Age variability in the association between heavy episodic drinking and adolescent suicide attempts: findings from a large-scale, school-based screening program.
OBJECTIVE
Alcohol use is a risk factor for suicidal behavior among adolescents, but it is not clear whether this association is consistent during the adolescent period. This study examined the age-specific associations between heavy episodic drinking (HED) and self-reported suicide attempts in a large and diverse sample of adolescents.


METHODS
Screening data from 32,217 students, between the ages of 11 and 19 years, in 225 schools were analyzed. Logistic regression analyses estimating the impact of HED on self-reported suicide attempts in the past year were performed.


RESULTS
Heavy episodic drinking was significantly associated with self-reported suicide attempts (odds ratio 1.78, p <.05) controlling for depressive symptoms. However, there was substantial age variability in this association, with the association between HED and self-reported attempts stronger among younger adolescents. Among youths aged 13 years and younger, those who reported an episode of HED during the past year were roughly 2.6 times more likely to report an attempt than those who did not report HED in the past year, in contrast to 1.2 times among youths aged 18 years and older.


CONCLUSIONS
Heavy episodic drinking is a clear risk factor for suicidal behavior among younger adolescents, beyond the risk conveyed by depressive symptoms. Further research investigating the bases for increased suicide risk among younger adolescents engaging in HED is warranted. Results provide support to AACAP's practice parameters calling for attention to substance abuse in the assessment of suicide risk and suggest that routine screening for HED by physicians may improve the detection of adolescent suicide risk, particularly among younger adolescents.
Aseltine
Robert H
RH
Drs. Aseltine, Schilling, and James are with the Division of Behavioral Sciences and Community Health and the Institute for Public Health Research, University of Connecticut Health Center; Ms. Glanovsky is with the Department of Statistics, University of Connecticut and the Institute for Public Health Research, University of Connecticut Health Center; Dr. Jacobs is with Harvard Medical School. Electronic address: aseltine@uchc.edu.
Schilling
Elizabeth A
EA
Drs. Aseltine, Schilling, and James are with the Division of Behavioral Sciences and Community Health and the Institute for Public Health Research, University of Connecticut Health Center; Ms. Glanovsky is with the Department of Statistics, University of Connecticut and the Institute for Public Health Research, University of Connecticut Health Center; Dr. Jacobs is with Harvard Medical School.
James
Amy
A
Drs. Aseltine, Schilling, and James are with the Division of Behavioral Sciences and Community Health and the Institute for Public Health Research, University of Connecticut Health Center; Ms. Glanovsky is with the Department of Statistics, University of Connecticut and the Institute for Public Health Research, University of Connecticut Health Center; Dr. Jacobs is with Harvard Medical School.
Glanovsky
Jaime L
JL
Drs. Aseltine, Schilling, and James are with the Division of Behavioral Sciences and Community Health and the Institute for Public Health Research, University of Connecticut Health Center; Ms. Glanovsky is with the Department of Statistics, University of Connecticut and the Institute for Public Health Research, University of Connecticut Health Center; Dr. Jacobs is with Harvard Medical School.
Jacobs
Douglas
D
Drs. Aseltine, Schilling, and James are with the Division of Behavioral Sciences and Community Health and the Institute for Public Health Research, University of Connecticut Health Center; Ms. Glanovsky is with the Department of Statistics, University of Connecticut and the Institute for Public Health Research, University of Connecticut Health Center; Dr. Jacobs is with Harvard Medical School.
D000293:Adolescent; D000367:Age Factors; D000435:Alcoholic Intoxication / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008403:Mass Screening; D016017:Odds Ratio; D018570:Risk Assessment / Q000706:statistics & numerical data; D012737:Sex Factors; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States