Inhalant use and suicidality among incarcerated youth

Inhaling, or "huffing," the vapors of common household solvents strongly correlates with suicidal thoughts and behavior among adolescents.

That's what researchers found in a study of 723 incarcerated youth--the first work to categorize inhalant use into levels of severity and relate this to suicidal ideas and suicide attempts in incarcerated juveniles. It is also one of the few studies to examine gender differences involved.

"Inhalant Use and Suicidality among Incarcerated Youth," by Dr. Stacey Freedenthal and Dr. Jeffrey M. Jenson, both of the University of Denver's Graduate School of Social Work, Dr. Michael G. Vaughn of the University of Pittsburgh, and Dr. Matthew O. Howard of the University of North Carolina, appears in the September 2007 issue of the academic journal Drug and Alcohol Dependence .

The investigators found an increase in suicidal thoughts and attempts with higher levels of use of volatile solvents. In fact, the majority of those in the sample who had been serious abusers prior to incarceration reported having tried to kill themselves at some point.

The researchers did not seek to determine which problem came first, the huffing or the suicidality, but showed that the two are connected, even when accounting for other factors.

The study points out that suicide is the third leading cause of death among adolescents in the U.S., and that the rates of suicide attempts appear to be very much higher for those who use inhalants than for those who do not.

The study categorized inhalant use into three levels: no use, use without dependence or abuse, and use with a diagnosis of dependence or abuse. The research controlled for factors such as alcohol and other drug use, psychiatric disturbances, and trauma to see if these accounted for the suicidal behavior, but the link specifically between higher levels of inhalant use and suicidality remained distinct for both genders.

The most startling numbers related to girls, revealing a history of suicide attempts among 81.3 percent of those who abused or were dependent on inhalants, with boys in the same category at 59.5 percent.

"Girls' problems tended to be more severe," Dr. Freedenthal says. "For participants who reported dependence or abuse of inhalants, rates of suicide attempts were dramatically higher for girls. However, prior research indicates that while girls attempt suicide more often than boys do, boys actually die by suicide at higher rates."

The study also indicated that suicidal thoughts were much higher for girls than for boys. Suicidal thoughts and attempts were considered two separate constructs, since thoughts do not always lead to attempts, and attempts are not always preceded by much thought.

The study involved 723 participants incarcerated by the Missouri Division of Youth Services, 33 percent of whom reported having inhaled volatile solvents. Twenty-five percent had attempted suicide, and 58 percent reported suicidal thoughts.

Fifty-three percent were from urban or suburban environments, and 47 percent were from rural areas or small towns. Fifty-five percent were white, 33 percent were black, and nearly 12 percent were other races. There were 629 boys and 94 girls. The average age was 15.

Participants were asked if they had huffed any of 35 common household substances, such as paint, paint thinner, glue, shoe polish, spot remover, floor polish, kerosene, gasoline, antifreeze, permanent markers, nail polish, nail polish remover, mothballs, waxes, lighter fluid, and others.

Study participants comprised 97.7 percent of all residents in Missouri's youth incarceration facilities at the time the data were collected, and 55 percent of all youth committed in Missouri that year.

"The very high proportion interviewed is an important distinction of our study. Researchers usually examine a small sample and extrapolate the results to a much larger population, but we interviewed nearly all adolescents incarcerated in juvenile detention centers in Missouri at that time," says Dr. Freedenthal. "This means our study is very closely representative of that state's incarcerated youth."

In light of their findings, the researchers recommend that professionals who deal with troubled youth ask both about solvent use and suicidality when assessing patients for either, because each may be a warning sign for the other.
However, Dr. Freedenthal and her co-authors acknowledge that their findings may not apply to non-incarcerated youth. She says future research should look at community samples, as well as samples with different proportions of gender, race, ethnicity, and type of community (rural vs. urban).

Future research should also explore whether inhalant use precedes the suicidality or vice versa to determine if one causes the other, and the specific ways the two issues relate to each other, she says.