5%, Hispanics 16.8%, and Asians 5.7%. In Chicago, males were 84% of suicides and 62.7% in suburban Cook County among 15-19-year-olds (p < 0.05). White race was significantly different in 10-14-year-olds: 0% in Chicago, 54% in suburban Cook County (p < 0.05). Racial and ethnic differences in suicides among 15-19-year-olds in Chicago vs suburban Cook County were: NH White 22.4% vs 74.5% (p < 0.001), NH Black 46.9% vs 13.7% (p < 0.05), Hispanic 24.5% vs 7.8% (p < 0.05). There were also differences for 20-24-year-olds with NH White 43% vs 65.4% and NH Black 32% vs 13.6% (p < 0.05 for both). For mechanism of death, in 15-19-year-olds, there were differences between city and suburban in firearm deaths (42.9% vs 20%, p < 0.05) and in poisoning (0 vs 14%, p < 0.05). CONCLUSIONS: Our analyses detected significant location-related differences in the characteristics of decedents within the Chicago region indicating that local data are needed to inform suicide prevention efforts so that those at most risk can be prioritized for services. IVDRS is a potent tool in identifying these variations.

Psychiatric disorders and substance use in homeless youth: a preliminary comparison of san francisco and chicago.

Youth homelessness is a growing problem in the United States. The experience of homelessness appears to have numerous adverse consequences, including psychiatric and substance use disorders. This study compared the frequencies of psychiatric disorders, including substance use, between homeless youth (18-24 years-old) in San Francisco (N = 31) and Chicago (N = 56). Subjects were administered the Mini International Neuropsychiatric Interview (M.I.N.I.) to assess DSM-IV-TR diagnoses and substance use disorders. Eighty-seven percent of the San Francisco youth, and 81% of the Chicago youth met criteria for at least one M.I.N.I. psychiatric diagnosis. Nearly two-thirds of the youth in both samples met criteria for a mood disorder. Approximately one-third met criteria for an anxiety disorder. Thirty-two percent of the San Francisco sample and 18% of the Chicago met criteria for Antisocial Personality Disorder. Approximately 84% of the San Francisco youth and 48% of the Chicago youth met criteria for a substance-related disorder, and more substances were used by San Francisco youth. In conclusion, the high rate of psychiatric disorders in homeless youth provides clear evidence that the mental health needs of this population are significant. Implications are discussed.