Suicidal Behavior in Chemically Dependent Adolescents
Cavaiola, Alan A., Lavender, Neil, Adolescence
Among 250 adolescents in a short-term residential treatment program for chemical dependency, 20% had attempted suicide in the two years prior to admission. Females, however, were found to have a higher attempt rate than did males. Suicide attempters were compared with a group of 50 nonsuicidal adolescents from the same treatment program and 50 non-chemically dependent, nonsuicidal high school students. Each, adolescent was administered the Symptom Checklist 90--Revised (SCL-90-R), and a biographical history was obtained. The suicidal group was found to be more psychologically distressed than were the other two groups. Post hoc analysis revealed that there were significant differences between the chemically dependent groups (suicidal, nonsuicidal) on the Global Severity Index of the SCL-90-R, as well as the following subscales: Somatization, Depression, Anxiety, and Phobic Anxiety. It was also found that the majority of suicidal gestures or attempts had gone untreated beyond medical management. It was found th at only 28% of the suicide attempters had received crisis intervention or emergency room treatment, and only 27% had received some type of follow-up treatment or counseling. These results are discussed, particularly in regard to the issue of "covert suicide."
Suicidal behavior and chemical dependency are two of society's most serious problems. Research points to correlations between the two. For example, in the adult population, associations between suicide and alcoholism have been reported (Agren & Jakobsson, 1987; Babigan, Lehman, & Reed, 1985; Lindberg & Agren, 1988; Ohara et al., 1989; Mayfield & Montgomery, 1972; Young, Fogg, Scheftner, & Fawcett, 1994).
Links between adolescent suicide and substance use have also been noted (Farberow, Litman, & Nelson, 1988; Kirkpatrick-Smith, Rich, Bonner, & Jans, 1989; Lewinsohn, Rohde, & Seeley, 1994). Holland and Griffin (1984) found that adolescents, when compared with adults, had higher rates of suicide attempts prior to receiving treatment for substance use disorders (36% vs. 26%, respectively). Both "chart review" and "psychological autopsy" retrospective studies of adolescent suicide have reported the presence of alcohol and drug abuse/dependency prior to the suicidal incident, as well as increased use at the time of the incident (Shaffer, Garland, Gould, Fisher, & Trautman, 1988; Hoberman & Garfinkel, 1988; Crumley, 1979; Brent, Perper & Allmon, 1987; Poteet, 1987; Rich, Sherman, & Fowler, 1990; RotheramBorus, Walker, & Ferns, 1996). In a study of 40 adolescents (ages 12 to 19) who were in treatment following a suicide attempt, Crumley (1979) found that the most common diagnoses were depressive disorders and subst ance abuse disorders. Brent, Kolko, Wartella, Boylan, Moritz, Baugher, and Zelenak (1993) noted that the conditions most closely associated with suicide in adolescents were affective disorders, substance use disorders, and conduct disorders. Mehr, Zeltzer, and Robinson (1981), investigating 232 adolescent admissions to a psychiatric facility, found that suicide attempters were most often female; in 71% of the cases, they used drugs in the attempt. In research with 2,062 female and 1,702 male high school students, Garrison, McKeown, Valois, and Vincent (1993) reported that substance use was associated with some but not all categories of suicidal behavior (the associations were more pronounced with the use of more dangerous drugs). Robbins and Alessi (1985) studied 64 adolescent psychiatric patients with histories of suicide attempts and found alcohol and substance abuse to be significantly associated with four dimensions of suicide (i.e., suicidal tendencies, gestures, seriousness of intent, and lethality). Ba sed upon clinical observation, it was hypothesized that the substance abuse was secondary to a primary affective disorder. They concluded that substance abuse may be indicative of high risk for suicide. …