Suicide Ideation and Attempts among Inhalant Users: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions

Background and Purpose. Suicide is the 4th leading cause of death for adults in the U.S. (CDCP, 2007). Approximately 14 % of adults report suicidal ideation during their lifetimes and 5 % report one or more suicide attempts (Kessler et al., 1999). Psychiatric disorders are strongly associated with increased risk for suicidal behavior, with substance use disorders among the most potent predictors of suicidality. Reports have documented notable rates of inhalant use and inhalant-related suicide ideation, attempts, and completed suicides in clinical or otherwise select populations of conduct disordered youth (Sakai et al., 2004), homeless and runaway adolescents (Greene & Ringwalt, 1996), men who have sex with men (Botnick et al., 2002), persons with schizophrenia spectrum disorders (Shoval et al., 2006), and aboriginal peoples (Wick et al., 2007). However, little is know about the prevalence of suicide ideation/attempts among inhalant-using adults in the general population. Thus, this study examined the relationship of inhalant use, abuse, and dependence to suicidal behavior using data from the largest (N = 43,093) comorbidity survey conducted in the U.S.

Methods. Data for this study were from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Young adults, African American, and Hispanic respondents were oversampled. Multivariate logistic regression was used to test the association between inhalant use and suicidality, while controlling for other sociodemographic, clinical variables and other potentially confounding variables. Estimates were adjusted to account for the complex survey design, various forms of nonresponse, and to reflect the 2000 census figures for the U.S. population.

Results. A total of 13,733 adults reported that they had experienced a time when they felt sad, blue, or down most of the time or during which they didn't care about/enjoy the things that they usually cared about/enjoyed for at least a 2-week period. Within this sample of lifetime low-mood respondents, inhalant users and persons with formal DSM-IV inhalant use disorders (IUDs) were significantly more likely to be young adults, never married, and to meet criteria for antisocial personality disorder and anxiety disorders than non-users. Suicide attempts were significantly more common among lifetime inhalant users (18.1%) and adults with IUDs (20.2 %) than in non-inhalant users (7.1 %). Suicide attempts were reported by nearly one-third (30.9 %) of adult women who had used inhalants. Respondents with IUDs were significantly more likely to report thinking about committing suicide (OR = 2.2), thinking about wanting to die (OR = 2.0), and thinking about one's own death (OR = 1.7).

Conclusions and Implications. Inhalant use has been called the “forgotten epidemic,” because such use is widespread but rarely addressed in public or professional settings. Suicidal thoughts and attempts are significantly elevated among inhalant users and persons with IUDs. Mental health, chemical dependency, and other social services settings wherein risk for suicide is elevated should routinely screen for inhalant use.