Gender differences in the relationship between prescription opioid misuse and depressive symptoms and suicidality among US High School Students

Background: Prescription opioid misuse and suicide among adolescents are significant health challenges. Purpose: This study investigated whether effects of prescription opioid misuse on depressive symptoms and suicidality are greater among female than male students. Methods: Using the 2017 Youth Risk Behavior Survey (N = 14,765), this research estimated additive interactions using risk differences as well as multiplicative interactions using odds ratios. Discussion: Results showed prescription opioid misuse was associated with significantly greater risks among females than males for depressive symptoms (31.1% vs. 20.8%), suicidal ideation (27.3% vs. 19.1%), suicide attempts (18.1% vs. 11.9%) and suicide attempts requiring treatment (8.5% vs. 4.4%). In contrast, multiplicative interactions using odds ratios were all nonsignificant. Conclusions: Among students who misused prescription opioids, females compared to males had much higher average predicted margins of depressive symptoms, suicidal ideation, suicide attempts, and suicide attempts requiring treatment. Screening for depression and suicidality among adolescents who misuse prescription opioids, and vice versa, is paramount.