Age Variability in the Association Between Heavy Episodic Drinking and Adolescent Suicide Attempts: Findings From a Large-Scale, School-Based Screening Program

Objective: Alcohol use is a risk factor for suicidal behavior among adolescents, but it is not clear whether this association is consistent during the adolescent period. This study examined the age-specific associations between heavy episodic drinking (HED) and self-reported suicide attempts in a large and diverse sample of adolescents. Method: Screening data from 32,217 students, between the ages of 11 and 19 years, in 225 schools were analyzed. Logistic regression analyses estimating the impact of HIED on self-reported suicide attempts in the past year were performed. Results: Heavy episodic drinking was significantly associated with self-reported suicide attempts (odds ratio 1.78, p<.05) controlling for depressive symptoms. However, there was substantial age variability in this association, with the association between HIED and self-reported attempts stronger among younger adolescents. Among youths aged 13 years and younger, those who reported an episode of HIED during the past year were roughly 2.6 times more likely to report an attempt than those who did not report HIED in the past year, in contrast to 1.2 times among youths aged 18 years and older. Conclusions: Heavy episodic drinking is a clear risk factor for suicidal behavior among younger adolescents, beyond the risk conveyed by depressive symptoms. Further research investigating the bases for increased suicide risk among younger adolescents engaging in HED is warranted. Results provide support to AACAP's practice parameters calling for attention to substance abuse in the assessment of suicide risk and suggest that routine screening for HIED by physicians may improve the detection of adolescent suicide risk, particularly among younger adolescents. J. Am. Acad. Child Adolesc. Psychiatry, 2009; 48(3):262-270.