Sex and Drug Use Increase Teen Suicide Risk

Depressed teen sitting on stairs
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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.

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 abuse: 51% of teens considered a major problem among peers
  • Alcohol use: 45% of teens considered a major problem among peers
  • Teen pregnancy: 34% of teens considered 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 which 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 

Sex & Teen 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%. 

Globally, 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 for higher-income families, social and economic pressure to "keep up" with others (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 often lower in all age groups decrease during periods of economic depression.

While the overall birth rate in the U.S. began to recover as the economy did, 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 (such as 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, as well as 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 abuse 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.

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