Authors: April Kortz, Alex Holter, and Aundrea Edwards
Helena College University of Montana
Suicidal ideation and attempts start emerging in adolescents and can be increased by the use of illicit drugs and/or alcohol. Montana adolescents participate in a survey, YRBSS, every other year that helps monitor mental health status, drug use, alcohol use, and other items. The researchers used the YRBSS data from 1999 to 2013 to look for a link between alcohol use, drug use, suicidal ideation and attempts. The data showed that students who answered yes to feeling hopeless were more likely to have had used drugs or drank alcohol on school property within 30 days, these students were more likely to answer to having attempted suicide within the last 12 months. This research shows more research is needed to look at the relationship between suicidal ideation/attempts and drugs/alcohol in Montana youth.
The Relationship between Drug and Alcohol Use and Suicidal Idealization and Attempts of Montanan Adolescence
The transition from childhood into adulthood represents a phase of biological and psychological development otherwise known as adolescence. Suicidal ideations and other suicidal thoughts first emerge as a major public health problem during adolescence. Judge and Billick (2004), reviewed the available suicide data for the United States and found that, during 2001, 4,382 U.S. youths between the ages of 15 and 24 completed suicide. Adolescents are faced with new and unexpected developmental changes starting in the middle school years. The frequent discrepancies in this process render some adolescents particularly vulnerable to periods of marked psychological pain and distress (Pfeffer, 1997).
The relationship between suicidal ideation/attempts and substance use have started to become an increasing interest for researchers. Zhang and Wu (2014) looked at four waves of public-use Add Health data to look into the association. They looked into past-year drug use (including alcohol and other drugs) in relation to past-year suicidal ideation. After they received the data, Zhang and Wu (2014) created fixed effects models with lagged dependent variable to test for unidirectional associations between substance use and suicidal ideation. Non-recursive models with feedback loops were also conducted to examine reciprocal relations between suicidal ideation and each substance that could have been used. Once the information was adjusted for the time-invariant effects and lagged effects of dependent variables, the associations from substance use to suicidal ideation were consistently significant. The use of cigarettes or alcohol increased the risk of suicidal ideation, while suicidal ideation was not associated with cigarette or alcohol use. The same held true for other substances used (Zhang and Wu, 2014).
A particular high risk factor for suicide attempts among adolescents is within 12 months after being discharged from a treatment facility. Czyz and King (2015) completed a longitudinal study of adolescents with suicidal ideation and how hospitalization affected the chance of re-hospitalizations or suicidal attempts. The 376 participants, ranging in ages 13-17 and sex, were assessed at hospitalization as well as 3, 6, and 12 months after discharge. Trajectory groups, and predictors, were identified by Czyz and King (2015) by using latent class growth modeling. Logistic regression was used to examine associations between trajectory groups and their likelihood of suicide attempts and re-hospitalization. The research found that adolescents in the chronically elevated ideation group had a 2.29 and 4.15 greater odds of attempting suicide and 3.23 and 11.20 greater odds of re-hospitalization. Hopelessness was associated with persisting suicidal ideation (Czyz and King, 2015). Their results suggest that suicidal ideation severity at their original hospitalization may not be an adequate marker for subsequent crises.
Psychoactive substance use disorder (PSUD) has also been researched in its relation among suicidal adolescents who have been hospitalized. Mean et. al (2005) conducted a study on 186 adolescents monitoring for substance intoxication at the moment of the attempt and the association PSUD at baseline and either occurrence of suicide or repetition of suicide attempt(s). 148 participants were traced again after 6 or 18 months for evaluations. The research found that 39.2% of the subjects were found to have a PSUD. A significantly higher proportion was intoxicated at the time of their attempt than those without PSUD. During the course of tracing the 148 participants, it was found that two had completed suicide and 30 had repeated suicide attempts. Mean et al (2005) found that adolescents that are hospitalized for suicide attempt or ideation have a high risk of attempting suicide again as well as a higher risk of completion and is marginally associated with PSUD.
A group of chemically dependent adolescents, a group that is commonly at high risk of self-destructive behavior, were studied for suicidal ideation and attempts. Deykin and Buka (1994), interviewed 300 addicts and their families aged 15 through 19 years as well as assessed by the diagnostic interview schedule and a social history interview. Their research found that 31%-75% of the subjects reported suicidal ideation while 28%-61% reported attempting suicide, with females predominating. They found that the subjects had a higher risk of a suicide attempt when thoughts of suicide coincide with morbid ideation that has been existing for an extended duration. Substance abuse treatment requires an assessment of suicidal potential as well as counseling for those in the high risk category, paying special attention to male subjects who have been exposed to abuse.
The association between suicidal ideation/attempts and different types/number of substances are unclear. Wong, Zhou, Goebert and Hishinuma (2012) examined data from the Youth Risk Behavior Survey (YRBS) from 2001 to 2009 which included 73,183 high school students. Their research examined the association between lifetime use of ten common substances of abuse (alcohol, cocaine, ecstasy, hallucinogens, heroin, inhalants, marijuana, methamphetamines, steroids and tobacco) and four different measures of suicidality they had over the past year (suicidal ideation, suicide plan, suicide attempt, and severe suicide attempt requiring medical attention). The logistic regression analyses of the data controlled for potential confounders in the data: socio-demographic variables, interpersonal violence, sexual intercourse and symptoms of depression and eating disorder. Wong, Zhou, Goebert, and Hishinuma’s (2012) results showed that adolescents that reported a history of heroin use had the strongest association with suicidal ideation, suicide planning, and suicide attempts including severe attempts. Each of the ten substances and the four measures of suicidality remained significant with multivariate analysis (p<0.05). Their research shows that there is a strong risk factor for suicidal thoughts and behaviors among American high school students with substance abuse. The relationship between them increases with particular illicit drugs and higher number of substances.
The relationship between suicidal ideation and attempts to use of illegal substances among adolescents is one that has been researched using different methods. The YRBS survey provides some insight into adolescents that otherwise could be missed during regular interviews. Using YRBS data, this study will aim to provide information on Montana students, in High school age, and how suicidal ideation/attempts relate to substance use (i.e. drugs and alcohol).
The data for this study was reviewed to determine if there is relationship between drug and alcohol use and suicidal idealization or suicide attempts in Montana adolescence. High school students in Montana were surveyed during school hours. The students were administered surveys in which participation was completely voluntary. Their responses were recorded according to the students’ prevalence of a given behavior. This survey is the Youth Risk Behavioral Surveillance System (YRBSS) and the data is evaluated by the Centers for Disease Control and Prevention. With the data from the YRBSS the CDC is able to determine the prevalence of the behaviors among adolescents in Montana as well as in other states. The data collection that we obtained occurred on odd numbered years starting in 1999 and ending in 2007. The data studied included the whole state of Montana high school students. This study looked at the data that included adolescents who used drugs, specifically marijuana and cocaine, and/or alcohol in school in the last 30 days. This study also looked at students that struggled with emotional feelings that included feeling sad or hopeless for more than 2 weeks in the past 12 months, or had thoughts of suicide and/or suicide attempts in the last 12 months.
After analyzing the data through SPSS, there was significant data for specific items that were investigated. First, a relationship was found between alcohol use in the last 30 days on school property and whether or not the respondents answered yes or no to the question of feeling sad or hopeless for more than 2 weeks in the past 12 months. These results are shown by F (11, 19966) =28.632, p<.001, Ƞ²=.016. This indicates that the overall means for yes are significantly higher than the overall means of no (see Table 1). As Figure 1 indicates, the difference between answering yes or no to feeling sad or hopeless for more than 2 weeks in the past 12 months cannot be explained by years because the issue of using alcohol in school in the last 30 days was there before 1999 and will be there after 2013. The data is significant, but it only explains .016 of the variance of the difference between the yes and no lines as explained by alcohol.
Second, a relationship was also found between marijuana use in the last 30 days on school property and whether or not the respondents answered yes or no to the question of feeling sad or hopeless for more than 2 weeks in the past 12 months. These results are shown by F (11, 19980) =23.176, p<.001, Ƞ²=.013. This indicates that the overall means for yes are significantly higher than the overall means of no (see Table 2). As Figure 2 indicates, the difference between answering yes or no to feeling sad or hopeless for more than 2 weeks in the past 12 months cannot be explained by years because the issue of using marijuana in school in the last 30 days was there before 1999 and will be there after 2013. The data is significant, but it only explains .013 of the variance of the difference between the yes and no lines as explained by marijuana.
The next relationship found, was between cocaine use in the last 30 days and whether or not the respondents answered yes or no to the question of feeling sad or hopeless for more than 2 weeks in the past 12 months. These results are shown by F (9, 15208) =28.245, p<.001, Ƞ²=.016. This indicates that the overall means for yes are significantly higher than the overall means of no (see Table 3). As Figure 3 indicates, the difference between answering yes or no to feeling sad or hopeless for more than two weeks in the past 12 months cannot be explained by years because the issue of using cocaine in the last 30 days was there before 1999 and will be there after 2007. The data is significant, but it only explains .016 of the variance of the difference between the yes and no lines as explained by cocaine.
After the suicidal ideations were compared to alcohol; marijuana; and cocaine, suicide attempts in the past 12 months where compared to the amount of alcohol consumed on school property in the last 30 days was analyzed. These results are shown by F (44, 24761) =109.949, p<.001, Ƞ²=.163. This indicates that the overall means for 5 or more times of attempting suicide as related with using alcohol in school in the last 30 days are significantly higher than the overall means of 4 or fewer times of attempting suicide as related with using alcohol in school in the last 30 days. As Figure 4 indicates, the difference between how many times a person attempted suicide in the past 12 months as related with using alcohol in school in the last 30 days cannot be explained by years because the issue was there before 1993 and will be there after 2013. The data is significant, but it only explains .163 of the variance of the difference between the amounts of times a person attempted suicide in the past 12 months as related with using alcohol in school in the last 30 days
The last comparison that was evaluated was suicide attempts in the past 12 months as it related to the amount of marijuana smoked on school property in the last 30 days. These results are shown by F (44, 24784) =59.633, p<.001, Ƞ²=.096. This indicates that the overall means for 5 or more times of attempting suicide as related with using marijuana in school in the last 30 days are significantly higher than the overall means of 4 or fewer times of attempting suicide as related with using marijuana in school in the last 30 days. As Figure 5 indicates, the difference between how many times a person attempted suicide in the past 12 months as related with using marijuana in school in the last 30 days cannot be explained by years because the issue was there before 1993 and will be there after 2013. The data is significant, but it only explains .096 of the variance of the difference between the amounts of times a person attempted suicide in the past 12 months as related with using marijuana in school in the last 30 days.
Adolescents have substantial volume changes in gray and white matter in the brain. Gray matter is made of neuronal cell bodies, dendrites, glial cells, synapses, and capillaries. While gray matter decreases during adolescence, white matter increases. White matter increasing is due to increased myelination of axons, thus allowing better communication between brain regions. Changes begin in the posterior portion of the brain and progress to the anterior regions. These neural changes occur well into the mid-to-late 20’s.
Alcohol affects GABA (Gamma-Amino Butyric Acid, inhibits neurotransmission which clams activity) receptors making them more inhibitory. Prevents glutamate (an excitatory neurotransmitter) from exiting the cell. Alcohol also affects the Prefrontal cortex which aids in decision making, memory, and impulse control. With how alcohol affects the brain function, when an adolescents drinks they are not able to make good decisions which can lead to attempting and or completing suicide, especially if paired with feeling hopeless and sad.
In marijuana, THC mimics anandamide (the brain’s own cannabinoid receptor) by binding to the cannabinoid receptors, which then allows dopamine to stay in the synapse. Marijuana slows down body movements, helping us feel relaxed and calm. Cocaine blocks dopamine transporters leaving them trapped in the synaptic cleft which overstimulates the cell. Cocaine also affects the area of the brain controlling voluntary movements. Alcohol is the most commonly used substance among adolescents with marijuana being the second most used substance.
Montana is a state that targets Meth use, this research shows that cocaine use is higher on school property as well as marijuana use. This would be another area to research more to see if Methamphetamines are the drugs that should be targeted or if the focus should change, especially if cocaine is found to be more commonly used across the U.S.A on school property. It is also possible that cocaine may be more easily accessible to students compared to methamphetamines, which is another area that would be considered with further study.
This research has found that there is an association between alcohol consumption as well as drug use on school campuses and suicidal ideation and/or attempts. Risk seeking behavior could be related to conduct disorder or a way for students to reach out for help, more research would need to be done in this area to know for sure. Data is limited to every other year and the most recent year, 2015, is not available to view to see if the increase of drug and alcohol use is continuing. The questions asked in the YRBSS do not cover all the possibilities that could explain suicidal ideation and did not provide as much raw data. Further research should be done on Montana adolescents to help explain the increase of drug use on school property as well as its link to suicidal ideation and attempts.
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END NOTES: This paper was originally presented at the Fourth Annual Montana Student Research Forum for Two Year Colleges on April 8, 2016. Research was conducted at Helena College University of Montana with Institutional Review Board approval through the University of Montana. Supervising faculty for this paper were Dr. Nathan Munn (PI) and Professor Peterson (analysis).