Injection drug use is associated with suicide attempts but not ideation or plans in a sample of adolescents with depressive symptoms.
OBJECTIVE
Based on the interpersonal theory of suicide, pain habituation that occurs with injection substance use may raise risk for a suicide attempt. The current study tested whether injection substance use, relative to painless routes of substance administration, was related to greater risk for suicide attempts. We also assessed whether this risk was specific to suicide attempts and not suicidal ideation or suicide plans.


METHODS
Data on 2095 substance-using adolescents aged 12-17 who endorsed clinically significant depression symptoms and answered questions on suicidal thoughts and behavior were drawn from the 2004-2011 National Survey on Drug Use and Health, a nationally representative household survey. Logistic regression analyses were conducted to assess the associations between injection substance use and suicidal ideation, plans, and attempts.


RESULTS
Injection substance use was associated with suicide attempts (OR = 3.02, 95% CI = 1.75-5.23) but not ideation or plans. These findings were not accounted for by sex, age, race/ethnicity, family income, abuse and dependence symptoms, and depression symptoms. Among ideators, injection substance use was associated with suicide attempts (OR = 2.92, 95% CI = 1.58-5.06), but not plans. Among suicide planners, injection substance use was associated with suicide attempts (OR = 5.16, 95% CI = 1.88-14.17).


CONCLUSIONS
Consistent with the interpersonal theory of suicide, adolescent injection drug use was associated with specific risk for suicide attempts but not ideation or planning. Hence, consideration of the manner in which adolescents use substances is important in evaluating suicide risk in this population.
Adolescent Mood and Behavior Program, Emma Pendleton Bradley Hospital, United States; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States. Electronic address: richard_liu@brown.edu.
Richard T
RT
Liu
Health Services Research Program, Emma Pendleton Bradley Hospital, United States; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States; Department of Health Services, Policy, and Practice, Public Health Program of Brown University, United States.
Brady G
BG
Case
Adolescent Mood and Behavior Program, Emma Pendleton Bradley Hospital, United States; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States.
Anthony
A
Spirito
D000293:Adolescent; D002648:Child; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D013287:Illicit Drugs; D007267:Injections; D008297:Male; D008606:Mental Processes; D008960:Models, Psychological; D015999:Multivariate Analysis; D012306:Risk; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D059020:Suicidal Ideation; D013406:Suicide, Attempted
D013287:Illicit Drugs
Adolescents; Epidemiology; Interpersonal theory of suicide; Substance use; Suicide