This week we will be discussing our first article of the New Year; an article published in September 2019 in the Journal of Social Psychiatry and Psychiatric Epidemiology. Authors Dean-Boucher, Robillard, and Turner examine and discuss the association between chronic medical conditions and the emergence of suicidality in adolescents.

What did they do?

The data used in this study came from the National Comorbidity Survey - Adolescent Supplement (NCS-A), which includes data from 10,148 American adolescents between the ages of 13 years and 17 years. Using multivariate modeling and discrete-time survival analyses, the authors examined the odds of an individual developing suicidal ideation in the presence of a chronic medical condition while controlling for a variety of factors.

Why did they do it?

As we have mentioned in some of our previous posts, suicide is a rising problem for American adolescents. Suicide is the second most common cause of death among adolescents in the U.S, and as the authors highlight, this amounts to over 6,000 adolescent deaths per year. The relationship between chronic medical conditions and suicidality is an increasingly researched, and highly important topic. As stated by the authors of this article, chronic medical conditions may increase the risk of suicidality by decreasing one’s sense of belonging, pain tolerance, and available coping resources. Chronic pain has also been shown to increase feelings of hopelessness and burdensomeness - two factors associated with suicidality. Much of the existing literature examining these associations are based on studies conducted in adult populations, and oftentimes these studies may not statistically control for covariate variables.

How did they do it?

Data included in this study came from the NCS-A, which is a survey designed to examine the prevalence, age of onset, course, and comorbidity of DSM-IV disorders in adolescents. Adolescents (n = 10,148) aged 13-17 completed a computer-assisted interview assessing presence and onset of various mental and physical health conditions. Caregivers (parents, guardians) of participants also completed a questionnaire assessing similar mental and physical health conditions of the adolescent as well as sociodemographic factors of the family.

The authors used a time-lagged system of coding where each participant life was treated as a unique observational record up to the first year of onset of suicidality. This helped the authors examine the associations between chronic medical conditions and onset of suicidal thoughts and behaviors. We pulled this direct quote from the article to help clarify: “If an adolescent reported onset of diabetes at age 11, it was coded as 0 in their 11th person-year file and as 1 in their 12th person-year file, to only predict a suicidality onset in their 12th year.”

What did they find?

The chronic medical condition categories examined in this study included Cardiovascular diseases (n = 397), Dermatological diseases (n = 2981), Diabetes (n = 88), Epilepsy (n = 253), Gastrointestinal diseases, (n = 589), Arthritis (n = 224), Asthma (n = 1914), Allergies (n = 3737), Headache (n = 3274), Back and Neck Pain (n = 1212), and Other Pain (n = 556). Apart from epilepsy and diabetes, all of the chronic health conditions were positively associated with suicidal ideation as well as suicide planning.

Of the chronic medical conditions assessed, cardiovascular conditions, headaches, and neck/back pain were the most strongly and the most consistently predictive of the onset of suicidal thoughts and behaviors. When analyses were adjusted to include sociodemographic factors as covariates, cardiovascular conditions remained associated with all facets of suicidal thoughts and behaviors, aside from suicidal ideation. Cardiovascular conditions were also the only conditions that were associated with suicide attempts. Dermatological conditions, asthma, allergies, headaches, and neck/back pain were found to be associated with elevated risk of suicidal ideation, and arthritis, asthma, headaches and neck/back pain were found to be associated with escalation from ideation to planning.

What does it all mean (our take)?

This study helped to more clearly evaluate the association between chronic medical conditions and suicidality. As identified quite clearly in this study, adolescents with chronic physical health problems are at an elevated risk for experiencing difficulties related to suicidality. We find this study to be incredibly important - as it highlights a specific population of adolescents that would benefit from closer monitoring and perhaps preventative intervention services. We look forward to reading new literature in this area, and thank the authors for carrying out this fantastic study.

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