Association Between Suicidality and Risky Driving Among US Adolescents—Results From the 2019 Youth Risk Behavior Survey

Abstract

This cross-sectional study examines the association between suicidality in adolescents and their rates of exercising risky driving behaviors.

Suicidality (eg, suicidal ideation, suicidal behaviors)¹ contributed to nearly 32% of all deaths among adolescents aged 12 to 18 years in 2019.² Risky driving behaviors, such as distracted driving via use of a cell phone, infrequent use of seat belts, driving while under the influence of alcohol, and driving with someone under the influence of alcohol, are also common among adolescents.^3,4 Engagement in risky driving behaviors may explain why motor vehicle traffic crashes, representing nearly 62% of unintentional injury deaths, were the leading cause of death among adolescents aged 12 to 18 years in 2019.² Novelty seeking, sensation seeking, and impulsivity have been identified as overlapping psychological traits implicated in both suicidality and engagement in risky driving behaviors among adolescents.^1,5 However, no known research has explored the association between these behaviors, which was the aim of this study.

Methods

In this cross-sectional study, data were obtained from the 2019 National High School Youth Risk Behavior Survey (13 677 adolescents). The Youth Risk Behavior Survey is conducted biannually by the Centers for Disease Control and Prevention to monitor health risk behaviors among adolescents. The Youth Risk Behavior Survey uses a 3-stage cluster sampling method to collect a nationally representative sample of US high school students. Data were collected on self-reported race and ethnicity (survey question options included American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian or Other Pacific Islander, and White). Both suicidality and risky driving behavior were measured using 4 distinct items (eMethods in the Supplement). The unadjusted percentage of risky driving behaviors by suicidality were estimated. The Youth Risk Behavior Survey uses active and passive written parental consent and is approved by the Centers for Disease Control and Prevention Institutional Review Board.⁶ In accordance with the University of Toronto’s Research Ethics Board policies on exempted research, this study was exempt from ethics review and informed consent because we used publicly available deidentified data.

Significant differences were ascertained by the adjusted F, a variant of the second-order Rao-Scott adjusted χ² statistic. Adjusted analyses were conducted using modified Poisson regression models with robust error variance to estimate prevalence ratios (PRs) while controlling for potential confounders. Statistical significance was defined as 2-sided P < .05. All analyses included preconstructed sample weighting and were conducted using Stata, version 17 (StataCorp, LLC).

Results

The nationally representative sample from the survey included data obtained from 13 677 adolescents (51% male and 49% female individuals). Of these individuals, 26% were aged 16 years. The participants self-identified as Asian (5%), non-Hispanic Black (12%), Hispanic (26%), White (51%), multiracial (5%), and other race or ethnicity (1%, which included American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander). Among the overall sample, 19% of participants self-reported suicidal ideation in the past 12 months, 16% of participants self-reported a suicide plan in the past 12 months, 9% of participants self-reported 1 or more suicide attempt in the past 12 months, and 3% of participants who self-reported a suicide attempt also self-reported a suicide-related injury.

Texting or emailing while driving was the most commonly reported form of risky driving behavior among participants, and reports of all risky driving behaviors were significantly more common among adolescents who self-reported suicidality compared with those who did not (Figure). For example, 44% of participants who self-reported suicidal ideation, 45% of participants who self-reported suicide planning, 47% of participants who self-reported 1 or more suicide attempt, and 54% of participants who self-reported a suicide injury also self-reported texting or emailing while driving. Adjusted analyses (Table) revealed that adolescents who self-reported 1 or more suicide attempt in the past 12 months vs those who reported none were 39% more likely to self-report infrequent seat belt use (PR, 1.39; 95% CI, 1.08-1.77; P < .01), 33% more likely to self-report driving with a drunk driver (PR, 1.33; 95% CI, 1.10-1.60; P = .003), and more than twice as likely to self-report driving drunk (PR, 2.02; 95% CI, 1.36-3.01; P < .001). Adolescents who self-reported a suicide injury in the past 12 months vs those who did not had the highest likelihood of reporting all 4 risky driving behaviors. For example, participants who self-reported a suicide injury were more than twice as likely to self-report driving drunk (PR, 2.50; 95% CI, 1.47-4.23).

Figure. Unadjusted Percentage of Risky Driving Behaviors by Suicidality Among Adolescent Participants in the 2019 National High School Youth Risk Behavior Survey.

The sample included a total of 13 677 adolescents. Preconstructed sample weighting was applied to all analyses. Significant differences between suicidality groups were ascertained by the adjusted F, a variant of the second-order Rao-Scott adjusted χ² statistic.

^aP < .05.

^bP < .01.

^cP < .001.

Table. Association Between Suicidality and Risky Driving Behaviors Among 13 677 Adolescents in the 2019 National High School Youth Risk Behavior Survey^a.

Suicidality	Risky driving behavior
	Infrequent seat belt use		Drove with drunk driver, past 30 d		Drove drunk, past 30 db		Texted or emailed while driving, past 30 db
	PR (95% CI)c	P value	PR (95% CI)c	P value	PR (95% CI)c	P value	PR (95% CI)c	P value
Suicidal ideation in the past 12 mo	1.20 (1.03-1.41)	.02	1.09 (0.94-1.27)	.24	1.43 (1.01-2.02)	.04	1.02 (0.91-1.15)	.73
Suicidal plan in the past 12 mo	1.17 (0.97-1.42)	.09	1.20 (1.03-1.41)	.02	1.49 (1.06-2.08)	.02	1.15 (1.02-1.29)	.02
1 or more suicide attempt in the past 12 mo	1.39 (1.08-1.77)	.01	1.33 (1.10-1.60)	.003	2.02 (1.36-3.01)	<.001	1.10 (0.94-1.30)	.24
Suicide injury in the past 12 mod	2.42 (1.53-3.82)	<.001	1.42 (1.06-1.89)	.02	2.50 (1.47-4.23)	.001	1.35 (1.05-1.74)	.02

Abbreviation: PR, prevalence ratio.

^a Preconstructed sample weighting was applied to all analyses. The PR in each cell represents the abbreviated output from a series of Poisson regression models with robust error variance specifying suicidality as the independent variables and risky driving behaviors as the dependent variables. Thus, the table represents the outputs from 16 Poisson regression models in total.

^b Participants who reported they did not drive were excluded.

^c Adjusted for age, sex, race and ethnicity, sexual orientation, school grades in the past 12 months, alcohol use in the past 30 days, feeling sad or hopeless in the past 12 months.

^d Participants who did not report 1 or more suicide attempts in the past 12 months were excluded.

Discussion

Suicide and motor vehicle crashes are 2 of the most common causes of death among adolescents aged 12 to 18 years.¹ This study of a nationally representative sample of adolescents found that self-reported suicidality is associated with risky driving behaviors. Overall, the findings revealed a pattern showing that as severity of suicidality increased (ie, from suicidal ideation to suicide attempt), so, too, did self-reported risky driving. Adolescents who self-reported a suicide injury were most likely to also self-report all 4 risky driving behaviors. Moreover, adolescents who self-reported suicidal ideation, the most common form of suicidality, including 19% of participants in this study, were more likely to self-report infrequent seat belt use and drunk driving. Limitations of the study include the use of self-reported data and cross-sectional study design. Given these findings, consideration of the association between suicidality and risky driving behaviors is warranted when health care professionals assess and treat adolescents.

Supplement.

eMethods. 2019 National High School Youth Risk Behavior Survey.