A latent class analysis of health lifestyles and suicidal behaviors among US adolescents.
BACKGROUND
Previous studies have documented the link between individual health behaviors and suicide, but little is known about the influence of health lifestyles on suicide among adolescents. This study aims to identify the unobserved patterns of health behaviors and to examine their associations with adolescent suicidal behaviors to inform screening of suicidality.


METHODS
Data were derived from a nationally representative sample of adolescents (n = 14,506, ages 12-18, 50.9% female) in the national school-based 2017 Youth Risk Behavior Survey. Latent class analysis was performed based on 13 health behaviors related to diet (e.g., frequency of consuming breakfast, fruits/vegetables, soda), physical activity (frequencies of physical activity, sports team participation), sleep, and media use (TV/computers). Suicidal behaviors were measured by three dichotomized variables, including suicidal ideation, plan, and attempts. Multivariate logistic regressions were used to examine associations between identified classes and suicidal behaviors.


RESULTS
Four classes of health lifestyles were identified. Class 1 (23.6%) consistently engaged in health-promoting behaviors, including eating breakfast daily, high intake of fruits/vegetables, physically active, and infrequent use of TV/computers. Class 2 (37.7%) had an irregular diet, moderate exercise, and high computer use. Class 3 (31.8%) had moderate diet, frequent exercise, and moderate sleep. Class 4 (6.9%) had the lowest engagement in health-promoting behaviors. Class 4 had higher odds of suicide plan than Class 1 (OR = 1.50, 95% CI = 1.10-2.05). Notably, Class 2 and 3 were less likely to attempt suicide than Class 1 (OR = 0.74, 95% CI = 0.57-0.95 for Class 2; OR = 0.65, 95% CI = 0.48-0.89 for Class 3).


LIMITATIONS
Due to the cross-sectional design, no causal inference can be drawn.


CONCLUSIONS
Both Class 1 (consistent) and Class 4 (lowest) engagement in health-promoting behaviors were associated with increased suicidal behaviors. Suicide prevention efforts that examine both lifestyles are keys to early detection of suicidal ideation and plans, and prevention of suicide attempts.
['Xiao|Yunyu|Y|', 'Romanelli|Meghan|M|', 'Lindsey|Michael A|MA|']
D000293:Adolescent D000294:Adolescent Behavior D002648:Child D003430:Cross-Sectional Studies D005260:Female D000070497:Healthy Lifestyle D006801:Humans D000077272:Latent Class Analysis D016015:Logistic Models D008297:Male D012309:Risk-Taking D012574:Schools D059020:Suicidal Ideation D013406:Suicide, Attempted D011795:Surveys and Questionnaires
Latent class analysis Health lifestyles Suicidal behaviors Adolescents Health behaviors