Suicide Ideation, Distress, and Peer Perceptions as Predictors of Substance Use

Background Substance use and suicide ideation are common behaviors that often overlap among college students. However, clues about their temporal relationship, as well as moderating factors (e.g., distress, peer perceptions of substance use), are understudied. Indeed, those with a history of suicide ideation may use avoidance coping (including substance use) to manage distress, underscoring the possibility of substance use as a response to suicide ideation, an oft-stressful experience in and of itself. Further, as a low sense of belongingness confers risk for suicide ideation, distress may increase compliance with perceived cultural norms, thus increasing substance use behavior. This study examined the effect of the suicide ideation-distress-peer perception interaction on substance use. Method Participants were 3,608 undergraduate students across eleven college campuses. Measures of past month substance use frequency, general distress, peer perceptions of substance use, and past year suicide ideation were utilized. Results Suicidal ideation was associated with e-cigarette, marijuana, and illicit drug use. There were main effects of suicide ideation (on e-cigarette and marijuana use) and peer perceptions of substance use (on tobacco, alcohol, e-cigarette, and marijuana use), but not distress, on past 30-day substance use. Further, the three-way interaction of suicide ideation, distress, and peer perceptions of substance use predicted frequency of past month tobacco and illicit drug use. Conclusions Suicide ideation may be temporally linked to use of specific substances. Peer perception and distress may strengthen the suicide ideation-substance use relationship. These factors should be carefully considered when treating individuals with substance use.