Investigating the association between age at first alcohol use and suicidal ideation among high school students: Evidence from the youth risk behavior surveillance system

Background: Although various studies have investigated and found a significant link between age at first alcohol use and health risk behaviors, few studies have investigated the effect of age at first alcohol use on suicidal ideation among adolescents. The objective of this study was to investigate the effect of age at first alcohol use on suicidal ideation. Methods: Data for this study were obtained from the 2015 Youth Risk Behavior Surveillance system. A sample of 10,745 adolescents aged 14-18 years (50.9% males) were analyzed using logistic regression with suicidal ideation as the outcome variable and age at first alcohol use as the main explanatory variable. Results: About 17% of adolescents experienced suicidal ideation during the past 12 months and 15.6% started having alcohol before age 13. Adolescents who started having alcohol before age 13 had 1.60 times higher odds of experiencing suicidal ideation and adolescents who started having alcohol by age 13 or over had 1.47 times higher odds of experiencing suicidal ideation. Other significant factors associated with suicidal ideation include experience of forced sex, physical teen dating violence, bullying, and feeling sad or hopeless. Having sufficient sleep lowered the odds of suicidal ideation. Limitations: The use of cross-sectional data limits the extent to which we can make causal claims regarding age at first alcohol use and suicidal ideation. Conclusions: Younger age at first alcohol use was associated with increased likelihood of suicidal ideation. Public health initiatives that seek to address the co-occurring problems of alcohol use and mental health illness, sexual violence, and victimization among sexual minority youth could help in reducing suicidal ideation.