Substance use and suicidal conducts : a study of adolescents hospitalized for suicide attempt and ideation

RESUME Objectifs: Etudier la prévalence des troubles liés à l'utilisation de substances psychoatives parmi des adolescents suicidaires; évaluer l'influence de la prise de substances psychoactives sur le geste suicidaire; analyser l'association entre les troubles liés à l'utilisation de substances psychoactives et le risque de récidive de la conduite suicidaire. Méthode: 186 adolescents, âgés de 16 à 21 ans, hospitalisés pour tentative de suicide ou idées suicidaires envahissantes, ont été inclus. Parmi eux, 148 ont été revus pour évaluation à 6 et/ou 18 mois. Des diagnostics psychiatriques, basés sur les critères du DSM-IV, ont été posés à l'aide d'un questionnaire, le MINI (Mini International Neuropsychiatric Interview). Résultats: A l'inclusion, 39.2% des sujets avaient un trouble lié à l'utilisation de substances psychoactives. Parmi eux, une proportion significativement plus élevée était sous l'influence d'alcool ou drogue au moment de la tentative de suicide (44.3% versus 25.4%). Des 148 adolescents suivis et revus à 6 ou 18 mois, 2 sont décédés par suicide et il y a eu 30 récidives de tentative de suicide durant l'étude. Une association significative a été trouvée entre les récidives de suicide et un diagnostic d'abus/dépendance à l'alcool à l'inclusion (OR=3.3; CI 0.7-15.0; 0R=2.6, CI 0.7-9.3). Des antécédents de plusieurs tentatives de suicide (OR=3.2; CI 1.1-10.0) et un âge supérieur à 19 ans (OR=3.2; CI 1.1-9.2) à l'inclusion étaient associés à la probabilité de mort par suicide ou de récidive de tentative de suicide. Conclusion: Parmi les adolescents hospitalisés pour tentative de suicide ou idées suicidaires envahissantes, le risque de décès ou de récidive est important. Ce risque est associé, entre autres, à des antécédents suicidaires et au diagnostic de trouble lié à l'utilisation de substances psychoactives. Le risque suicidaire ainsi que la consommation de substances psychoactives devrait être évalué chez les adolescents. De plus, les sujets jugés à risque devraient être suivis systématiquement après une hospitalisation pour conduite suicidaire. ABSTRACT Aim: To study the prevalence of psychoactive substance use disorder (PSUD) among suicidal adolescents, psychoactive substance intoxication at the moment of the attempt and the association between PSUD at baseline and either occurrence of suicide or repetition of suicide attempt(s). Methods: 186 adolescents aged 16 to 21 hospitalised for suicide attempt or overwhelming suicidal ideation were included (TO); 148 of them were traced again for evaluations after 6 months and/or 18 months. DSM-IV diagnoses were assessed each time using the Mini International Neuropsychiatric Interview. Results: At TO, 39.2% of the subjects were found to have a PSUD. Among them, a significantly higher proportion was intoxicated at the time of the attempt than those without PSUD (44-.3% vs. 25.4%). Among the 148 adolescents who could be traced at either Ti or T2, two died from suicide and 30 repeated suicide attempt once or more time. A marginally significant association was found between death by suicide/repetition of suicide attempt and alcohol abuse/dependence at baseline (0R=3.3; CI 0.7-15.0; 0R=2.6, CI 0.7-9.3). More than one suicide attempt before admission to hospital at TO (OR=3.2; CI 1.1-10.0) and age over 19 at TO (0R=3.2; CI 1.1-9.2) were independently associated with the likelihood of death by suicide or repetition of suicide attempt. Conclusion: Among adolescents hospitalised for suicide attempt or overwhelming suicidal ideation, the risk of death or repetition of attempt is high and is associated with previous suicide attempts - especially among older adolescents - and also marginally associated with PSUD; these adolescents should be carefully evaluated for such risks and followed up once discharged from the hospital.

Excessive alcohol consumption in young men: is there an association with their earlier family situation? A baseline-analysis of the C-SURF-study (Cohort Study on Substance Use Risk Factors).

AIMS: To determine whether parental factors earlier in life (parenting, single parent family, parental substance use problem) are associated with patterns of alcohol consumption among young men in Switzerland. METHODS: This analysis of a population based sample from the Cohort Study on Substance Use Risk Factors (C-SURF) included 5,990 young men (mean age 19.51 years), all attending a mandatory recruitment process for the army. These conscripts reported on parental monitoring and rule-setting, parental behaviour and family structure. The alcohol use pattern was assessed through abstention, risky single occasion drinking (RSOD), volume drinking and dependence. Furthermore, the impact of age, family socio-economic status, educational level of the parents, language region and civil status was analysed. RESULTS: A parental substance use problem was positively associated with volume drinking and alcohol dependence in young Swiss men. Active parenting corresponded negatively with RSOD, volume drinking and alcohol dependence. Single parent family was not associated with a different alcohol consumption pattern compared to standard family. CONCLUSION: Parental influences earlier in life such as active parenting (monitoring, rule-setting and knowing the whereabouts) and perceived parental substance use problem are associated with alcohol drinking behaviour in young male adults. Therefore, health professionals should stress the importance of active parenting and parental substance use prevention in alcohol prevention strategies.

Moderating effects of gender and general self-efficacy on the relationship between sensation-seeking and adolescent substance use /

This study performed a aecondvy dau analysis of information collected during the Youth Leisure Study (YLS). The purpose of this study was to examine the potential moderating influences of gender and general self-efTicacy on the relationships aoKXig sensation-seeking and various forms of substance use in adolescents. Specifically, the predictive ability of sensation seeking on five adolescents substance use outcomes (alcohol, tobacco, and marijuana use; binge drinking; and number of times drunk) was examined. Moderated hierarchical multiple regression (MHMR) analyses were used to examine the relationships among study variables. The results for this study indicate that the relationships among sensation-seeking and forms of adolescent substance use are more complex than literature suggests. Main effect relationships were found consistently for sensation-seeking and general self-efficacy with each of the outcome variables. Results for gender were not consistent across the substance use outcomes. Gender was a significant predictor for marijuana use only. The moderating effects of general self-efficacy (GSE) on the sensation-seekingsubstance use relationship were inconsistent. While no significant interactions were found for tobacco or alcohol use outcomes, GSE was found to moderate the relationship between sensation-seeking and marijuana use indicating that feelings of high general selfefficacy act as a buffer or guard against marijuana use. A consistent pattern was found among the alcohol use variables (alcohol use. binge drinking, and number of times drunk). Gender was found to moderate each of these variables indicating that higher levels of sensation seeking are more predictive of higher levels of adolescent alcohol use in males only. Implications of this study on the field of education, are discussed further, and suggestions for future research are presented.

Moderating effects of gender on the relationships among substance use and school outcomes /

The following study was a secondary analysis of data drawn from adolescents in South Western Ontario. The purpose of the study was to: examine the relationships among substance use and school outcomes, explore the relationships between gender and school outcomes, examine the moderating potential of gender on the substance useschool outcomes relationship, and to provide researchers and educators further knowledge of adolescent substance use behaviours. Many previous studies have failed to include the three most common substances used by adolescents (i.e., alcohol, tobacco, and marijuana). Furthermore, many studies have included only one school outcome instead of comparing several outcome variables. Moderated hierarchical regression was used to determine if gender moderated the substance use-school outcomes relationships. The dependent variables consisted of alcohol use, binge drinking, tobacco use, and marijuana use. Five measure of school outcomes were used as independent variables, including Grade Point Average, Positive School-role Behaviour, Negative School Behaviour, School Withdrawal, and School Misbehaviour. The results for this study indicated that substance use and gender were both predictors of all school outcome variables. Furthermore, gender was found to moderate 5 of the 25 substance use-school outcome relationships.

Relationships among adolescent substance use, leisure boredom, and physical activity

This study was a secondary analysis of data drawn from the Youth Leisure Study. The purpose of the study was to: a) explore the relationships among physical activity, leisure boredom, and various substance use variables; b) determine if leisure boredom moderated the relationship among physical activity and substance use variables; and c) create a foundation of knowledge with which to educate adolescents and educators of the importance of adopting and maintaining a healthy lifestyle early in life (i.e., free from unhealthy behaviours such as substance use and physical inactivity). Studies examining relationships among physical activity and substance are limited and, in the past, have yielded inconsistent results. The interaction of leisure boredom with physical activity intensity variables, including both team and individual pursuits were tested using moderated hierarchical regression procedures. Six measures of physical activity were used as independent variables, including, frequency of high, medium, and low intensity individual and team physical activities. Various types of substance use, including, tobacco, marijuana, and alcohol use, binge drinking, and drunkenness were used as dependent variables. The results for this study indicated that frequency of physical activity intensity was a consistent, positive predictor of alcohol use and binge drinking, but not tobacco use, marijuana use, or drunkenness. Leisure boredom was found to be a highly significant predictor of tobacco use, however, it was not a moderator of relationships among physical activity intensity and substance use variables. The implications for the study findings, are discussed further, and suggestions for future research are presented.

Does Education Setting Influence the Relationship between Substance use and Depression among Post Secondary Students

Background. This study examined whether experiences of and relationships between depressive symptoms and substance use differs for first year college and university students. Methods. A proportionate stratified random sample of 6,100 university students and a census sample of 7,300 college students were invited to anonymously complete the National College Health Assessment. The final sample included 444 young adult first year university (n = 298) and college (n = 146) students. Results. More college than university students used tobacco (26.7; 11.1%) and marijuana (26.7%; 20.8%). Similar proportions consumed alcohol (75.3%; 76.5%). Almost all students reported past-year depressive symptoms. Mean number of symptoms was 5.43. Tobacco, alcohol and marijuana use were each positively associated with depression after adjusting for age and gender. Educational setting moderated the relationship between depression and tobacco use, and depression and marijuana use, with the relationship being stronger for university students. Implications. University campus health professionals especially, need to assess depression among students using substances and vice versa. Differences between college and university students require further attention.

The impact of religious affiliation while growing up on substance use by African-American crack cocaine users

This paper explores the relationship between church attendance while growing up and the substance use issues reported by 159 African American crack cocaine users in Houston Texas. It was found that more frequent juvenile attendance at church was associated with being less likely to suffer withdrawal symptoms or to take drugs to avoid withdrawal. However/ there were no differences between regular/ irregular and non-attendees in respect of number of substance use issues reported or attendance at a self help group for substance use/ even though these are often faith-based. The relevance of including questions on religious participation when young in screening instruments to be used with adult substance abusers is questioned.

Narcotics Anonymous participation and changes in substance use and social support

In Victoria (a southern Australian state) in 1995, Narcotics Anonymous had a small but growing membership providing an opportunity to study the early experience of new self-help members. Ninety-one new members were interviewed and 62 (68%) were reinterviewed after 12 months. Three measures of self-help participation were examined: service role involvement, step work, and stable meeting attendance. Lower prior involvement in treatment services and greater participation in self-help predicted subsequent self-help participation. Higher levels of secondary school education predicted service role involvement and longer periods in stable meeting attendance. Higher self-help participation through the 12 months prior to follow-up was associated with lower levels of hazardous alcohol use and higher emotional support at reinterview. Multivariate regression analysis suggested stable self-help meeting attendance and step work continued to predict reductions in hazardous alcohol use and improvements in social support, after controlling for a range of alternative predictors.

Puberty and the onset of substance use and abuse

Objective: Substance abuse remains one of the major threats to adolescent health in Western cultures. The study aim was to ascertain the extent of association between pubertal development and early adolescent substance use.

Methods: The design was a cross-sectional survey of 10- to 15-year-old subjects in the states of Washington, United States, and Victoria, Australia. Participants were 5769 students in grades 5, 7, and 9, drawn as a 2-stage cluster sample in each state, and the questionnaire was completed in the school classrooms. The main outcomes of the study were lifetime substance use (tobacco use, having been drunk, or cannabis use), recent substance use (tobacco, alcohol, or cannabis use in the previous month), and substance abuse (daily smoking, any binge drinking, drinking at least weekly, or cannabis use at least weekly).

Results: The odds of lifetime substance use were almost twofold higher (odds ratio [OR]: 1.7; 95% confidence interval [CI]: 1.4–2.1) in midpuberty (Tanner stage III) and were threefold higher (OR: 3.1; 95% CI: 2.4–4.2) in late puberty (Tanner stage IV/V), after adjustment for age and school grade level. Recent substance use was moderately higher (OR: 1.4; 95% CI: 1.0–1.9) in midpuberty and more than twofold higher (OR: 2.3; 95% CI: 1.7–3.3) in late puberty. The odds of substance abuse were twofold higher (OR: 2.0; 95% CI: 1.2–3.2) in midpuberty and more than threefold higher (OR: 3.5; 95% CI: 2.2–5.4) in late puberty. Reporting most friends as substance users was more likely in the later stages of pubertal development, a relationship that accounted in part for the association found between later pubertal stage and substance abuse.

Conclusions: Pubertal stage was associated with higher rates of substance use and abuse independent of age and school grade level. Early maturers had higher levels of substance use because they entered the risk period at an earlier point than did late maturers. The study findings support prevention strategies and policies that decrease recreational substance use within the peer social group in the early teens.

Factors that influence women's disclosures of substance use during pregnancy : a qualitative study of ten midwives and ten pregnant women

The present study was designed to examine the factors that motivate or act as barriers to disclosure of substance use by pregnant women. Participants included 10 midwives and 10 pregnant women who attended two ante-natal clinics at an Australian maternity hospital. One clinic specialized in women who were substance users and one clinic was specifically for young women (under 19 years of age). Midwives and pregnant women were interviewed in-depth about disclosure of substance use. Interview transcripts were analyzed, and the results revealed six main themes: practice style, assessment of substance use, practice environment and privacy, child protection issues, health of the baby, and continuity of care. The findings are discussed in relation to recommendations for best practice in midwifery care when working with pregnant women who use substances.