The Impact of Substance Use and Protective Factors on Suicidal Ideation Among Middle School Students: Findings from the 2013 New Mexico Youth Risk and Resiliency Survey

INTRODUCTION: Suicide is the third leading cause of death among children aged 10-14 nationally; however, there are few studies examining the risks for suicide among this age group. Suicidal ideation, an important risk factor for suicide, is strongly associated with alcohol and substance use, particularly use initiated during early adolescence. Furthermore, the association between suicidal ideation and substance use appears to be stronger for girls compared to boys. Despite the many risk factors for suicidal behavior, among older adolescents, other factors such as family cohesion, connection with friends, and other forms of social support can be protective and help adolescents build resilience. However, these associations are not well studied among younger children. The purpose of this study is to explore the associations between suicidal ideation, substance use, and protective factors among New Mexico middle school students to determine possible areas for intervention.

METHODS: The 2013 New Mexico Youth Risk and Resiliency Survey provided the data for this analysis and included a representative sample of 16,246 students in grades 6-8 sampled from public middle schools in New Mexico. The dependent variable, suicidal ideation, was defined as affirmative responses to questions about thoughts of killing oneself and/or making a suicide plan. Independent variables included demographics (grade and gender), risk factors (alcohol, tobacco, marijuana, inhalant, and other drug use) and six protective factors (e.g. having caring friends/adults). We used logistic regression to test for interaction between risk factors and protective factors among boys and girls separately. 

RESULTS: The prevalence of suicidal ideation was 22.8% [95% CI: 21.3-24.4] and was higher among girls [30.1% (95%CI: 27.7 – 32.5)] than boys [16.0% (95% CI: 14.6 – 17.6)]. Among girls and boys, all forms of substance use were strongly associated with suicidal ideation. Among girls, having a caring friend was associated with lower odds of suicidal ideation [0.46 (95%CI: .30 - .70)]; however, the use of other drugs modified this relationship (p=0.011). Among boys, having a caring friend and being involved in community activities decreased the odds of suicidal ideation, [0.62 (95%CI: 0.43 – 0.88)] and [0.67 (95% CI: 0.50 – 0.91)], respectively.

CONCLUSIONS: Suicidal ideation is prevalent among middle school children. Substance abuse is associated with suicidal ideation in this age group; however, individual and community support can be protective. Interventions aimed at reducing suicidal behaviors among school-age children should account for the impact of substance use and help strengthen social support to build resiliency.