Now I Am Ready to Die: A Look at Substance Use, Suicidality and Acquired Capability in Adolescents

Background: Although a lot of media attention focuses on adolescent homicide, suicide deaths should be of equal or greater concern to society.  Suicide deaths are more prevalent in adolescents than homicide.  It is reported that 17.0% of students in Grades 9th -12th seriously considered attempting suicide in the previous 12 months.  However only a percentage of those who consider attempting suicide go on to attempt suicide.  Joiner Interpersonal Theory of Suicide theorized that for an individual to move from thinking about suicide to trying to die by suicide, acquired capability for suicide (ACS) is necessary. Literature has commonly identified substance use as a risk factor for suicide.  Marijuana, alcohol and prescription drug use were most prevalent among adolescent substance uses.  The purpose of this study is to examine the role of substance use (alcohol, prescription drugs and marijuana) as a proxy to ACS in adolescents who reported suicide ideation.  Methods: A cross-sectional design, using secondary data gathered from the 2015 Youth Risk Behavior Survey (YRBS) were used for this study.  The YRBS is a national, representative school-based survey was developed in 1990 to monitor priority health risk behaviors that contribute markedly to the leading causes of death, disability, and social problems among students in Grades 9 through 12 in the United States.  Because this study was looking at adolescents who reported suicide ideation, the sample for this study was the 2,808 students who reported suicide ideation.  Results: A multiple logistic regression was performed to measures the likelihood of the substance use increasing ACS.  Results show substance use was significantly associated with greater odds of attempting suicide; adolescent who use alcohol had 49% greater odds, marijuana 47% greater odds, and prescription drugs 55% greater odds of attempting suicide. Being females had 67% greater odds of attempting suicide. Race significantly contributes to the probability of attempting suicide, being black or Hispanic had 56% greater odds of attempting suicide, reporting race as Other had 64% greater odds of attempting suicide compared to those who reported race as White.  Conclusion and Implications: In conclusion, substance use, was identified as a proxy to ACS, these findings help shape the framework to explain how adolescents who have suicide ideation transitions to attempting suicide.  Suicide is a preventable death, with further investigation into the role of substance use and its impact on ACS can inform prevention, treatment methods and better assess the risk associated with suicidality and the co-occurrence of substance use.   

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