Abstract

Objective: Dually diagnosed adolescents are a high-risk population for experiencing suicidal thoughts and behavior. Given that research suggests risk factors for suicidal ideation and suicide attempts may be different, this study examined whether internalizing disorder severity, frequency of substance use, and the interaction between them differentiated adolescents who attempted suicide from those who ideated. Methods: Baseline data from 287 adolescents who received formal substance use disorder (SUD) treatment were used in this analysis. Major depressive disorder (MDD) and generalized anxiety disorder (GAD) severity as well as past-3 month use of alcohol, cannabis, and other illicit drugs were considered. The outcome of interest was a three-category measure of suicide risk: no reported suicidal ideation or attempts, suicidal ideation only, and suicide attempts. Results: Over half of the sample disclosed prior suicidal ideation (30.0%) or attempts (27.9%). Multinomial logistic regression models indicated more severe MDD and GAD symptomology differentiated ideators from non-suicidal adolescents, but internalizing disorder severity did not differ between ideators and attempters. Substance use frequency did not differ between suicide risk groups. MDD severity and frequency of alcohol use interacted to increase the risk of attempts, yet the effects were minimal. Instead, prior weapon violence victimization and sexual abuse were the largest differentiators between attempters and ideators. Conclusions: Findings suggest that internalizing disorder severity and prior traumatic experiences put adolescents with SUD histories at higher risk of suicidal thoughts and behaviors. Thus, integrating evidence-based suicide prevention and intervention efforts into SUD treatment is critical, particularly for dually diagnosed adolescents who meet these risk profiles. Psychotherapy and medication may help curtail the development of ideation by reducing symptoms of MDD and GAD, whereas adolescents with prior traumatic experiences may benefit from additional treatments shown to lower risk of suicide attempts.

摘要

目的：双重诊断青少年是出现自杀念头和行为的高危人群。鉴于研究表明自杀意念和自杀未遂的风险因素可能不同，本研究检验了内化障碍的严重程度、物质使用频率以及它们之间的相互作用是否能将试图自杀的青少年与有自杀念头的青少年区分开来。方法：该分析使用了来自 287 名接受正式物质使用障碍 (SUD) 治疗的青少年的基线数据。考虑了重度抑郁症 (MDD) 和广泛性焦虑症 (GAD) 的严重程度以及过去 3 个月使用酒精、大麻和其他非法药物的情况。感兴趣的结果是自杀风险的三类测量：没有报告自杀意念或企图、只有自杀意念和自杀企图。结果：超过一半的样本披露了之前的自杀意念 (30.0%) 或企图 (27.9%)。多项逻辑回归模型表明更严重的 MDD 和 GAD 症状学将想法者与非自杀青少年区分开来，但内化障碍的严重程度在想法者和尝试者之间没有差异。物质使用频率在自杀风险组之间没有差异。MDD 的严重程度和饮酒频率相互作用会增加尝试的风险，但影响很小。相反，之前的武器暴力受害和性虐待是尝试者和想法者之间的最大区别。结论：研究结果表明，内化障碍的严重程度和先前的创伤经历会使有 SUD 历史的青少年产生自杀念头和行为的风险更高。因此，将基于证据的自杀预防和干预措施纳入 SUD 治疗至关重要，特别是对于符合这些风险特征的双重诊断青少年。心理治疗和药物治疗可能有助于通过减少重度抑郁症和广泛性焦虑症的症状来减少观念的发展，而有过创伤经历的青少年可能会受益于额外的治疗，这些治疗被证明可以降低自杀企图的风险。