This week Mad in America examines several articles related to adolescent suicide, including one that finds a link between suicide and debt, another that links suicide to adverse childhood experiences, bullying, and cannabis use, and one that argues against psychiatric hospitalization for people at high-risk of suicide.
Debts and Experienced Financial Scarcity: Associations with Nonsuicidal Self-Injury and Suicidality in Adolescents at Risk for Psychopathology
A new article published in Child and Adolescent Mental Health finds that being in debt is linked to increased risk of suicide in adolescents. This research, led by Susan J. Ravensbergen of the Erasmus University Medical Center Rotterdam, also finds a link between the experience of financial scarcity to suicidality and non-suicidal self injury (NSSI).
The aim of the current work was to investigate links between being in debt and experiencing financial scarcity to suicidality and NSSI in adolescents. The authors used data collected from 1,022 adolescents living in the Greater Rotterdam region of the Netherlands. Potential participants were given the Strengths and Difficulties Questionnaire – Youth to measure emotional and behavioral health. The adolescents that scored in the highest 15%, indicating higher rates of emotional and behavioral problems, were invited to participate in the study along with a random sample from the remaining 85%. Participants’ suicidality, debt, demographics, etc. was measured once at baseline, and once 3 years later.
Measures
Debt was measured by asking participants to self-report the amount of money owed to individuals and institutions, payment arrears, bank account overdrafts, and student loans. Financial insecurity was measured using a version of the Psychological Inventory of Financial Scarcity adapted for adolescents. This survey assesses worries about financial resources and participants’ sense of control over their financial circumstances.
NSSI was measured using the Inventory of Statements about Self-Injury. This survey asks participants about how often they have engaged in self-injury behaviors without suicidal intent in the past two years. The authors measured suicidality using the 10-item Questions on Suicide and Self-Harm – Short Version survey. This assessment asks about suicidal thoughts and attempts in the past two years. The researchers coded both suicide attempts and suicidal thoughts as suicidality.
The authors used the Brief Symptom Inventory to assess parental psychopathology. This is a self-report survey in which participants’ parents answered questions about their levels of psychological distress and mental health symptoms over the past seven days. Participants’ social support was measured with the Multidimensional Scale of Perceived Social Support. This self-report survey asks participants about social support from family, friends, and significant others.
The participants also took an IQ test and answered questions around their demographic data such as age, sex, and ethnicity. Participants’ parents additionally reported the families yearly household income.
Results
The majority of participants were female (54.8%) and reported a Western ethnic background (85.5%). A total of 16.6% of participants reported both suicidality and NSSI at the 3 year follow-up. Twenty-eight-point-three percent of participants reported NSSI and 24.3% reported suicidality in the past two years. The rates of both NSSI and suicidality were higher for females. While 54.8% of participants were female, 66.8% of those reporting NSSI, and 66.5% reporting suicidality, were female.
Seven-point-six percent of participants reported having debt. Student loans were the most common (46.9%) followed by borrowing money from individuals (18.4%), falling behind on payments (8.2%), and mobile phone related debt (8.2%). Adolescents with debt were nearly twice as likely (1.94) to report suicidality, but were not more likely to report NSSI after adjusting for confounding variables such as ethnic background and parental psychopathology. Each one point increase on the financial scarcity measure was associated with 9% increased odds of NSSI and 15% increased odds of suicidality.
Limitations
The authors acknowledge several limitations to the current work. The design means the data can only speak to associations, not causes. In other words, this study cannot definitively say that debt and financial hardship cause NSSI or suicidality. Student loans were far more common than other types of debt. This means the results may be less generalizable to populations without student loans. The surveys did not ask about when NSSI or suicidality occurred, meaning NSSI and suicidality could have happened before financial hardship and debt. The self-report nature of the surveys could bias the data through misremembering and misreporting. As most of the sample had a Western ethnic background, and the research was conducted with adolescents from the Greater Rotterdam region of the Netherlands, generalizability to other populations in limited.
Association of Adolescent Cannabis Use with Poor Mental Health and Suicidality in Young Adulthood: A Cross-Sectional Study Using YRBS 2023 Data
A new study published in the Electronic Journal of General Medicine finds that suicidality and poor mental health are associated with cannabis use in adolescents. The current work, led by Joseph Ntein Inungu from Central Michgan University, also finds a strong link between adverse childhood experiences and both poor mental health and suicidality in adolescents.
This research aimed to examine the association between poor mental health and suicidality to cannabis use in US high-school students. The authors used data from the 2023 Youth Risk Behavior Survey (YRBS), a nationally representative assessment given to US high school students to measure risk behaviors and mental health.
Participant mental health was assessed using a single question: “during the past 30 days, how often was your mental health not good? ” Students that answered “most of the time” or “always” were considered to have poor mental health. Suicidality was similarly assessed with a single question: “during the past 12 months, did you ever seriously consider attempting suicide?”
Cannabis use was assessed by asking participants how many times they had used cannabis in their lives, and how many times they had used in the past 30 days. The authors coded participants’ cannabis use as never, former, or current.
The researchers also collected demographic data, such as sex, age, and race, as well as socioeconomic information, data on social media use, and whether participants got eight or more hours of sleep on most school nights. The participants also answered a survey about adverse childhood experiences (ACEs). In total, the authors analyzed data from 8,065 participants.
Results
ACEs showed the strongest association with poor mental health. Students reporting one ACE were 85% more likely to have poor mental health. Those with two or three ACEs were 2.63 times more likely to report poor mental health, and students with four + ACEs were nearly five times more likely (4.93) to report poor mental health.
ACEs were also the factor most associated with suicide attempts. Students with one ACE were 2.54 times more likely to endorse suicidality, those with two or three ACEs were 4.82 times more likely, and students with four or more ACEs were 10 times more likely (10.04).
Current cannabis users were 47% more likely to have poor mental health and 83% more likely to report suicidality. Former cannabis users were also more likely (80%) to report suicidality.
Bullying was also linked to poor mental health and suicidality. Students that reported being bullied on school property were 79% more likely to have poor mental health and more than twice as likely to endorse suicidality (2.18). Those that experienced cyberbullying were 46% more likely to have poor mental health and 53% more likely to report suicidality.
Limitations
This research has several limitations. The design of the study cannot establish causality. This means the data cannot determine whether cannabis use causes suicidality and poor mental health, or if people with poor mental health and suicidality are self-medicating with cannabis. The self-report nature of surveys used in the current work mean the data may be biased through misremembering and misreporting. Data on frequency and potency of cannabis use was not available. While the sample was representatvie of US high-school students, there is limited generalizability to to students in non-traditional school settings and populations outside the US.
Beyond Risk: Rethinking Hospitalization for Suicidal Individuals
While psychiatric hospitalization is frequently used as a deterrent for suicide, a new opinion piece published in Frontiers in Psychiatry argues that it shouldn’t be. The current work, led by Christian Greiner of the Geneva University Hospital in Switzerland, points to non-hospitalization interventions like safety planning and brief suicide focused therapies as better alternatives to psychiatric hospitalization.
The authors start by pointing out that suicide prediction assessments are “no better than chance” at predicting who will attempt suicide in the future. These assessments are even worse in emergency situations and do not typically assess risk after discharge. The authors argue that a focus on categorizing suicide risk may detract from other forms of care that may actually be helpful.
There is no evidence that psychiatric admission prevents suicides, and some evidence that it may actually increase it. Psychiatric hospitalization itself can also be distressful and is often disconnected from service user’s subjective needs, especially involuntary psychiatric detention.
While there is little to no evidence that practices associated with psychiatric hospitalization, such as constant monitoring, safety contracts, and seclusion, improves suicidality, the authors note that a single suicide targeted therapy session that included a collaborative safety plan and connections to follow-up care was associated with 30% less suicide attempts. Despite the evidence, psychiatric hospitalization is used often and viewed by many psy-professionals as reducing suicide risk.
The authors argue that treatment for suicide should involve distress management, building trust (or repairing it in cases where the service user has already been hospitalized), and supporting transition back into the community after discharge from psychiatric facilities.
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Greiner, C., Huber, J., Prada, P., & Large, M. (2025). Beyond risk: Rethinking hospitalization for suicidal individuals. Frontiers in Psychiatry, 16. (Link)
Inungu, J. N., Olofu, J. I., Budhathoki, N., & Osakue, N. (2026). Association of adolescent cannabis use with poor mental health and suicidality in young adulthood: A cross-sectional study using YRBS 2023 data. Electronic Journal of General Medicine, 23(1). (Link)
Ravensbergen, S. J., de Neve‐Enthoven, N. G. M., Bouter, D. C., van Dijk, W. W., Hoogendijk, W. J. G., & Grootendorst‐van Mil, N. H. (2026). Debts and experienced financial scarcity: Associations with nonsuicidal self‐injury and suicidality in adolescents at risk for psychopathology. Child and Adolescent Mental Health. (Link)