Social Support and Substance Use as Moderators of the Relationship Between Depressive Symptoms and Suicidal Ideation in Adolescents.

Andrés Rubio,Dario Páez,Juan Carlos Oyanedel,Camila Zisis,Cristián Céspedes,Fernanda Cancino,Luna Benavente

doi:10.3389/fpsyg.2020.539165

Abstract

Literature reports that depressive symptoms may precede suicidal ideation. Several studies have identified social support and substance use as moderators of this relationship. However, no study has evaluated these variables together by testing how substance use can affect the moderating effect of social support in this relationship. The purpose of this article is to individually evaluate dimensions of social support (friends, family, significant others, and school) and substance use (alcohol, marijuana, and other illicit drugs), as moderators of the relationship between depressive symptoms and suicidal ideation, as well as analyze the moderating role of substance use in the moderation exerted by social support in this relationship. This study, quantitative and cross-sectional, considered 775 adolescents [Average age = 15.48 (SD = 0.96), 45.9% women], from 20 randomly selected schools in Santiago de Chile. Simple moderation models were used to analyze possible moderators separately, and double moderation models were used to analyze the moderating role of substance use in the moderating effect of social support. The results show that the four dimensions of social support moderate the relationship between depressive symptomatology and suicidal ideation, showing the strongest interaction in the case of family support, followed by support of a significant person, support at school, and support of friends, in that order. On the other hand, alcohol was the only drug that moderated the relationship in question. In addition, the results show that the use of alcohol limits the moderating effect of social support in the fields of family, significant person, and school support, but not in the case of support of friends. The use of marijuana and other illicit drugs did not affect the moderating effects of social support for any of the areas evaluated. The results are discussed according to the different roles that alcohol use can play in adolescence, and how these, together with perceived social support, are related to the emergence of suicidal ideation from depressive symptoms.

Highlights

Depressive disorders are the mental disorders that cause the most disability-adjusted life years (Rehm and Shield, 2019)
Based on what was theoretically argued in the introduction of the article, the depression dimension for this study was constructed by adding a score obtained in each item of the subscale depression, excluding the item “I think about death or suicide,” which was considered as a separate dependent variable of the study
It can be seen that both thoughts of death or suicidal ideation and depression were associated negatively with the four types of perceived social support and positively with the three types of substance use

Summary

Introduction

Depressive disorders are the mental disorders that cause the most disability-adjusted life years (Rehm and Shield, 2019). These disorders, whose prevalence has its peak in adolescence (Patel, 2013; Whiteford et al, 2013), have serious consequences in various areas of people’s lives. The diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) define the major depressive disorder based on the presence of a series of symptoms that “cause clinically significant distress or impairment in social, occupational, or other important areas of functioning” At least five must occur during a period of 2 weeks, and at least one of them must be (a) depressed mood or (b) loss of interest

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