Menninger Department of Psychiatry, Baylor College of Medicine, Houston, Texas, United States of America.
School of Medicine, Baylor College of Medicine, Houston, Texas, United States of America.
PLoS One. 2023 Oct 17;18(10):e0292922. doi: 10.1371/journal.pone.0292922. eCollection 2023.
Suicide is among the top three causes of adolescent mortality. There is a scarcity of research examining cannabis use and suicidal behavior in adolescents.
To determine the association between cannabis use disorder (CUD) and suicide attempt/self-harm in a hospitalized sample of adolescents.
We conducted a cross-sectional observation study using data from the Nationwide Inpatient Sample collected over four years from January 1, 2016, through December 31, 2019. We included adolescents aged 10-19 hospitalized during the above period (N = 807,105). The primary outcome was suicide attempt/self-harm and the main predictor was CUD. The International Classification of Diseases Tenth Revision (ICD 10) diagnostic codes was used to identify a diagnosis of CUD, suicide attempt/self-harm, and other diagnoses included in the analyses. Adolescents diagnosed with CUD (n = 53,751) were compared to adolescents without CUD (n = 753,354). Univariate and multivariate logistic regressions were conducted to determine the association between CUD and suicide attempts/self-harm.
807,105 adolescent hospitalizations were analyzed, of which 6.9% had CUD. Adolescents with CUD were more likely to be older (17 years vs. 15 years), female (52% vs. 48%), have depression (44% vs. 17%), anxiety (32% vs. 13%), an eating disorder (1.9% vs. 1.2%), ADHD (16.3% vs. 9.1%), Conduct Disorder (4.1% vs. 1.3%), Alcohol Use Disorder (11.9% vs. 0.8%), Nicotine Use Disorder (31.1% vs. 4.1%), Cocaine Use Disorder (5.4% vs. 0.2%), Stimulant Use Disorder (0.8% vs. 0.4%) and report suicide attempts/self-harm (2.8% vs. 0.9%) [all ps<0.001]. After adjusting for potential confounders, CUD was associated with a higher risk of suicide attempts/self-harm (OR = 1.4, 95% CI 1.3-1.6, p <0.001). Post-hoc analyses showed the presence of depression moderated the association between CUD and suicide attempts/self-harm in that adolescents with CUD and depression had 2.4 times the odds of suicide attempt/self-harm compared to those with CUD but no depression after controlling for potential confounders (p<0.001).
Our study provides evidence for the association between CUD and suicide risk among hospitalized adolescents and underscores the importance of recognizing and addressing co-occurring mental and substance use disorders along with CUD to mitigate suicide risk. Identifying high-risk adolescents in inpatient settings provides an opportunity for intervention.
自杀是青少年死亡的三大主要原因之一。目前，研究青少年使用大麻与自杀行为之间关系的文献很少。
在住院的青少年样本中，确定大麻使用障碍（CUD）与自杀企图/自伤之间的关联。
我们使用 2016 年 1 月 1 日至 2019 年 12 月 31 日期间全国住院患者样本（N = 807105）中的数据，进行了一项横断面观察性研究。纳入了在此期间住院的 10-19 岁青少年（N = 807105）。主要结局是自杀企图/自伤，主要预测因素是 CUD。采用国际疾病分类第十版（ICD 10）诊断代码识别 CUD、自杀企图/自伤和纳入分析的其他诊断。将诊断为 CUD 的青少年（n = 53751）与未诊断为 CUD 的青少年（n = 753354）进行比较。进行单变量和多变量逻辑回归以确定 CUD 与自杀企图/自伤之间的关联。
对 807105 例青少年住院病例进行了分析，其中 6.9%患有 CUD。患有 CUD 的青少年更有可能年龄较大（17 岁 vs. 15 岁），女性（52% vs. 48%），患有抑郁症（44% vs. 17%）、焦虑症（32% vs. 13%）、饮食失调症（1.9% vs. 1.2%）、注意力缺陷多动障碍（ADHD）（16.3% vs. 9.1%）、品行障碍（4.1% vs. 1.3%）、酒精使用障碍（11.9% vs. 0.8%）、尼古丁使用障碍（31.1% vs. 4.1%）、可卡因使用障碍（5.4% vs. 0.2%）、兴奋剂使用障碍（0.8% vs. 0.4%）和报告自杀企图/自伤（2.8% vs. 0.9%）[均 P <0.001]。在调整了潜在混杂因素后，CUD 与自杀企图/自伤的风险增加相关（OR = 1.4，95%CI 1.3-1.6，P <0.001）。事后分析表明，抑郁症的存在调节了 CUD 与自杀企图/自伤之间的关联，即在控制了潜在混杂因素后，患有 CUD 且患有抑郁症的青少年自杀企图/自伤的可能性是患有 CUD 但无抑郁症的青少年的 2.4 倍（P <0.001）。
我们的研究为 CUD 与住院青少年自杀风险之间的关联提供了证据，并强调了识别和处理与 CUD 同时存在的精神和物质使用障碍以降低自杀风险的重要性。在住院环境中识别高风险青少年为干预提供了机会。
