Sex and Drug Use Increase Teen Suicide Risk

Depressed teen sitting on stairs

Petar Chernaev / E+ / Getty Images

Information presented in this article may be triggering to some people. If your child is having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

According to the Centers for Disease Control and Prevention (CDC), suicide is the third leading cause of death for teens in the United States. The rates of depression and suicide in U.S. teenagers have been increasing for decades. 

Although many factors are involved, several studies suggest that adolescents who engage in high-risk behaviors are more likely to attempt suicide. Research has also suggested that sexual activity and illegal drug use significantly increase teens’ risk for depression, suicidal thoughts, and suicide attempts.

Teen Awareness

Teens growing up in the U.S. are well aware of the mental health challenges facing their generation: In 2018, a Pew Research survey found 70% of teens aged 13–17 consider mental health to be “a major problem” among their peers. 

When teens were asked about specific issues of concern within their peer groups and communities, substance use and teen pregnancy were among the problems noted: 

  • Drug use: 51% of teens considered drug use a major problem among peers.
  • Alcohol use: 45% of teens considered alcohol use a major problem among peers.
  • Teen pregnancy: 34% of teens considered teen pregnancy a major problem among peers.

In recent decades, the rates of substance use and sexual activity among U.S. teens have been decreasing, while the rates of depression and suicide have continued to increase. 

There’s little doubt these factors can contribute to poor mental health for teens, but the relationship is complex. For adults who are seeking to understand the impact of these factors and behaviors, seeking and reviewing the most recent research, data, and guidelines (as well as considering their context) is key to mitigating the effects and improving the mental health of teens.

What Research Suggests

Around 28% of U.S. high school students have experienced severe depression, and suicide is the third leading cause of death for teens between the ages of 15–19. For those who study adolescent mental health, the first step in preventing these rates from increasing (and finding ways to lower them) is figuring out what forces are driving them.

In 2004, a team of researchers lead by Denise D. Hallfors, Ph.D., a Senior Research Scientist at the Pacific Institute for Research and Evaluation in Chapel Hill, North Carolina, analyzed various sex and drug behavior patterns via data from a survey of nearly 19,000 teens in grades 7–12. The data were gathered from 132 U.S. schools as part of the National Longitudinal Study of Adolescent Health.

The researchers divided the teens into 16 groups according to their behaviors, including: 

  • “Abstainers” (completely avoid sex and drugs)
  • Sex “dabblers” (experimentation with sexual behavior)
  • Teens with multiple sexual partners
  • Alcohol and sex “dabblers”
  • Illegal drug users 

Teen Sex & Pregnancy

The teens in the “abstainer” group reported the lowest levels of depression, suicidal thoughts, and suicide attempts, while the teens in groups associated with sex and illicit drug use reported the highest levels. 

Teens who were “dabblers” in sex, drugs, alcohol, and tobacco fell somewhere in the middle in terms of depression and suicide risk. 

The study found that female teens were less likely than males of the same age to pursue high-risk behaviors. However, the girls who did engage in these behaviors were more vulnerable to depression, suicidal thoughts, and suicide attempts than their male peers.

That's not to say that simply engaging in sexual behaviors means a teen will become depressed—the type and relationship context may make a difference. In 2018, a team of researchers at Cornell found that teens who engage in casual, non-romantic sex or “hookups” may be more prone to developing depression than their sexually-active peers who are in stable relationships. 

Other studies have indicated that sexually-active teens who participate in “sexting” may be more likely to have mental health problems as well as be more likely to be delinquent. However, previous research has indicated that academically, teens who are sexually active don’t do any better or worse in school than their abstinent peers.

While these behaviors and activities may influence mental health for teens who are or become sexually active, they may not be the majority in their peer group. Data presented in a January 2018 edition of the CDC’s Morbidity and Mortality Weekly Report indicated teens are waiting longer to have sex for the first time.

In 1991, 53% of U.S. high schoolers had been sexually active. By 2005, the percentage had fallen to 47%. In 2015, the number of high school students who had ever had sex was down to 41%. In 2017, the rate had dropped to 39.5%. 

In fact, the rates of teens having sex have been on the decline for the last several decades. One survey from 2018 put the percentage of teens who had ever had sex at just 40%—the lowest numbers since tracking began in 1991. 

Substance Use

Research from 2018 indicates that teens are using drugs and alcohol at lower rates than in previous decades. According to CDC data, alcohol, tobacco, and marijuana continue to be the most commonly used substances by teens in the U.S.

With the exception of marijuana (the rates for which have remained steady) and vaping (which has significantly increased), drug and alcohol use among teens has also been declining. In 2018, the rate of use for tobacco was actually the lowest in the survey’s history. 

Teens are more likely to use marijuana every day than cigarettes. In response to an annual NIH survey, 71% of high school seniors said they don’t see much harm in using marijuana every day. However, in the same survey, 64% of high school seniors said they disapprove of daily marijuana use.

Self-reported student data collected by the CDC indicates that the rate of illicit drug use among U.S. teens is declining. In 2007, 22.6% of teens reported they had tried at least one illicit drug. In 2017, only 14% of teens reported ever using drugs. 

Socioeconomic Factors

Hallfors’ study also found that the risk of depression for teens is reduced by half if they come from a family of higher socioeconomic status. However, at the same time, coming from a higher socioeconomic background increased teens’ risk for suicidal thoughts. 

While the association isn't completely clear, previous research lead by the Federal Reserve Bank in San Francisco in 2010 investigated the high rate of suicides in wealthy California neighborhoods. The study suggested that for higher-income families, social and economic pressure to "keep up" with others (such as neighbors, colleagues, etc.) likely contributes to stress which in turn raises the risk of depression and suicide.

The socio-economic circumstances of a teen's family may influence their mental and sexual health in other ways. Research has shown that growing up in a low-income family can be a stronger determinant of the age at which a teen becomes sexually active than genetics (which is generally regarded as a prominent influence). Studies have shown that female teens who begin having sex at a younger age may be more prone to depression.

As noted by Pew Research, the downward trend in teen births over the last few decades occurred in the context of an economic recession. Historically, birth rates are lower in all age groups during periods of economic depression.

While the overall birth rate in the U.S. began to recover as the economy did, however, the teen birth rate did not. In fact, it has continued to fall. The rates of teen pregnancy and parenthood have been steadily declining over the last decade. In 2018, the birth rate among teen girls was half of what it was in 2008. 

Screening and Treatment

At the end of her team's study, Hallfors said doctors treating adolescent patients should “strongly consider” screening teens for depression, as well as assessing their suicide risk if they report having sex and/or using drugs.

However, surveys of medical professionals have found that doctors may not be talking about sex and drug use with teen patients. These findings are concerning, but researchers are hoping to encourage and support these important dialogues between doctors and the adolescents they treat.  

Healthcare providers should ask all adolescent patients about sexual activity and drug use. Any teen who reports engaging in the behaviors, especially if more than “dabbling,” needs to be screened for depression and suicide risk. 

When talking to teens about the risks of sexual intercourse and drug use, studies have shown that harm reduction approaches are most effective (for example, when compared to abstinence-only sex education).

Research has also consistently indicated that providing information about and access to contraceptives to teens does not lead to increased sexual activity.  

A Word From Verywell

For teens, emerging sexuality, peer pressure, and exposure to substances can cause stress. It's important that the adults around them (including parents, teachers, coaches, doctors, and counselors) understand how these behaviors can contribute to depression in teens. This includes being aware of the most current research and statistics and being able to use these facts to engage teens when discussing these topics freely—and without shame.

It's also important that preteens and teens have access to accurate and actionable information and resources to help them become more informed about their sexual health. Teenagers also need supportive adults to educate them on and help them recognize the signs of substance use problems. They also need to become familiar with the resources available at school or within their community from which they can seek help if they (or someone in their peer group) is using substances.

Was this page helpful?
Article Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Miniño AM. Mortality Among Teenagers Aged 12-19 Years: United States, 1999-2006. NCHS Data Brief No. 37, May 2010. Centers for Disease Control and Prevention. Updated November 6, 2015.

  2. Miron O, Yu KH, Wilf-Miron R, Kohane IS. Suicide Rates Among Adolescents and Young Adults in the United States, 2000-2017. JAMA. 2019;321(23):2362-2364. doi:10.1001/jama.2019.5054

  3. Horowitz JM, Graf N. Most U.S. Teens See Anxiety and Depression as a Major Problem Among Their Peers. Pew Research Center’s Social & Demographic Trends Project. Published February 20, 2019. 

  4. Hallfors DD, Waller MW, Ford CA, Halpern CT, Brodish PH, Iritani B. Adolescent depression and suicide risk: association with sex and drug behavior. Am J Prev Med. 2004;27(3):224-31. doi:10.1016/j.amepre.2004.06.001

  5. Mendle J, Ferrero J, Moore SR, Harden KP. Depression and adolescent sexual activity in romantic and nonromantic relational contexts: a genetically-informative sibling comparison. J Abnorm Psychol. 2013;122(1):51-63. doi:10.1037/a0029816

  6. Mori C, Temple JR, Browne D, Madigan S. Association of sexting with sexual behaviors and mental health among adolescents: A systematic review and meta-analysis. JAMA Pediatr. 2019. doi:10.1001/jamapediatrics.2019.1658

  7. McCarthy B, Grodsky E. Sex in school: Adolescent sex and educationSocial Problems. 2011;58 (2):213-234. 

  8. Key Statistics From the National Survey of Family Growth: Teenagers. National Survey of Family Growth (NSFG). National Center for Health Statistics. Centers for Disease Control and Prevention website. Updated June 23, 2017.

  9. Witwer E, Jones R, Lindberg L. Sexual Behavior and Contraceptive and Condom Use Among U.S. High School Students, 2013–2017. New York: Guttmacher Institute, 2018. doi:10.1363/2018.29941

  10. Kuehn BM. Teen sex, drug use decline. JAMA. 2018;320(4):333. doi:10.1001/jama.2018.9638

  11. Teen Substance Use & Risks. CDC Features. Centers for Disease Control and Prevention website. Update April 1, 2019.

  12. Monitoring the Future 2018 Survey Results. National Institute on Drug Abuse. Published December 17, 2018. 

  13. Monitoring the Future Survey: High School and Youth Trends. National Institute on Drug Abuse. Published 2019. 

  14. Teens’ Drug Use Is Lower Than Ever (Mostly). NIDA for Teens. National Institute on Drug Abuse. Published 2018. 

  15. Fewer U.S. High School Students Having Sex, Using Drugs. CDC Newsroom. Centers for Disease Control and Prevention. Published 2019. 

  16. Hallfors DD, Waller MW, Bauer D, Ford CA, Halpern CT. Which comes first in adolescence—sex and drugs or depression?. Am J Prev Med. 2005;29(3):163-70. doi:10.1016/j.amepre.2005.06.002

  17. The Changing Face of America’s Adolescents. U.S. Department of Health and Human Services. Published February 25, 2019.

  18. Daly MC, Wilson DJ, Johnson NJ. Relative Status and Well-Being: Evidence from U.S. Suicide Deaths (April 2007). FRB of San Francisco Working Paper No. 2007-12. doi:10.2139/ssrn.1026351

  19. Carlson MD, Mendle J, Harden KP. Early adverse environments and genetic influences on age at first sex: Evidence for gene × environment interaction. Dev Psychol. 2014;50(5):1532-42. doi:10.1037/a0035479

  20. Gonçalves H, Gonçalves Soares AL, Bierhals IO, et al. Age of sexual initiation and depression in adolescents: Data from the 1993 Pelotas (Brazil) Birth Cohort. J Affect Disord. 2017;221:259-266. doi:10.1016/j.jad.2017.06.033

  21. Livingston G, Thomas D. Why is the teen birth rate falling? Pew Research Center. Published August 2, 2019. 

  22. DeSilver D. The concerns and challenges of being a U.S. teen: What the data show. Pew Research Center. Published February 26, 2019.

  23. Alexander SC, Fortenberry JD, Pollak KI, et al. Sexuality talk during adolescent health maintenance visits. JAMA Pediatr. 2014;168(2):163-9. doi:10.1001/jamapediatrics.2013.4338

  24. Kulak JA, Griswold KS. Adolescent substance use and misuse: Recognition and managementAm Fam Physician. 2019;99(11):689-696. 

  25. Slemon A, Jenkins EK, Haines-Saah RJ, Daly Z, Jiao S. "You can't chain a dog to a porch": a multisite qualitative analysis of youth narratives of parental approaches to substance use. Harm Reduct J. 2019;16(1):26. doi:10.1186/s12954-019-0297-3

  26. Promiscuity Propaganda: Access to Information and Services Does Not Lead to Increases in Sexual Activity.Guttmacher Institute. Published June 12, 2019. 

  27. American Adolescents’ Sources of Sexual Health Information. Guttmacher Institute. Published January 3, 2019.

Additional Reading