The associations of suicide attempts in adolescents

E R Woods, Y G Lin, A Middleman, P Beckford, L Chase, R H DuRant
Pediatrics 1997, 99 (6): 791-6

OBJECTIVE: Suicide completion has increased in the United States among 15- to 24-year-olds from 4.5 per 100 000 (1950) to 13.2 per 100 000 (1990). Suicide attempts have been found to be associated with depression, substance use, overall number of life stressors, gender, and impulsive behaviors. We hypothesized that suicide attempt is associated with many other health risk behaviors.

DESIGN: To evaluate this hypothesis, we analyzed the data from the 1993 Massachusetts Youth Risk Behavior Survey from a representative sample of students in grades 9 through 12 in public and private high schools. We examined the relationships between ever attempting suicide and engaging in other health risk or problem behaviors (eg, sexual activity, substance use, violence, and seat belt nonuse).

RESULTS: The 3054 students were distributed among the 9th to 12th grades; 50.7% were female, 77.7% white, 6.7% black, 5.9% Hispanic, 4. 6% Asian, .8% Native American, and 4.4% other; and the mean age was 16 +/- 1.2 years. Based on logistic regression analysis, ever attempting suicide was associated with physical fights in the past 12 months (odds ratio [OR] = 1.3[95% confidence interval (CI), 1. 22-1.44]), regular cigarette use in the past 30 days (2.0[1.41-2. 97]), female gender (3.2[2.21-4.71]), lack of seat belt use (1.3[1. 21-1.34]), gun carrying in the past 30 days (1.4[1.12-1.70]), substance use before last sexual activity (1.4[1.09-1.84]), Native American or other (2.4[1.21-4.71]), and lifetime use of other drugs (1.2[1.04-1.40]). The full model correctly assigned 92% of the youth. There were small differences in models for males, females, and sexually active youth. Same gender sexual experiences for sexually active youth did not significantly improve the model (partial r = .0, OR = .87 [95% CI, .33-2.30]) and fewer (88%) of the youth were correctly assigned by the model.

CONCLUSIONS: Ever attempting suicide is associated with other problem behaviors. This research proposes an empirical model of the relationship between suicide attempts and other health risk behaviors. Identifying which adolescents are at risk for suicide attempts from the presence of accompanying risk behaviors will help clinicians to evaluate suicide risk when other problem behaviors are identified, thus enabling the design of possible prevention strategies.

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