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Depressive Symptoms and Suicidality in Adolescents Using e-Cigarettes and Marijuana

A Secondary Data Analysis From the Youth Risk Behavior Survey

Chadi, Nicholas, MD; Li, Guilin, MBBS; Cerda, Natalie, MD; Weitzman, Elissa R., ScD, MSc

doi: 10.1097/ADM.0000000000000506
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Objectives: E-cigarette use has increased dramatically among adolescents in the past 5 years alongside a steady increase in daily use of marijuana. This period coincides with a historic rise in depression and suicidal ideation among adolescents. In this study, we describe the associations between e-cigarette and marijuana use and depressive symptoms and suicidality in a large nationally representative sample of high school students.

Methods: We used data from the 2 most recent waves (2015 and 2017) of the Youth Risk Behavior Survey. Our sample (n = 26,821) included only participants with complete information for age, sex, race/ethnicity, and exposure to e-cigarettes and marijuana (89.5% of survey respondents). We performed multivariate logistic regressions to explore the associations between single or dual use of e-cigarette and marijuana and depressive and suicidal symptoms in the past year adjusting for relevant confounders.

Results: E-cigarette-only use was reported in 9.1% of participants, marijuana-only use in 9.7%, and dual e-cigarette/marijuana use in 10.2%. E-cigarette-only use (vs no use) was associated with increased odds of reporting suicidal ideation (adjusted odds ratio [AOR]:1.23, 95% CI 1.03–1.47) and depressive symptoms (AOR: 1.37, 95% CI 1.19–1.57), which was also observed with marijuana-only use (AOR: 1.25, 95% CI 1.04–1.50 and AOR: 1.49, 95% CI 1.27–1.75) and dual use (AOR: 1.28, 95% CI 1.06–1.54 and AOR: 1.62, 95% CI 1.39–1.88).

Conclusions: Youth with single and dual e-cigarette and marijuana use had increased odds of reporting depressive symptoms and suicidality compared to youth who denied use. There is a need for effective prevention and intervention strategies to help mitigate adverse mental health outcomes in this population.

Adolescent Substance Use and Addiction Program, Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA (NC); Harvard Chan School of Public Health, Harvard University, Boston, MA (NC, GL); Developmental Medicine Center, Division of Developmental Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA (NC); Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA (ERW).

Send correspondence to Nicholas Chadi, MD, Adolescent Substance Use and Addiction Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115. E-mail: nicholas.chadi@childrens.harvard.edu

Received 25 October, 2018

Accepted 10 January, 2019

The authors have indicated they have no financial relationships relevant to this article to disclose.

The authors have indicated they have no potential conflicts of interest to disclose.

© 2019 American Society of Addiction Medicine