Lifetime use of multiple substances and youth suicide risk: assessing the role of depressive symptoms using structural equation modeling.

OBJECTIVES: This study assessed the direct and indirect effects (via depressive symptoms) of lifetime use of a broad range of substances on suicide risk among US adolescents. STUDY DESIGN: This was a cross-sectional study. METHODS: Data from the 2021 Youth Risk Behavior Survey were used (N = 12,303, 48.7% female). Associations between five types of substance use (cigarette, e-cigarette, alcohol, marijuana, and prescription pain medicine) and three dimensions of suicide risk (suicidal ideation, suicide plan, and suicide attempt) were measured by multivariate logistic regression models. The role of depressive symptoms was further examined by structural equation modeling. RESULTS: Almost three in five (57.5%) adolescents had used one or more substances in their lifetime (18.1% one type, 12.2% two types, 13.1% three types, 10.2% four types, and 3.8% five types). Adolescents using five substances were up to 16 times more likely to experience suicidal ideation and behaviors. Depressive symptoms significantly linked the pathway from substance use to suicide risk, resulting in much stronger indirect effects than the direct effects. Collectively, the five substance use behaviors and depressive symptoms explained about 60.4% of variance in suicidal ideation, 53.6% of variance in suicide plan, and 55.0% of variance in suicide attempt. CONCLUSIONS: Lifetime use of multiple substances is significantly correlated with suicidal ideation and behaviors among adolescents via the pathway of depressive symptoms. Routine screening for a broad range of substance use behaviors is needed to identify adolescents at risk for suicide and accessible mental health services could potentially attenuate the linkage between substance use and suicide risk.

Suicidal Thoughts and Behaviors Among US Adolescents: The Cumulative Effects of Polysubstance Use Behaviors.

Background: The linkage between substance use and youth suicidality is less developed due to the predominant focus on certain types of substances (e.g., alcohol consumption, prescription opioid misuse). This study examines polysubstance use and its mutual impact on suicidal thoughts and behaviors among US adolescents. Methods: Data from 2019 Youth Risk Behavior Survey were utilized. Associations between the concurrent use of five substances (cigarette, e-cigarette, alcohol, marijuana, and prescription opioid) and suicidality (suicidal thoughts, suicide plans, and suicide attempts) were measured by logistic regression models. The combined effect of polysubstance use on suicidality was further assessed by structural equation modeling. Results: About two in five (42.1%) adolescents used at least one type of substances in the past month and one in seven (13.5%) used three or more types concurrently (polysubstance use). Adolescents with polysubstance use behaviors were three to five times more likely to experience suicidal thoughts (OR=3.8, p < 0.05), make a suicide plan (OR=3.5, p < 0.05), or attempt suicide (OR=4.6, p < 0.05) than non-users. In the final structural model, polysubstance use and suicidality were significantly correlated with each other (ß=0.37, p < 0.05). Collectively, polysubstance use explained about 14% of variance in youth suicidality. Conclusions: Polysubstance use shows a significant impact on youth suicidality. School-based health centers and educational programs are recommended to reduce substance use and suicidal behaviors among adolescents. Accessible mental health services and targeted treatments are needed for polysubstance users to mitigate their risk of suicide.

Concurrent changes in nonsuicidal self-injury and suicide thoughts and behaviors.

BACKGROUND: Nonsuicidal self-injury (NSSI) is a risk factor for suicide, yet how changes in NSSI engagement relate to suicide ideation, planning, and attempts remains largely unknown. The current study aims to fill this gap by examining how changes in NSSI frequency over time related to concurrent changes in suicide thoughts and behaviors. METHODS: Data came from a sample of 403 self-injuring young adults who completed assessments of NSSI and suicide thoughts and behaviors at baseline, 6, and 12 months. Bivariate latent growth modeling, adjusting for covariates of lifetime NSSI frequency and treatment status, was used to examine the extent to which changes in NSSI frequency related to suicide ideation and suicide planning. RESULTS: The frequency of NSSI declined across the study period. The slopes of NSSI and suicide ideation were significantly correlated, suggesting individuals with sharper declines in NSSI across time also showed sharper declines in suicide ideation. The intercepts between NSSI and suicide planning were significantly correlated, suggesting those with high NSSI frequency at baseline tended to report higher suicide planning across time. After covariate adjustment, the intercept of suicide planning marginally (p = 0.08) correlated with the slope of NSSI, tentatively suggesting that those who had less reductions in NSSI tended to have higher frequencies of suicide planning. CONCLUSION: These results provide new evidence that changes in NSSI are related to subsequent changes in suicide thoughts and behaviors. Monitoring suicide risk among those with NSSI is important and treatment aiming to reduce NSSI may also reduce suicide risk.

Fear of detachment from mobile phone: nomophobia and suicidality among Malaysian university students before and during the COVID-19 pandemic.

The attachment to mobile devices during the COVID-19 pandemic has led to the possibility of increased nomophobia, which is the intense fear of losing access to one's mobile device. Therefore, this study aimed to determine if nomophobia was independently associated with suicidality before and during the COVID-19 pandemic among university students in Malaysia. This cross-sectional study had two-time points in data collection: one year before and one year into the COVID-19 pandemic. N = 806 university students aged ≥ 18 years completed an online questionnaire comprising the Nomophobia Questionnaire, Multidimensional Scale of Perceived Social Support, and the Suicidal Behaviors Questionnaire-Revised. A multiple logistic regression (controlling for gender, age, and social support) was conducted to determine the association between nomophobia and suicidality before and during the COVID-19 pandemic. The prevalence of severe nomophobia before and during the COVID-19 pandemic was 15.7% and 35.6% respectively. The level of nomophobia was significantly higher during the COVID-19 pandemic compared to pre-pandemic. Pre-pandemic, there were no significant associations. During the pandemic, participants with moderate (aOR 3.09, 95% CI [1.14-8.40], p = .027) and severe (aOR 3.57, 95% CI [1.25-10.20], p = .018) nomophobia had higher odds of suicide plan. During the pandemic, moderate and severe nomophobia were independently associated with more than three times higher odds for a lifetime suicide plan. Our study findings carry implications for the well-being of university students.

Self-injurious thoughts and behaviors that differentiate soldiers who attempt suicide from those with recent suicide ideation.

BACKGROUND: Risk for suicide attempt (SA) versus suicide ideation (SI) is clinically important and difficult to differentiate. We examined whether a history of self-injurious thoughts and behaviors (SITBs) differentiates soldiers with a recent SA from nonattempting soldiers with current/recent SI. METHODS: Using a unique case-control design, we administered the same questionnaire (assessing the history of SITBs and psychosocial variables) to representative U.S. Army soldiers recently hospitalized for SA (n = 132) and soldiers from the same Army installations who reported 30-day SI but did not make an attempt (n = 125). Logistic regression analyses examined whether SITBs differentiated attempters and ideators after controlling for previously identified covariates. RESULTS: In separate models that weighted for systematic nonresponse and controlled for gender, education, posttraumatic stress disorder, and intermittent explosive disorder, SA was positively and significantly associated with the history of suicide plan and/or intention to act (odds ratio [OR] = 12.1 [95% confidence interval {CI} = 3.6-40.4]), difficulty controlling suicidal thoughts during the worst week of ideation (OR = 3.5 [95% CI = 1.1-11.3]), and nonsuicidal self-injury (NSSI) (OR = 4.9 [95% CI = 1.3-18.0]). Area under the curve was 0.87 in a full model that combined these SITBs and covariates. The top ventile based on predicted risk had a sensitivity of 24.7%, specificity of 99.8%, and positive predictive value of 97.5%. CONCLUSIONS: History of suicide plan/intention, difficult to control ideation, and NSSI differentiate soldiers with recent SA from those with current/recent SI independent of sociodemographic characteristics and mental disorders. Longitudinal research is needed to determine whether these factors are prospectively associated with the short-term transition from SI to SA.

Relational-Level Factors Influencing Suicidal Behaviors Among Korean Adolescents.

PURPOSE: To identify relational-level risk and protective factors for suicidal ideation, suicide plan, and suicide attempt in a nationally representative sample of Korean adolescents. STUDY DESIGN: This study is a secondary data analysis of cross-sectional national data on Youth Health Behavior collected in June 2017. The final sample (n = 62,276), collected from 2,400 classes in 800 schools, reflects stratification, clustering, and weight. It is representative of the population (n = 3,027,488). METHODS: This study used relational factor variables, including experiences of assault, living with family or not, and adolescents' confidants. Dependent variables included suicidal ideation, suicide plan, and suicide attempt. This study used logistic regression analyses on the complex sample to examine relational-level risk and protective factors for suicidal ideation, plan, and attempt. FINDINGS: The adjusted logistic regression models found that experiences of assault, living with family or not, and adolescents' confidants were all significantly associated with suicidal ideation, plan, and attempt. In particular, 35.3% of victims had thought about suicide seriously, and victims of assault were approximately eight times more likely to attempt suicide compared to nonvictims. CONCLUSIONS: The experience of assault by others was found to be a strongly associated risk factor for suicidal behaviors in adolescents. Living with family and the presence of confidants to talk with were found to be protective factors against suicidal behaviors. To be specific, talking with parents about personal worries and troubles was more protective against suicidal behaviors than talking with a sibling, friend, or teacher. CLINICAL RELEVANCE: Nurses should provide crisis intervention for symptoms of trauma and suicidal behaviors among assault victims. Suicide prevention efforts should focus more on adolescents not living with family. They should also aim to enhance adolescents' family interactions. Encouraging adolescents to talk with their parents may mitigate the effects of risk factors on suicidal behaviors.

Suicide-specific rumination as a predictor of suicide planning and intent.

BACKGROUND: Suicide-specific rumination (SSR), that is repetitive negative thinking about suicide, has been proposed as a risk factor for suicidal behavior. Yet, few studies have investigated associations between SSR and suicide intent and planning in a longitudinal study design. The purpose of the present study was to investigate the association between SSR, suicide intent, suicide planning and suicide attempts in a sample of adult outpatients undergoing psychotherapy. METHOD: Data from N = 637 patients (58.4% female, 41.6% male; Mage = 35.81, SDage = 13.50, range: 18-79 years) who started therapy at an outpatient clinic were collected. A subsample of n = 335 patients (n = 335; 56,4% female, 43,6% male; Mage = 35.4, SDage = 13.1, range: 18-73 years) also took part in a post-treatment assessment after twelve therapy sessions. RESULTS: SSR differentiated lifetime suicide attempters from suicide ideators. Furthermore, SSR was associated with lifetime suicide attempt status above age, sex, suicide ideation, depression, anxiety, and stress. Finally, SSR served as a prospective predictor of both suicide planning and suicide intent. CONCLUSION: The results emphasize the key role of SSR in understanding the suicidal process.

Differentiating the association between age of alcohol use initiation and conditional suicidal behaviors among adolescents.

INTRODUCTION: Suicide and early alcohol use initiation are public health concerns. Previous studies have explored the associations between age of alcohol use initiation and suicidal behaviors, which progresses from ideation to action. Distinguishing between the various associations can help gain a deeper understanding of suicidal behaviors and aid in developing social suicide prevention strategies. METHODS: The study utilized the Youth Risk Behavior Survey to investigate this association. A total of 17 209 students were finally included in the study. Conditional suicidal behaviors included no suicidal behavior (NS), suicidal ideation without a plan or attempt (SINPA), suicide plan without an attempt (SPNA) and suicide attempt (SA). RESULTS: Among 17 209 students, the prevalence of suicidal ideation, suicide plan, and suicide attempt were 21.4%, 17.3%, and 11.1%, respectively. Moreover, 15.2% of the students used alcohol before age 13, whereas 31.7% of students used alcohol at age 13 or older. Compared to NS, students using alcohol showed significant associations with SA (OR = 2.34, p < .001; OR = 1.29, p < .01), SPNA (OR = 1.68, p < .001; OR = 1.19, p < .05) and SINPA (OR = 1.55, p < .001; OR = 1.40, p < .001). Comparing with SINPA and SNPA, students using alcohol before age 13 were associated with SA (OR = 1.61, p < .001; OR = 1.46, p < .001), whereas those using alcohol at or after the age 13 were not associated with SA (OR = 0.98, p > .05; OR = 1.09, p > .05). DISCUSSION: This study demonstrated that early alcohol use initiation was significantly associated with suicide attempts among students with suicidal ideations or plans.

Stress and hope distinguish individuals with suicidal plan from suicide ideators among Chinese college students.

Background: Suicide among college students is a significant public health concern in China. While suicidal ideation serves as a crucial predictor of subsequent suicidal plans and behaviors, it is important to recognize that most instances of suicidal ideation may only be fleeting thoughts that do not progress to an actual plan. Therefore, it is imperative to identify the factors associated with the transition from suicidal ideation to a concrete plan. Consequently, this study aims to investigate whether certain frequently cited factors can differentiate individuals who have formulated a specific suicidal plan from those who have experienced suicidal thoughts without planning, based on data obtained through a cross-sectional survey. Materials and methods: This survey was conducted as part of routine mental health assessments among second-year college students in October 2023. Data from a total of 4,858 second-year college students were utilized for the final analyses. Two survey questions were employed to identify past-year suicidal ideation and past-year suicidal plan. All participants were required to complete various assessments, including the Chinese version of Depression Anxiety Stress Scale 21 items (DASS-21), the Chinese version of Gratitude Questionnaire-six items (GQ-6), the Chinese version of Meaning in Life Questionnaire (MLQ), and the Chinese version of State Hope Scale (SHS). Results: Among 4,858 participants, a total of 134 individuals (2.8%) were confirmed to have experienced past-year suicidal ideation. Out of these, 53 (1.1% overall) reported having a past-year suicidal plan, accounting for approximately 39.6% of those with suicidal ideation. Logistic regression analyses revealed that while most potential variables differentiated between students with and without suicidal ideation, only two factors stood out in distinguishing individuals with a suicidal plan from those who had not made such plans despite experiencing suicidal thoughts-presence of stress (OR=2.49, 95% CI: 1.04-5.96) and lower scores of hope agency (OR=0.84, 95% CI: 0.72-0.98). Conclusion: These findings suggest that the stress may contribute to susceptibility for transitioning from mere thoughts to actual planning regarding suicide; conversely, hope agency appears to offer protection against this transition process. Therefore, we advocate for targeted interventions aimed at fostering hope among individuals who have encountered adverse and stressful life events.

The Role of Social Support in Preventing Suicidal Ideations and Behaviors: A Systematic Review and Meta-Analysis.

BACKGROUND: Numerous epidemiological studies have explored the relationship between social support and suicidal behaviors; however, the overall impact remains unclear. Therefore, a systematic assessment of the association between social support and suicide is necessary. Study Design: This is a systematic review study. METHODS: We conducted a comprehensive search of PubMed, Web of Science, and Scopus databases until March 2023 and screened reference lists for relevant studies. Epidemiological studies that investigated the associations between social support and suicidal behaviors were included. Furthermore, between-study heterogeneity was investigated using I2 statistics. In addition, the likelihood of publication bias was evaluated using the Begg and Egger tests, and a trim-and-fill analysis was conducted. The overall effect size was calculated as an odds ratio (OR) with 95% confidence intervals (CIs) using a random-effects model. RESULTS: Out of the 21004 identified studies, 118 studies (involving 692266 participants) met the eligibility criteria. The analysis of data revealed a significant inverse association between social support and suicidal ideation (OR: 0.79, 95% CI: 0.76-0.82), suicide plans (OR: 0.86, 95% CI: 0.79-0.95), suicide attempts (OR: 0.96, 95% CI: 0.94-0.98), and suicide death (OR: 0.85, 95% CI: 0.75-0.96). Moreover, significant heterogeneity was observed across studies, but there was little concern regarding the presence of publication bias. CONCLUSION: Our meta-analysis provides clear evidence for a significant inverse association between social support and suicidal behaviors. However, the observational nature of the included studies and the significant heterogeneity observed across studies highlight the need for further research, including prospective studies and intervention trials, to explore the complex relationship between social support and suicidal behaviors.

Specificity, frequency, and intent: Multiple characteristics of adolescents' suicide plan correlate with their history of suicidal behavior.

BACKGROUND: Suicide plans (SP) can be a common precipitant to suicidal behavior (SB) during adolescence, and SPs can vary in how specific they are, how frequently they are thought about, and how strongly they are intended to be enacted. To date, we have limited understanding of how discrete SP characteristics (i.e., specificity, frequency, and intent to act) present among adolescents, and whether they relate to SB. In the current study, we investigated SP characteristics and their association with SB history among adolescents who had previously considered suicide. METHODS: Participants were 142 community-based adolescents (14-19 years; M = 17.6, SD = 1.4) who reported a history of suicidal ideation. Adolescents provided responses pertaining to their SP history, SP characteristics, and SB history, via the Self-Injurious Thoughts and Behaviors Interview-Revised (SITBI-R). RESULTS: Greater specificity, frequency, and intent were each associated with modestly increased odds of reporting an SB history. The associations between plan specificity and SB history, as well as between frequency of thinking about one's SP and SB history, were mediated by adolescents' intent to act on their SP. CONCLUSIONS: It may not only be whether, but how, adolescents plan for suicide that relates to their tendency to engage in SB.

Association of Obesity, Suicide Behaviors, and Psychosocial Wellness Among Adolescents in the United States.

BACKGROUND: Adolescents with obesity are more likely to exhibit suicide behaviors, but this association may be confounded by psychosocial stigma related to obesity. We examined whether the obesity is independently associated with suicide behaviors among United States adolescents, after adjusting for the psychosocial factors. METHODS: We analyzed data from 2019 Youth Risk Behavior Survey data (N = 13,871 United States adolescents) on recent (past year) suicide behavior (attempt, ideation, and plan); demographics (age, sex, and race/ethnicity); and psychosocial factors (feeling sad/hopeless, alcohol and illegal drug use, being bullied, and sexually abused). Participants were classified as having obesity (Y/N) per standardized percentiles. Logistic regression was employed to examine the association between obesity and suicide attempt, ideation, and plan, while adjusting for psychosocial covariates. RESULTS: The prevalence of suicide attempt, ideation, and plan was 8.90%, 18.75%, and 15.71%, respectively. Obesity prevalence was 15.5%. The odds of suicide attempt, ideation, and plan were 1.65 (1.30-2.11), 1.31 (0.89-1.61), and 1.27 (1.02-1.57), respectively, among those with obesity versus without obesity. DISCUSSION: Obesity is significantly associated with a suicide attempt, ideation, and plan among United States adolescents, even after adjusting for confounding psychosocial factors. Further research on the temporality and causality of this association is needed.

The effect of childhood adversities on the persistence of suicidal ideation and plans among college students: A longitudinal study.

BACKGROUND: Exposure to childhood adversities (CAs) is known to be associated with the onset of suicidal ideation and plans. However, little is known regarding the contribution of CAs to their persistence. AIMS: The study aims to examine the type, number and frequency of CA exposure on the persistence of suicidal ideation and plans at one-year. METHOD: Data were drawn from the French portion of the World Mental Health International College Student survey. At baseline (n = 2661, response rate = 7,58 %), exposure to 12 types of CAs prior to age 18, lifetime mental disorders, lifetime and 12-month suicidal ideation and plans were assessed. At one-year follow-up (n = 1221), 12-month mental disorders, suicidal ideation and plans were assessed. Among those with a prior history of suicidal ideation, logistic regressions were performed to examine the role of CAs on the persistence of ideation and plans at one-year. RESULTS: At baseline, frequency and number of CAs were associated with 12-month suicidal ideation and plans. Among lifetime ideators, 49.6 % reported 12-month suicidal ideation at follow-up. Physical abuse was associated with an increased risk of suicidal ideation and plan persistence at one year in univariate analyses. However, CAs were not associated with the persistence of suicidal ideation and plans at one-year in multivariate analyses. LIMITATIONS: Retrospective report of CA exposure, and low baseline response rate. CONCLUSIONS: Using a fine-grained operationalization of CA exposure, CAs were not involved in the persistence of suicidal ideation or plans, their deleterious effect more likely to occur early in the course of psychopathology.

Differentiating the associations between alcohol use, cigarette smoking, and conditional suicidal behaviors among adolescents.

BACKGROUND: Both alcohol use and cigarette smoking have been identified as risk factors for suicidal behaviors. However, suicide is a process from ideation to action, and some evidence have implied us that alcohol use and cigarette smoking may play different roles in the different process of suicidal behaviors. METHODS: Data was derived from the 2019 Youth Risk Behavior Survey (YRBS), and a total of 12, 487 valid samples were analyzed in the study. To distinguish the different situation of suicidal behaviors, participants were divided into general people without any suicidal behavior (GNS), suicidal ideators without plan or attempt (SINPA), suicide planners without attempt (SPNA), and suicide attempters (SA).1 RESULTS: The prevalence of suicidal ideation, plan, and attempt were 19.4 %, 15.9 %, and 7.7 %, respectively. Comparing to GNS, alcohol use and cigarette smoking were associated with SINPA (OR = 1.27, P < 0.05; OR = 1.47, P < 0.001), SPNA (OR = 1.29, P < 0.01; OR = 1.26, P < 0.01), and SA (OR = 1.31, P < 0.01; OR = 2.11, P < 0.001). However, alcohol use was not associated with SA comparing to SINPA (OR = 1.05, P > 0.05) and SPNA (OR = 1.03, P > 0.05), while cigarette smoking was associated with SA (OR = 1.40, P < 0.01; OR = 1.74, P < 0.001). LIMITATIONS: Firstly, using the secondary data was possibly limited. Next, this was a cross-sectional study, the casual relationship was unsure. Lastly, the amount of alcohol consumption and cigarette smoking status were not considered. CONCLUSION: Both alcohol use and cigarette smoking are risk factors for any suicidal behaviors. However, controlling alcohol use may be a limited method to prevent the further suicidal behaviors for ideators and planners. Managing cigarette smoking should be considered.

Protective Associations between Supportive Environment and Suicidality among Minority and Majority Adolescents.

OBJECTIVE: To examine the association between supportive environments and adolescent suicidal behavior, especially among marginalized minority groups. METHODS: Participants included 12,196 middle and 16,981 high school students who completed the 2019 Vermont Youth Risk Behavior Survey. Multiple logistic regression models were used to assess the association between three protective factors that were part of a supportive environment (feeling like they matter to people in their community, usually eating dinner at home, having a trusted adult) and suicidality (plan or attempt), controlling for key demographics (sex, sexual orientation, gender identity, and race/ethnicity). Moderating effects of demographics were also explored. RESULTS: All supportive environment variables were protective of making a suicide plan and making a suicide attempt (ORs < 0.75, p-values < 0.005). Students of minority identities were significantly more likely to make a suicide plan (middle school ORs: 1.34-3.51, p-values < 0.0005; high school ORs: 1.19-3.38, p-values < 0.02) and attempt suicide (middle school ORs: 1.42-3.72, p-values < 0.006; high school ORs: 1.38-3.25, p-values < 0.0005) compared to students with majority demographic characteristics. Generally, the associations between having a supportive environment and suicidality did not vary within sexual orientation, gender identify, or race/ethnicity subgroups, suggesting that these supportive environment factors were more universally protective. However, a few associations were stronger among students in the majority demographic groups. CONCLUSIONS: These data suggest that having a supportive environment is protective of suicidality for adolescents from both majority and minority demographic groups.HIGHLIGHTSA supportive environment is protective of adolescent suicide plan and attempt.Minority sexual, gender, and racial identities are risk factors for suicidality.Minority and majority students are protected by supportive environments.

Misuse of Prescription Opioids and Suicidal Behaviors Among Black Adolescents: Findings from the 2017 and 2019 Youth Risk Behavior Survey.

PURPOSE: Although some studies have examined the association between prescription opioid misuse and mental health outcomes, few have investigated the effects of prescription opioid misuse on suicidal behaviors among Black adolescents. The objective of this study was to investigate the cross-sectional association between prescription opioid misuse and suicidal ideation, suicide plan, and suicide attempt among Black adolescents. METHODS: Data for this study came from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 4798 Black adolescents aged 14-18 years (51.2% female) was analyzed using binary logistic regression. The outcome variables investigated were suicidal ideation, suicide plan, and suicide attempt, and the main explanatory variable was prescription opioid misuse. RESULTS: Of the 4798 Black adolescents, 15% reported ever misusing prescription opioids; 16.2% experienced suicidal ideation; 14% made a suicide plan; and 11.3% attempted suicide during the past 12 months. In the multivariate logistic regression models, Black adolescents who misused prescription opioids had 1.39 times higher odds of making a suicide plan and 1.65 times higher odds of making a suicide attempt during the past 12 months when compared to their counterparts who did not misuse prescription opioids. Other significant factors associated with suicidal behaviors include female sex, school bullying, cyberbullying, depressive symptoms, and illicit drug use. In addition, physical activity had a protective effect on suicide attempt. CONCLUSION: The findings of the present study demonstrate the effects of prescription opioid misuse and its association with suicidal behaviors among Black adolescents.

The global burden of suicidal behavior among people experiencing food insecurity: A systematic review and meta-analysis.

BACKGROUND: Food insecurity has become a growing burden within a global context where climate change, catastrophes, wars, and insurgencies are increasingly prevalent. Several studies have reported an association between suicidal behaviors (i.e., suicide ideation, plans, and attempts) and food insecurity. This meta-analytic review synthesized the available literature to determine the pooled prevalence of suicidal behaviors among individuals experiencing food insecurity, and examined the strength of their association. METHODS: Databases (Ovid, PubMed, Web of Science, and CINAHL) were searched from inception to July 2022 using appropriate search terms. Eligible studies reporting the number/prevalence of suicidal behaviors among individuals experiencing food insecurity or the association between food insecurity and suicidal behaviors were included. The pooled prevalence of suicidal behaviors was determined using the random-effects model. The review was registered with PROSPERO (CRD42022352858). RESULTS: A total of 47 studies comprising 75,346 individuals having experienced food insecurity were included. The pooled prevalence was 22.3 % for suicide ideation (95 % CI: 14.7-29.9; I2 = 99.6 %, p < 0.001, k = 18), 18.1 % for suicide plans (95 % CI: 7.0-29.1; I2 = 99.6 %, p < 0.001, k = 4), 17.2 % for suicide attempts (95 % CI: 9.6-24.8; I2 = 99.9 %, p < 0.001, k = 12), and 4.6 % for unspecified suicidal behavior (95 % CI: 2.8-6.4; I2 = 85.5 %, p < 0.001, k = 5). There was a positive relationship between experiencing food insecurity and (i) suicide ideation (aOR = 1.049 [95 % CI: 1.046-1.052; I2 = 99.6 %, p < 0.001, k = 31]), (ii) suicide plans (aOR = 1.480 [95 % CI: 1.465-1.496; I2 = 99.1 %, p < 0.001, k = 5]), and (iii) unspecified suicide behaviors (aOR = 1.133 [95 % CI: 1.052-1.219; I2 = 53.0 %, p = 0.047, k = 6]). However, a negative relationship was observed between experiencing food insecurity and suicide attempts (aOR = 0.622 [95 % CI: 0.617-0.627; I2 = 98.8 %, p < 0.001, k = 15]). The continent and the countries income status where the study was conducted were the common causes of heterogeneity of the differences in the odds of the relationships between experiencing food insecurity and suicidal behaviors - with North America and high-income countries (HICs) having higher odds. For suicide attempts, all non HICs had a negative relationship with food insecurity. LIMITATIONS: There was significant heterogeneity among the included studies. CONCLUSION: There is a high prevalence of suicidal behaviors among individuals experiencing food insecurity. Initiatives to reduce food insecurity would likely be beneficial for mental wellbeing and to mitigate the risk of suicidal behaviors among population experiencing food insecurity. The paradoxical finding of suicide attempts having a negative relationship with food insecurity warrants further research.

Hierarchical Analysis of Disparities in Suicidal Outcomes With Intersection of Sexual Minority and Gender Among U.S. Youth, 2017.

Sexual minority youth have a higher risk of suicidal behaviors than their straight peers. Despite this alarming trend, there is limited information on how health-risk factors are systematically associated with suicidal outcomes in relation to the intersection of sex and sexual orientation identity. Data from the 2017 Youth Risk Behavior Survey (Grades 9-12, N = 14,108) were analyzed to examine three distinct suicidal outcomes (i.e., suicidal ideation, suicide planning, and suicide attempt). Separate hierarchical logistic regression models were performed to gradually adjust for influencing factors in examining the association between suicidal outcomes and sexual orientation identity (i.e., heterosexual, gay/lesbian, bisexual, and unsure), stratified by self-reported sex. There exist significant differences in youth suicidal behaviors based on sexual orientation identity and sex: lesbians (adjusted odds ratio [AOR] = 2.7, 95% CI [1.5, 5.0]), bisexual girls (AOR = 1.9, 95% CI [1.3, 2.6]) and bisexual boys (AOR = 2.6, 95% CI [1.3, 5.2]) had higher odds of suicide attempts than their straight peers. Unsure boys and girls also reported higher risks of suicidal ideation and suicide plan as compared with their straight peers. Having a very short sleep duration, reporting ever use of illicit drugs, being bullied, and feeling sad/hopeless were associated with elevated risks of suicidality across males and females. This study identified potential disparities in suicidal outcomes by sexual orientation identity as well as factors that attenuate or strengthen this relationship in a representative sample of adolescents across the United States. An improved understanding of the differences in suicidal outcomes will serve as an opportunity to ameliorate any potential inequalities and improve sexual minority youth' health outcomes.

Carbon Monoxide Poisoning was Associated With Lifetime Suicidal Ideation: Evidence From A Population-Based Cross-Sectional Study in Hebei Province, China.

Objectives: We want to test the association between carbon monoxide poisoning (CMP) experiencing and lifetime suicidal ideation/suicide plan among community residents. Methods: This is a population-based cross-sectional study conducted among community residents in Hebei province, China. We analyzed a total of 21,376 valid questionnaires. CMP experience and lifetime suicidal ideation/suicide plan were assessed in this study. Logistic regression and false discovery rate correction were conducted to analyze the associations and correct the p values. Results: We found that CMP (OR = 2.56, p < 0.001, corrected-p = 0.001) was associated with lifetime suicidal ideation, and the other risk factors were female (OR = 0.53, p < 0.001, corrected-p = 0.001). The association between CMP and suicide plan was not supported after false discovery rate correction (OR = 2.15, p = 0.035, corrected-p = 0.385). For the CMP patients, experiencing ≥2 times CMP (OR = 2.76, p = 0.001, corrected-p = 0.011) was also in higher risk of lifetime suicidal ideation. The association between CMP times and lifetime suicidal plan was not supported after false discovery rate correction (OR = 4.95, p = 0.021, corrected-p = 0.231). Conclusion: CMP patients are in higher risk of lifetime suicidal ideation. For CMP patients, some strategies are needed to control their suicidal ideation.

Association Between the Patterns of Five Unhealthy Behaviors and Suicidal Behaviors Among Adolescents in Six Provinces of China.

Background: In adolescents, multiple unhealthy behaviors frequently occur together and are likely to be associated with suicidal behaviors (SBs), increasing the risk of suicide. This study aimed to clarify the potential patterns of unhealthy behaviors in Chinese adolescents and to examine the associations between the different patterns of unhealthy behaviors and SBs. Methods: A total of 22,628 middle school students were enrolled in this study. Self-reported unhealthy behaviors and SBs were investigated using questionnaires. Latent class analysis (LCA) was performed based on five unhealthy behaviors [smoking, alcohol use (AU), diet pill use (DPU), screen time (ST), and problematic mobile phone use (PMPU)]. Multivariate logistic regressions were used to examine associations between the different patterns of unhealthy behaviors and SBs. Results: Four subgroups of unhealthy behaviors were identified by LCA, including high-risk class (smoking/AU/DPU/PMPU/ST), moderate-risk class 1 (DPU/PMPU), moderate-risk class 2 (smoking/AU/ST), and low-risk class. Compared with the low-risk class, moderate-risk class 1, moderate-risk class 2, and high-risk class had higher risks of suicidal ideation, suicide plan, and suicide attempt. Conclusions: These findings suggested that patterns of unhealthy behaviors were related to SBs in Chinese adolescents. Accordingly, considerations of different classes of unhealthy behaviors may be essential for developing effective preventive programs.