Original article
Victimization, Suicidal Ideation, and Alcohol Use From Age 13 to 15 Years: Support for the Self-Medication Model

https://doi.org/10.1016/j.jadohealth.2016.09.019Get rights and content

Abstract

Purpose

Recent years have seen increased coverage of adolescent victimization and suicide. Both adolescent peer victimization and substance use have been associated with suicidal ideation, with evidence suggesting that all three factors are interrelated. There are at least four models which can explain the associations between these factors (i.e., self-medication, secondary mental disorder, bidirectional, and common factor). However, none of them is being empirically supported as the dominant model because few longitudinal studies have explored the association between these factors.

Methods

The present study compared longitudinal paths of all four models simultaneously using a cross-lagged model. This was done using self-reported measures of peer victimization, suicidal ideation, and alcohol use at age 13, 14, and 15 years in a longitudinal sample of 238 adolescents.

Results

All three variables were moderately stable across time. Significant cross-lagged associations were found, showing that frequent peer victimization at age 13 years was associated with higher odds of having suicidal ideation at age 14 years (odds ratio, 1.82; p < .05). In turn, presence of suicidal ideation at age 14 years was significantly associated with higher alcohol use frequency at age 15 years (β = .13; p < .05).

Conclusions

Results support previous literature suggesting that peer victimization predates alcohol use and extends it by showing clear directionality between suicidal ideation and alcohol use over 1 year, supporting the self-medication model. Clarifying the empirical basis of these underlying models could allow for earlier prevention strategies, by targeting the risk factor that appears the earliest in the model.

Section snippets

Peer victimization and suicidal ideation and behavior

Most studies that have examined the link between peer victimization and suicide ideation or behavior are cross sectional and found greater association of suicide ideation and attempts in adolescents who reported being bullied or victimized. For a comprehensive review on the subject, see the study by Kim and Leventhal [10].

Most prospective studies have tested a link that presumes a direction going from peer earlier victimization to later suicidal behaviors or thoughts. For instance, in one

Participants

The adolescents come from a longitudinal study for which participants were randomly selected at birth in 1996 from the Québec birth registry. Five hundred and seventy-two of 1,000 families contacted participated in the first wave of the study (see Table 1 for more sociodemographic information concerning these 572 families). The Louis-Hippolyte Lafontaine Hospital and the Centre Hospitalier Universitaire Sainte-Justine Research Center ethics committees approved this project. Children were first

Descriptive statistics

Of the 238 participants, 10% (14 girls, 6 boys) reported suicidal ideation at 13 years, 13% (13 girls, 8 boys) at 14 years, and 15% (21 girls, 3 boys) at 15 years. Mean scores for peer victimization remained relatively constant from 13 years (M = 9.6, SD = 2.7), to 14 years (M = 9.2, SD = 2.4), to 15 years (M = 9.2, SD = 2.3), whereas mean frequency of alcohol use increased significantly between ages 13 and 15 years (t = 5.11, p < .001): from 1.5 (SD = 1.0) at 13 years, to 2.2 (SD = 1.4) at

Discussion

The main objective for this study was to examine the longitudinal associations between peer victimization, suicide ideation, and alcohol use in adolescence, to clarify which developmental models (i.e., self-medication, secondary mental disorder, bidirectional, or the common factor) were best supported empirically. A general cross-lagged approach was used, which allowed us to test simultaneously all the paths proposed by the four models. Results revealed a significant developmental sequence

Acknowledgments

The authors are grateful to their partner, the Institut de la Statistique du Québec. They thank all the parents and children for their generous participation in the study.

The first draft was written by Shawn Marschall-Lévesque.

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    Conflicts of Interest: The authors have no conflicts of interest to disclose.

    Disclaimer: The study sponsors have no role in the article.

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