Abstract
In 1995, in the United States, 72% of all deaths between school-age youth and young adults resulted from four causes: motor vehicle crashes, other unintentional injuries, homicides, and suicides. This study examined the adolescent and young adult suicide and accidental death rates for a 5-year period, 1990–1995, in two counties in Florida in relation to substance use/abuse prior to the death. Gender differences, methods of suicide and/or accident, pertinent risk factors, and toxicology results were reviewed. The results of this study validate the growing body of literature reporting an alarming increase in the role of substance use/abuse in adolescent and young adult accidental and suicidal deaths.
In the United States in 1995, 72% of all deaths between school-age youth and young adults resulted from four causes: motor vehicle crashes, other unintentional injuries, homicide, and suicide (Kann et al., 1996). The increase in the suicide rate among adolescents and young adults over the past three decades is well documented in the literature and has become a major public health problem (Kann et al., 1996; Shaffer et al., 1996; Brent, 1995). The rate of suicide in adolescents has increased from 2.7 per 100,000 in 1950 to 11.1 per 100,000 in 1990 (Brent, 1995). Shaffer et al. (1996) reported the incidence of suicide among 15- to 19-year-old males reached 17.8 per 100,000 in 1992.
In the Youth Risk Behavior Surveillance done in the United States in 1995 by Kann et al., nearly one quarter of the adolescents surveyed had seriously considered attempting suicide in the 12 months prior to the survey. Females (30.4%) were significantly more likely than males (18.3%) to have considered suicide; however, males have a higher percentage rate than females for completed suicides. White adolescents (24.9%) were significantly more likely than Black adolescents (20%) to have considered suicide. Nationwide, 8.7% of the adolescents surveyed had actually attempted suicide during the 12 months prior to the survey and 2.8% reported having made a suicide attempt resulting in an injury, poisoning, or overdose requiring medical intervention. Suicide attempts among adolescents is one of the most frequent psychiatric emergencies, occurring in 2% to 10% of adolescents.
Along with the increase in the adolescent suicide rate, the past decade has produced extensive research on the variables and risk factors associated with attempted and completed suicide (Shaffer et al., 1996; Kann et al., 1996; Brent, 1995; Young, et al., 1994; Fremouw et al., 1993). A review of the literature cites the two most important risk factors in attempted and completed adolescent and young adult suicide as substance abuse and mental disorders. Brent (1995), in a review of both psychological autopsy and longitudinal studies of completed suicides, reported that more than 90% of all adolescents completing suicide have suffered from at least one major psychiatric disorder. Affective disorder, conduct disorder, major depression, and adjustment disorders were the most prevalent psychiatric disorders found in these adolescents. Substance use/abuse tended to be listed either as a psychiatric disorder or a risk factor for suicide if coinciding with an affective disorder (Shaffer et al., 1996; Brent, 1995; Brent et al., 1993; Bukstein et al., 1993).
Other risk factors frequently cited in the literature include parental factors such as psychopathology in the parent, economic status, family dysfunction, and divorce. Life stress factors, such as interpersonal loss and/or conflict, legal problems, physical/sexual abuse, and exposure to suicide represent further environmental stressors (Brent, 1995; Bukstein et al., 1993; Fremouw et al., 1993). Also frequently noted in the literature as contributing to the increase in the adolescent and young adult suicide rate is the easy accessibility to weapons, such as firearms, either from the home or off the street due to the increasing gang and drug trade (Bussing et al., 1996; Brent and Perper, 1995; Bukstein et al., 1993).
Complicating these statistics on adolescent and young adult suicide is the increasing number of adolescent/young adult deaths deemed accidental, unintentional, and/or motor vehicle related. A review of the literature notes the difficulty often confronting the researcher in classification of death especially when the adolescent/young adult was a known substance abuser (Kjelsberg et al., 1995; Cherpitel, 1995). Behaviors such as drinking and driving, carrying a weapon, poor impulse control, and interpersonal stress increase the likelihood of death when substance use/abuse is present (Kann et al., 1996).
The purpose of this study was to examine the adolescent and young adult suicide and accidental death rates for the 5-year period between 1990–1995, in relation to substance use/abuse prior to the death. Gender differences, methods of suicide, pertinent risk factors, and toxicology results were also reviewed. Implications and recommendations for psychiatric advanced practice practitioners are presented in relation to outcomes of this study.