528 - Substance Use and Suicide Risk Among Pediatric Medical Patients: The Importance of Integrated Approaches to Prevention

Poster Number: 528
Publication Number: 528.422

Patrick C. Ryan, National Institutes of Health, Bethesda, MD, United States; Nathan J. Lowry, National Institute of Mental Health, Bethesda, MD, United States; Laika D. Aguinaldo, University of California, San Diego School of Medicine, La Jolla, CA, United States; Cristan Farmer, National Institute of Mental Health, Bethesda, MD, United States; Shayla A. Sullivant, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Elizabeth A. Wharff, Boston Children's Hospital/Harvard Medical School, Boston, MA, United States; Maryland Pao, NIMH, Bethesda, MD, United States; Jeffrey Bridge, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Lisa M. Horowitz, National Institute of Mental Health, Bethesda, MD, United States

Background: Substance use is common among U.S. high school students, with 29.2% reporting alcohol use and 21.7% reporting cannabis use within the past 30 days. Youth substance use is regularly identified as a risk factor for suicidal ideation in young adulthood. Understanding the relationship between substance use and suicide risk can inform pediatric suicide prevention strategies.

Objective: Describe self-reported substance use and its association with suicide risk among pediatric medical patients.

Design/Methods: This is a secondary analysis of cross-sectional data from three multisite instrument validation studies. The sample included pediatric medical patients aged 10 to 20 years, who presented to the emergency department, inpatient medical units, or outpatient specialty and primary care units. Patients completed the Ask Suicide-Screening Questions (ASQ), a brief four-item tool to detect elevated risk for suicide, and questions about lifetime alcohol and cannabis use. Participants were grouped into three categories; “neither alcohol nor cannabis use”, “alcohol use only”, and “co-use of alcohol and cannabis.” Logistic regression analyses identified whether prior substance use was associated with elevated suicide risk. Due to a small cell size, youth who used cannabis but not alcohol were excluded.

Results: Sample consisted of 1359 youth (57.2% female; 55.3% White; age=M15.3[SD 2.60 years]). Overall, 12.7% (172) of patients screened positive for suicide risk on the ASQ. 17.5% (238) of patients reported prior alcohol use, but denied cannabis use. 10.6% (144) of patients reported prior use of both alcohol and cannabis. Among patients who self-reported only alcohol use, the odds of screening positive for suicide risk were nearly twice as great compared to patients who denied prior alcohol use (p=0.02, adjusted OR=1.68[1.08, 2.58]). Among patients who reported both prior alcohol and cannabis use, the odds of screening positive for suicide risk were nearly three times as great compared to patients who denied prior alcohol or cannabis use (p < 0.001, adjusted OR=2.95[1.83,4.74]), and almost twice as great compared to patients with only prior alcohol use (p=0.03, adjusted OR=1.76[1.06, 2.91]).Conclusion(s): Nearly half of the patients who were at elevated risk for suicide on the ASQ reported lifetime substance use. Prior alcohol consumption, alone or in combination with cannabis use, was significantly associated with elevated suicide risk. These findings further support the importance of pediatric providers inquiring about substance use for more comprehensive suicide prevention.