Abstract
Only a handful of public health studies have investigated expectations of early death among adolescents. Associations have been found between these expectations and risk behaviors in adolescence. However, these beliefs may not only predict worse adolescent outcomes, but worse trajectories in health with ties to negative outcomes that endure into young adulthood. The objectives of this study were to investigate perceived chances of living to age 35 (Perceived Survival Expectations, PSE) as a predictor of suicidal ideation, suicide attempt and substance use in young adulthood. We examined the predictive capacity of PSE on future suicidal ideation/attempt after accounting for sociodemographics, depressive symptoms, and history of suicide among family and friends to more fully assess its unique contribution to suicide risk. We investigated the influence of PSE on legal and illegal substance use and varying levels of substance use. We utilized the National Longitudinal Study of Adolescent Health (Add Health) initiated in 1994–95 among 20,745 adolescents in grades 7–12 with follow-up interviews in 1996 (Wave II), 2001–02 (Wave III) and 2008 (Wave IV; ages 24–32). Compared to those who were almost certain of living to age 35, perceiving a 50–50 or less chance of living to age 35 at Waves I or III predicted suicide attempt and ideation as well as regular substance use (i.e., exceeding daily limits for moderate drinking; smoking ≥ a pack/day; and using illicit substances other than marijuana at least weekly) at Wave IV. Associations between PSE and detrimental adult outcomes were particularly strong for those reporting persistently low PSE at both Waves I and III. Low PSE at Wave I or Wave III was also related to a doubling and tripling, respectively, of death rates in young adulthood. Long-term and wide-ranging ties between PSE and detrimental outcomes suggest these expectations may contribute to identifying at-risk youth.
Highlights
Perceptions of immortality and invincibility have been offered as explanations for heightened risk-taking among youth [1]
We investigated the relationship between Wave III Perceived Survival Expectations (PSE) and Wave IV suicidal behavior controlling for the full set of covariates with Wave III values where available
To the authors’ knowledge, this is the first study to demonstrate that adolescent expectations of early death can have long-lasting associations with risk behaviors over a decade later, independent of depressive symptoms and other important confounding individual and contextual factors
Summary
Perceptions of immortality and invincibility have been offered as explanations for heightened risk-taking among youth [1]. Cross-sectional studies linked adolescent expectations of early death to risk behaviors like suicide ideation/act, impulsive sensation-seeking, drinking and driving, and selling drugs [2,3]. Studies utilizing data from the National Longitudinal Study of Adolescent Health (Add Health) identified low perceived chances of living to age 35 (which we term Perceived Survival Expectations, PSE) as a predictor of future suicide attempt, fight-related injury, unsafe sexual activity, police arrest, human immunodeficiency virus (HIV) diagnosis [4]–and most recently to cigarette smoking [5]. One in seven adolescents at Wave I of Add Health reported perceiving a 50–50 chance or less of living to age 35 [4]
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