Research Article| Volume 27, ISSUE 3, P224-231, October 2004

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Adolescent depression and suicide risk

Association with sex and drug behavior


      Depression is common among adolescents, and suicide is the third leading cause of death among 15- to 19-year-olds. Although both health problems have been associated with drug use and early sexual intercourse, the relationship has not been systematically studied in a nationally representative sample.


      Sixteen patterns of combined sex and drug use behaviors were obtained using cluster analysis of responses to Wave I of the National Longitudinal Study of Adolescent Health conducted from September 1994 through December 1995. Bivariate and multivariate analyses tested correlations between behavior patterns and current depression, serious suicidal ideation, and previous suicide attempt, controlling for gender, race/ethnicity, Hispanic ethnicity, family structure, and parent education.


      Compared to youth who abstain from risk behaviors, involvement in any drinking, smoking, and/or sexual activity was associated with significantly increased odds of depression, suicidal ideation, and suicide attempts. Odds ratios were highest among youth who engaged in illegal drug use. There were few differences between boys and girls who abstain from sex and drug behaviors. Girls were less likely than boys to engage in high-risk behaviors, but those who did tended to be more vulnerable to depression, suicidal ideation, and suicide attempt.


      Teens engaging in risk behaviors are at increased odds for depression, suicidal ideation, and suicide attempts. Although causal direction has not been established, involvement in any sex or drug use is cause for concern, and should be a clinical indication for mental health screening for girls; both boys and girls should be screened if engaging in any marijuana or illegal drug use.
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      1. Anderson R. Deaths: leading causes for 1999. Natl Vital Stat Rep 2001;49:14.

      2. Minino A, Smith B. Deaths: preliminary data for 2000. Hyattsville MD: National Center for Health Statistics, 2001.

      3. Freid V, Prager K, MacKay A, Xia H. Chartbook on Trends in the health of Americans. Health, United States, 2003. Hyattsville MD: National Center for Health Statistics, 2003.

        • Lewinsohn P.
        • Rohde P.
        • Seeley J.
        Adolescent suicidal ideation and attempts.
        Clin Psychol. 1996; 3: 25-46
        • Grunbaum J.A.
        • Kann L.
        • Kinchen S.A.
        • Williams B.
        • Ross J.G.
        • Lowry R.
        • Kolbe L.
        Youth risk behavior surveillance—United States, 2001. In.
        MMWR. 2002; 51: 5-11
        • Petronis K.R.
        • Samuels J.F.
        • Moscicki E.K.
        • Anthony J.C.
        An epidemiologic investigation of potential risk factors for suicide attempts.
        Soc Psychiatry Psychiatr Epidemiol. 1990; 25: 193-199
        • Gould M.S.
        • Greenberg T.
        • Velting D.M.
        • Shaffer D.
        Youth suicide risk and preventive interventions.
        J Am Acad Child Adolesc Psychiatry. 2003; 42: 386-405
        • Brent D.A.
        • Perper J.
        • Moritz G.
        • Baugher M.
        • Allman C.
        Suicide in adolescents with no apparent psychopathology.
        J Am Acad Child Adolesc Psychiatry. 1993; 32: 494-500
        • Shaffer D.
        • Gould M.S.
        • Fisher P
        • et al.
        Psychiatric diagnosis in child and adolescent suicide.
        Arch Gen Psychiatry. 1996; 53: 339-348
        • King R.A.
        • Schwab-Stone M.
        • Flisher A.J
        • et al.
        Psychosocial and risk behavior correlates of youth suicide attempts and suicidal ideation.
        J Am Acad Child Adolesc Psychiatry. 2001; 40: 837-846
        • Brook J.S.
        • Cohen P.
        • Brook D.W.
        Longitudinal study of co-occurring psychiatric disorders and substance use.
        J Am Acad Child Adolesc Psychiatry. 1998; 37: 322-330
        • Brooks T.L.
        • Harris S.K.
        • Thrall J.S.
        • Woods E.R.
        Association of adolescent risk behaviors with mental health symptoms in high school students.
        J Adolesc Health. 2002; 31: 240-246
        • Burge V.
        • Felts M.
        • Chenier T.
        • Parrillo A.V.
        Drug use, sexual activity, and suicidal behavior in U.S. high school students.
        J School Health. 1995; 65: 222-227
      4. Felts MWP, Chenier TP, Barnes RE. Drug use and suicide ideation and behavior among North Carolina public school students. Am J Public Health 1992;82:870–2.

        • Kandel D.B.
        • Raveis V.H.
        • Davies M.
        Suicidal ideation in adolescence.
        J Youth Adolesc. 1991; 20: 289-309
      5. Rector RE, Johnson KA, Noyes LR. Sexually active teenagers are more likely to be depressed and to attempt suicide. Washington DC: Heritage Foundation, 2003.

      6. Johnston LD, O'Malley PM, Bachman JG. Monitoring the Future national results on adolescent drug use: overview of key findings, 2002. Bethesda MD: National Institute on Drug Abuse, 2003.

        • American Academy of Child and Adolescent Psychiatry
        Shaffer D, Pfeffer C, Issues WGoQ.
        Practice parameter for the assessment and treatment of children and adolescents with suicidal behavior. J Am Acad Child Adolesc Psychiatry. 2001; 40: 24-51
        • Basen-Engquist K.
        • Edmundson E.W.
        • Parcel G.S.
        Structure of health risk behavior among high school students.
        J Consult Clin Psychol. 1996; 64: 764-775
        • Brener N.D.
        • Collins J.L.
        Co-occurrence of health-risk behaviors among adolescents in the United States.
        J Adolesc Health. 1998; 22: 209-213
        • Donovan J.E.
        • Jessor R.
        Structure of problem behavior in adolescence and young adulthood.
        J Consult Clin Psychol. 1985; 53: 890-904
        • Farrell A.D.
        • Danish S.J.
        • Howard C.W.
        Relationship between drug use and other problem behaviors in urban adolescents.
        J Consult Clin Psychol. 1992; 60: 705-712
        • Garrison C.Z.
        • McKeown R.E.
        • Valois R.F.
        • Vincent M.L.
        Aggression, substance use, and suicidal behaviors in high school students.
        Am J Public Health. 1993; 83: 179-184
        • Jessor R.
        • Jessor S.L.
        The sociol-psychological framework.
        in: Jessor R. Jessor S.L. Problem behavior and psychosocial development: a longitudinal study of youth. Academic Press, New York1977: 17-42
      7. Lindberg LD, Boggess S, Williams S. Multiple threats: The co-occurrence of teen health risk-behaviors. In: Trends in the wellbeing of America's children and youth, 1999. Washington DC: U.S. Department of Health and Human Services, 2000:489–504.

        • Neumark-Sztainer D.
        • Story M.
        • French S.
        • Cassuto N.
        • Jacobs Jr, D.R.
        • Resnick M.D.
        Patterns of health-compromising behaviors among Minnesota adolescents.
        Am J Public Health. 1996; 86: 1599-1606
        • Shrier L.A.
        • Emans S.J.
        • Woods E.R.
        • MPH, DuRant R.H.
        The association of sexual risk behaviors and problem drug behaviors in high school students.
        J Adolesc Health. 1996; 20: 377-383
        • Bergman L.R.
        A pattern-oriented approach to studying individual development: snapshots and processes.
        in: Cairns R.B. Bergman L.R. Kagan J. Methods and models for studying the individual: essays in honor of Marian Radke-Yarrow. Sage, Thousand Oaks CA1998: 83-8122
      8. Bearman PS, Jones J, Udry JR. The National Study of Adolescent Health: research design. Chapel Hill NC: Carolina Population Center, 1997. Available at:

        • Turner C.F.
        • Ku L.
        • Rogers S.M.
        • Lindberg L.D.
        • Pleck J.H.
        • Sonenstein F.L.
        Adolescent sexual behavior, drug use, and violence.
        Science. 1998; 280: 867-873
      9. Hallfors D, Watson K, Khatapoush S, Kadushin K, Saxe L. A comparison of paper vs. computer assisted self interview for school alcohol, tobacco, and other drug surveys. Eval Prog Planning 2000:1–8.

      10. Harris KM. The health status and risk behavior of adolescents in immigrant families. In: Hernandez D, ed. Children of immigrants: health, adjustments, and public assistance. Washington DC: National Academy Press, 1999:286–347.

        • Magnusson D.
        The logic and implications of a person-oriented approach.
        in: Cairns R.B. Bergman L.R. Methods and models for studying the individual. Sage Publications, Thousand Oaks CA1998: 33-64
      11. Bauer DJ, Shanahan MJ. Modeling complex interactions: person-centered and variable-centered approaches. In: Little TD, Bovaird J, Marquis J, eds. Modeling developmental processes in ecological context, 2004. In press.

        • Radloff L.S.
        The CES-D Scale.
        Appl Psychol Measurement. 1977; 1: 385-401
        • Rushton J.L.
        • Forcier M.
        • Schectman R.M.
        Epidemiology of depressive symptoms in the National Longitudinal Study of Adolescent Health.
        J Am Acad Child Adolesc Psychiatry. 2002; 41: 199-205
        • Roberts R.E.
        • Lewinsohn P.M.
        • Seeley J.R.
        Screening for adolescent depression.
        J Am Acad Child Adolesc Psychiatry. 1991; 30: 58-66
        • Goodman E.
        • Capitman J.
        Depressive symptoms and cigarette smoking among teens.
        Pediatrics. 2000; 106: 748-755
        • Canino G.
        • Roberts R.
        Suicidal behavior among Latino youth.
        Suicide Life Threat Behav. 2001; 31: 122-131
        • Metha A.
        • Weber B.
        • Webb L.D.
        Youth suicide prevention.
        Suicide Life Threat Behav. 1998; 28: 150-164
        • Kessler R.C.
        • Nelson C.B.
        • McGonagle K.A.
        • Edlund M.J.
        • Frank R.G.
        • Leaf P.J.
        The Epidemiology of co-occurring addictive and mental disorders.
        Am J Orthopsychiatry. 1996; 66: 17-31
        • Elster A.B.
        Comparison of recommendations for adolescent clinical preventive services developed by national organizations.
        Arch Pediatr Adolesc Med. 1998; 152: 193-198
      12. U.S. Preventive Services Task Force. Screening for depression. Washington DC: Agency for Health Care Research and Quality, Department of Health and Human Services, 2002.

        • Gaynes B.N.
        • West S.L.
        • Ford C.A.
        • Frame P.
        • Klein J.
        • Lohr K.N.
        Screening for suicide risk in adults.
        Ann Intern Med. 2004; 140: 822-835
        • Emslie G.J.
        • Rush A.J.
        • Weinberg W.A
        • et al.
        A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression.
        Arch Gen Psychiatry. 1997; 54: 1031-1037
        • Reinecke M.A.
        • Ryan N.E.
        • DuBois D.L.
        Cognitive-behavioral therapy of depression and depressive symptoms during adolescence.
        J Am Acad Child Adolesc Psychiatry. 1998; 37: 26-34
        • Hughes C.W.
        • Emslie G.J.
        • Crismon M.L
        • et al.
        The Texas Children's Medication Algorithm Project.
        J Am Acad Child Adolesc Psychiatry. 1999; 38: 1442-1454
        • Keller M.B.
        • Ryan N.D.
        • Strober M
        • et al.
        Efficacy of paroxetine in the treatment of adolescent major depression.
        J Am Acad Child Adolesc Psychiatry. 2001; 40: 762-772