Examining the Relationship between Substance Use and Suicide among Pediatric Patients: Exploring differences by Race and Ethnicity

Individuals who use substances are at high risk for suicide and suicide attempts. In fact, substance use disorder is documented as an important risk factor for suicidality (SUDs; Poorolajal et al., 2016; Armoon et al., 2021), including among adolescents (e.g., Kelly et al., 2004). However, fewer studies have examined substance use at varying levels of severity.  Further, some researchers have documented a bidirectional relationship between these variables among adolescents and young adults, where substance use influences suicidality and suicidality influences substance use, with differences by particular substance (Zhang & Wu, 2014). Yet, few studies have leveraged nationally-representative clinical datasets encompassing both outpatient and inpatient encounters to comprehensively examine this complex relationship.  
 
Despite a growing body of literature on substance use and suicide among adolescent, a significant gap remains. Previous studies have explored the variations in the relationships between substance use and suicide mortality among different racial and ethnic groups (e.g., Karch et al., 2006; Garlow, 2002). However, a systematic investigation of disparities in clinical visits related to suicidality/self-harm involving substance use, as well as substance-related clinical visits linked to suicidality/self-harm, based on race/ethnicity, is lacking. Understanding these disparities is crucial for tailoring interventions and addressing health inequities among adolescents engaged in substance use and/or experiencing suicidality.    
 
The importance of using nationally-representative clinical data to examine more nuanced suicide outcomes among adolescents cannot be overstated; clinical data allows for a comprehensive examination of suicidal behaviors (including ideation, attempts, and self-harm incidents) as well as substance use behaviors (use, dependence, overdose; differences by substance type), all within the context of the larger medical history.  
 
– Aim 1: Determine how frequently visits for suicidality/self-harm events involve substance use (including comorbid visit diagnosis or attempt/self-harm by ingestion)?  
 
– Aim 2: Examine the odds that visits related to suicidality, suicide attempts, or self-harm events involving substance use are linked to prior or subsequent visit related to substance use? 
 
– Aim 3: Explore differences in frequency of comorbid suicidality/self-harm and substance use visits and differences in odds of a substance-related visit before or after suicidality/self-harm visit by race/ethnicity.