Suicidal Ideation Among Midwestern Adolescents: Hopelessness, Sexual Assault, and Alcohol Abuse

Introduction: According to the CDC, Indiana has the second highest rate of teen suicide of the entire U.S. with a rate of 14.4 suicides per 100,000 teens. Illinois has the fifth lowest rate of teen suicide with a rate of 10.6 suicides per 100,000 teens. Despite the similarities of these two neighboring Midwestern states, a difference in their respective suicide rates is apparent. The objective of this study is to identify factors that underlie this difference in the suicide rate between the two states.

Methods: The Social Ecological Model guided the analysis of the behavioral and mental health data from the CDC’s Youth Risk Behavior (YRBS) 2015 survey. The outcome of interest was student level suicidal ideation (measured as serious thoughts of committing suicide during the past 12 months). Student level covariates included age, sex, race, bullying, depression, tobacco use, alcohol use, marijuana use, illicit drug use, prescription pill abuse, and history of sexual assault. Strata level variables captured the environments of sexual assault, bullying, substance abuse, and prescription pill abuse to assess the effects on student level outcomes. The analysis consisted of a 3-level hierarchical linear model to assess the social ecological effects that group/strata and state level factors have on individual level predictors and suicidal ideation. Analysis relied on HLM v7.02 software.

Results: Results indicate that suicidal ideation is a function of the student’s reported feelings of hopelessness (β = -0.141085, p ≤ 0.001). Across both states, students reporting ever having been sexually assaulted are 1.2 times (95% CI 1.04, 1.357) more likely to report suicidal ideation during the past 12 months and students who reported alcohol use are 1.1 times (95% CI 1.004, 1.203) more likely to report suicidal ideation during the past 12 months. Suicidal Ideation differed by the level of state sexual assault (β = 0.171628, p =0.012) and alcohol abuse (β =0.94284, p = 0.042), meaning that residing in Indiana puts students at a 17.16% increased risk for sexual assault and a 9.43% increased risk for alcohol use. Of note, the bullying environment of Indiana is significantly higher compared to Illinois (β = 0.063246 p = 0.013).

Conclusions: The experience of Midwestern adolescents is not monolithic. Suicide intervention and prevention is not solely a matter of individual factors, but rather a combination of community and state level variables as well. These factors include the levels of substance abuse, sexual assault, and bullying. An important consideration for the design of suicide prevention efforts is the differences in factors at the state and community levels in addition to individual experiences.