(PS13-25) Risk of Suicidal Behavior in Depressed Youth with Comorbid Problematic Substance Use

Suicidal behavior is a rising public health concern for youth in the United States, and extant research has identified depressed youth as being more likely to engage in suicidal behavior compared to healthy controls. Problematic substance use appears to be one factor that exacerbates instances of suicidal behavior in youth and may be one factor that magnifies the association of depression and suicidality given the frequent co-occurrence between problematic substance use and depression. There has been a general paucity of research surrounding the impact of comorbid depression and problematic substance use and its association with suicidality in youth, suggesting that additional work in this area is needed to guide prevention and intervention development efforts for this population. As such, the present study examines differences in clinical features (i.e., suicidal ideation, suicide attempt history, depression severity, adaptive functioning across domains) and demographic characteristics (i.e., age, gender, and race/ethnicity) among depressed youth with and without problematic substance use.  

The present study utilized data collected from the baseline visit of participants enrolled in the TX-YDSRN research initiative across Texas. The sample included 797 depressed youth ages 8–20 years with and without problematic substance use. Participants completed the Mini-International Neuropsychiatric Interview for Children and Adolescents, the Car Relax Alone Forget Friends Trouble, the Concise Health Risk Tracking–Self-Report, the Patient Health Questionnaire for Adolescents, the Patient-Reported Outcomes Measurement Information System 25-item, and the Social Adjustment Scale–School Module Self-Report. 

Results indicated that depressed youth with problematic substance use were significantly older and more likely to exhibit suicidal ideation and a history of suicide attempts. Relative to youth with only depression, those with comorbid problematic substance use had significantly worse school functioning after controlling for age, sex, race, and ethnicity. Furthermore, problematic substance use did not moderate the effect of depression severity on suicidal ideation or suicide attempt history. 

The current study begins to address the extant gap in the literature regarding youth depression and suicidality by examining differences in clinical features and demographic characteristics among clinically depressed youth with and without problematic substance use across Texas. Our findings lay the foundation for future research aimed at further discerning the impact of comorbid depression and problematic substance use and its association with suicidality in youth populations. Despite equivocal findings concerning the moderating role of problematic substance use in the relationship between depression and suicidality, the present study offers guidance for research and practical evidence-based intervention efforts to address the pressing public health concern of youth depression and suicidality. As such, it will be important for future research to continue to examine the relations among depression, problematic substance use, and suicidality longitudinally and with diverse community samples of youth nationwide.