The mediation and moderation effect of social support on the relationship between opioid misuse and suicide attempts among native American youth in New Mexico: 2009-2019 Youth Risk Resiliency Survey (NM-YRRS)

Abstract

Background Suicide attempt and opioid misuse continue to be major behavioral health challenges among American Indians and Alaska Natives (AI/AN). The aim of the study is to evaluate the mediating and moderating role that social support (SS) plays in their association among AI/AN high-school students in New Mexico (NM). Methods An aggregated NM Youth Resiliency and Risk Survey (NM-YRRS, 2009-2019: odd years) dataset was used. Multivariable logistic regression modeling and mediation analysis were conducted while adjusting for confounding variables. Results Overall, 12.0 and 14.0% of AI/AN students reported opioid misuse and suicide attempt, respectively. The adjusted odds ratio of suicide attempt in students with high SS relative to low SS who misused opioids was 0.43 (p-value = 0.007). The effect of high SS relative to low SS among males who misused opioids was more pronounced (AOR = 0.24, p-value < 0.0001) compared to females (AOR = 0.43, p-value = 0.007). Relative to low SS, high SS was protective for suicide attempt among AI/AN students who misused opioids and attended school in off-reservation (AOR = 0.42, p-value = 0.012) communities, rural communities (AOR = 0.44, p = 0.040), and in communities that are both rural and off-reservation (AOR = 0.39, p = 0.035). Overall, 23.64, and 41.05% of the association between opioid misuse, and suicide attempt was mediated and moderated by SS, respectively. The mediation effect of SS was lowest for rural, on-reservation schools. Conclusion More resources need to be allocated to rural on-reservation schools to enhance social support. The study highlights key insights into the significant role SS plays in promoting health and mitigating the association between opioid misuse and suicide attempt.

Resilience and health in American Indians and Alaska Natives: A scoping review of the literature

“…For males, school support was the most protective for having thought about suicide, having made a suicide plan, and for having attempted suicide (Parshall et al, 2023). Finally, another study reported that general social support availability appears to affect risk for suicide in American Indian high school students, with those students who reported high levels of social support being less likely to report attempting suicide (Agyemang et al, 2022). Overall, these findings indicate that there are several social protective factors which are important in reducing the risk for suicidal behavior in American Indian and Alaska Native youth.…”

Social support, psychological strain, and suicidality: Evidence from Chinese universities

“…Taking all these risk factors into account, it is fair to say a variation of 0.01 in suicidal behavior can be attributed to the protective role played by social support. Third, the moderating effect of social support was documented in previous studies that either examined the moderation effect between psychological stress and suicidality (Otsuka et al, 2022) or between opioid misuse and suicide attempts (Agyemang, 2023).…”

“…A systematic review (Hu et al, 2023) researched studies on the moderating effect of social support on suicide risk among patients with mental illness and concluded that both quantitative and qualitative studies supported the negative effect of social support on suicide risk. A bunch of studies documented similar evidence supporting the protective effect of social support as a moderator on suicidal attempts (Agyemang et al, 2022;Datta & Nakhaie, 2022;Demir & Sümer, 2022;Mitchell et al, 2021;Pickover et al, 2021;Shah et al, 2021;Shin et al, 2021;Su et al, 2022).…”