Alcohol Use, Marijuana Use, and Suicidal Ideation Among Child Welfare Involved Youth: A Longitudinal Examination

Background and Purpose: Alcohol and marijuana misuse and suicide are pervasive public health problems among youth in the United States. It is estimated that over 190,000 youth go to the emergency department each year as a result of alcohol related injuries and over 5,000 youth are estimated to die each year from alcohol related incidents. Moreover, suicide is the second leading cause of death for adolescents, resulting in more than one in ten deaths among adolescents. Having a history of childhood abuse confers risk for suicidal ideation and alcohol and marijuana use, however, some significant gaps remain in the empirical literature. The purpose of this study was to examine the co-occurrence of alcohol and marijuana use and suicidal thoughts among maltreated youth over time and to investigate longitudinal predictors of alcohol use, marijuana use, and suicidal thoughts among maltreated youth.

Methods: Data from this study come from the National Survey of Child and Adolescent Wellbeing II (NSCAW II), a three wave longitudinal survey of U.S. youth and their families who had child abuse or neglect investigations conducted by Child Protective Services. For this study, adolescents (N = 1,402) age 11-17.5 (M_age = 14.13; 52.85% White; 55.43% female) were included in analyses. Variables included alcohol use; marijuana use; suicidal ideation; deviant peer affiliation; age; gender; race; maltreatment type; placement type; caregiver physical health, mental health, drug abuse, alcohol dependence; and time. Three random effect models were estimated for alcohol use, marijuana use, and suicidal ideation.

Results: The first model was significant (Wald Chi² = 117.13, p < .001) with marijuana use, caregiver drug abuse, deviant peer affiliation, age, and race predicting alcohol use. The second model was significant (Wald Chi² = 70.57, p < .001) with alcohol use, deviant peer affiliation, age, and time predicting marijuana use. The third model was significant (Wald Chi² = 47.45, p < .001) with alcohol use, deviant peer affiliation, age, and gender predicting suicidal ideation. When controlling for all other variables, adolescents with suicidal ideation were 113% more likely to drink alcohol than those without, and adolescents who drank alcohol were 134% more likely to have suicidal ideation than those who did not.

Conclusions and Implications: Results indicate a bidirectional relationship between alcohol use and suicidal ideation among child welfare involved youth. This relationship was not present between marijuana use and suicide ideation. Findings highlight the critical need for additional supports and interventions for youth involved with the child welfare system and suggest that the child welfare system may benefit from the implementation of integrated alcohol and suicide prevention services in an effort to ameliorate the public health problems of alcohol misuse and suicide.