Depression Symptoms and Alcohol Use and Their Association with Suicidal Behavior Among Dominican Adolescents

Background and Purpose.   The World Health Organization (WHO) has identified suicide behavior among young people as a worldwide public health concern. There is an increasing interest in understanding the role played by risk factors in the suicide attempts reported by adolescents living in developing countries.  Among the many risk factors influencing adolescent suicidal behavior (e.g., family history), depression and problematic alcohol use are two of the most important.  This project aims to answer three questions: (1) What are the levels of depressive symptoms, problematic alcohol use, and suicidal behavior among adolescents attending public secondary schools in Dominican Republic? (2) Are depression symptoms, and problematic alcohol use associated with suicide attempts? (3) Is there an independent effect of problematic alcohol use on suicide attempts even when controlling for depressive symptoms among Dominican youth? 

 Methods. For this report we drew data from the 566 questionnaires completed by adolescents who were attending two public secondary schools (grades 9 to 12) in urban and rural settings in Dominican Republic. Data was collected between January and February 2008. At each school, one classroom of students from each grade was randomly selected to complete the questionnaires (eight classrooms in total).  The outcomes and demographic measures were based on a modified Spanish version of the National Longitudinal Study of Adolescent Health.  Self-reported surveys included questions about risk behaviors (e.g., alcohol use), depression, and suicidal behaviors.  Data manipulation and analysis were performed using Stata Release 11 (StataCorp, College Station, TX, 2011).

 Results.  Dominican adolescent females reported higher rates of depressive symptoms and suicidal behavior than males (depression: 34.32% vs. 17.54%; suicide planning: 10.64% vs. 2.73%; suicide attempts: 13.43% vs. 5.36%).  Boys reported higher rates of lifetime alcohol use (81% vs. 74.93%).  The theorized relationship between depression symptoms, problematic alcohol use, and suicide attempts was confirmed by the data (Likelihood χ²=54.92, p<.0000).    Adolescents who were depressed had a 3.16 greater likelihood (p<.000) of attempting suicide that those who were not, when controlling for problematic alcohol use, age and gender.  Those adolescents who reported problematic alcohol were 4.78 times (p<.000) more likely to attempts suicide. Being a female increased the likelihood of attempting suicide by 2.51 times (p<.01)

 Conclusions and implications.  Consistent with the literature, Dominican adolescent females reported higher rates of depressive symptoms and suicidal behavior than males.  Boys, on the other hand, reported higher rates of lifetime alcohol use. Problematic alcohol use has a stronger independent direct effect than depressive symptoms on suicide attempts.  Thus, depression symptoms and problematic alcohol use increase the risk of suicide attempts among Dominican adolescents. This is an important finding, taking into consideration the higher levels of alcohol consumption and problematic alcohol use described for this sample.  This study has implications for social workers interested in depression, alcohol abuse and suicide prevention services development and implementation in Dominican Republic.