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Official websites use. Share sensitive information only on official, secure websites. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Suicide is one of the leading causes of death amongst adolescents and decades of research have failed to curb suicide rates within this population. There is thus a need to better understand factors that correlate with adolescent suicidal thoughts and behaviors STBs. Lifetime psilocybin use was associated with lowered odds of lifetime suicidal thinking, planning, and attempts aOR range 0. Our study demonstrates that individual classic psychedelics share varying relationships to STBs among adolescents. Future cross-sectional and longitudinal studies are needed to further elucidate the link between classic psychedelic use and STBs in youth. Suicide is the second leading cause of death among adolescents, and suicide rates in this population continue to rise despite years of research and medical advances 1 , 2. Even with a nearly exponential increase in the number of RCTs studying suicidal thoughts and behaviors STBs in the last decades, existing treatments have continued to have limited efficacy 3 , 4. Moreover, given that current research has not yielded improvements in treatment efficacy nor reductions in STBs among adolescents, there is a need for a wider range of research on factors that correlate with adolescent STBs. Classic psychedelics e. Conversely, these substances also can have negative consequences such as increased anxiety, paranoia, and significant distress associated with acute administration. Some of the most commonly used classic psychedelics are psilocybin the psychoactive agent in more than species of fungi , lysergic acid diethylamide LSD; derived from the hydrolysis of an ergot fungus , peyote a small cactus , and mescaline the main psychoactive compound in peyote. MDMA, on the other hand, is a synthetic amphetamine derivative that releases serotonin and is known to increase feelings of empathy and social connection; conversely, this substance can also give rise to adverse states of panic, anxiety, and fear as well. Researchers in the last decade have begun to explore the potential of classic psychedelics as a treatment for a multitude of mental disorders, many of which confer risk for STBs 7 , 8. Recent research has shown that classic psychedelics, most namely psilocybin and LSD, can alleviate anxiety and depression two of the main risk factors of suicide 9 , In a pilot experiment, researchers found that a single session of psilocybin-assisted psychotherapy led to sustained decreases in both anxiety and depression among subjects with advanced-stage cancer In , these findings were extended in a study that found that improvements in anxiety, depression, quality of life, and optimism due to psilocybin-assisted psychotherapy; furthermore, these improvements continued to be clinically significant at a 6-month follow-up Similarly, a pilot study in found that LSD can reduce anxiety when administered in a supervised psychotherapeutic environment Recent research has also found classic psychedelics to help treat substance use disorders, which are another significant risk factor for suicide 14 — MDMA-assisted psychotherapy in particular has been found to be not only safe, but also more effective than traditional therapy in patients with treatment-resistant PTSD 18 — It is important to note, however, that all of the aforementioned treatment studies on MDMA and classic psychedelics have been conducted using adult samples, underscoring the need for examining the link between these substances and suicidality in adolescents. Population-based survey studies, while not causal in nature, have helped further establish externally valid links between classic psychedelics and MDMA and STBs; these studies also invite further inquiry into the associations between psychedelics and suicidality in adolescents. A follow-up study by Hendricks et al. Additionally, Sexton et al. More recently, research by this team has extended previous work by analyzing data from the NSDUH spanning from to and found that lifetime MDMA use was associated with reduced odds of past-year suicidal thinking and planning while lifetime psilocybin use was associated with reduced odds of past month psychological distress and past year suicidal thinking in adults Importantly, this study also found that LSD was associated with increased odds of past-year suicidal thinking, indicating that in some cases classic psychedelics can confer increased risk for STBs. Although previous research has established an association between classic psychedelics and MDMA and STBs, few studies have examined the effects of these substances, let alone their link with STBs, among adolescents. Given that classic psychedelic use among adolescents has been rising 27 and MDMA is one of the most commonly used illicit substances by adolescents 28 , there is a need to assess the link between these substances and STBs in adolescents. This study used data from the National Survey on Drug Use and Health NSDUH; — , an annual survey that collects information on substance use and mental health outcomes in a nationally representative sample of the U. Furthermore, we carried out all methods in this project in accordance with the relevant guidelines and procedures. These independent variables were selected as this study aimed to extend findings from Jones and Nock a , which assessed the relationships of these substances to STBs in a sample of U. In line with Jones and Nock a , our study included the following demographic factors and substance use variables as a priori covariates in our analyses: sex, age, income, race, education, self-reported engagement in risky behavior, and lifetime use of the following substances cocaine, heroin, PCP, inhalants, pain relievers, tranquilizers, stimulants, sedatives, marijuana. Furthermore, these covariates also match those from numerous population-based psychedelic studies as well 23 , 25 , 29 — Our time horizons for the dependent variables in this study deviate from Jones and Nock a , which examined the associations between psychedelic use and past year STB outcomes for adults; however, all adolescent suicidality variables in the NSDUH assess lifetime STBs, thus explaining our approach for the current study. We used survey-weighted multivariable logistic regression to estimate the associations between our independent variables and our STB outcomes in this study. The demographics of our sample are presented in Table 1 , stratified by those who have versus have not tried classic psychedelics. Adolescents who have tried classic psychedelics were significantly more likely to fall into the following demographic categories: older, male, White, and more likely to engage in risky behavior. There were no significant differences in the income levels of those who had versus had not tried psychedelics. Psilocybin conferred significant lowered odds of all three outcome measures: lifetime suicidal thinking aOR 0. On the other hand, LSD conferred increased odds of all three outcomes: lifetime suicidal thinking aOR 1. In Supplemental Table 1 , we report the results from robustness analyses that assess whether our associations for psilocybin and LSD remain consistent while additionally controlling for a lifetime major depressive episode MDE , a major risk factor for suicide. We reconducted our original survey-weighted multivariable logistic regression models while including all of our original independent variables and covariates but also added a lifetime MDE in all models as a covariate as well. When we controlled for a lifetime MDE, psilocybin no longer shared a significant association with lifetime suicidal thinking aOR changed from 0. However, aside from this one difference, our pattern of results remained unchanged i. S adolescents. This study was an extension of Jones and Nock a , which tested the associations of the aforementioned substances to STBs in U. Importantly, this study yielded a similar pattern of results to Jones and Nock a , which found lifetime psilocybin use to be associated with reduced odds of past month psychological distress and past year suicidal thinking, and LSD to be associated with increased odds of past-year suicidal thinking in adults. The main limitation to this study is the findings cannot be used to establish a causal relationship between psychedelic use and STBs in adolescents. Future longitudinal research will be needed to more rigorously assess the associations that these substances share with STBs in adolescents. Additionally, because we used binary lifetime use outcomes to measure substance use, we cannot establish the recency nor the frequency of psychedelic use in the study. Relatedly, the operationalization of the variables in the NSDUH does not allow us to establish temporal precedence between psychedelic use and STBs as well. Follow-up work that employs more granular assessments of STBs can support a greater understanding of the impact of psychedelics on STBs in adolescents as well. Next, although we conducted robustness analyses to control for MDEs in our analyses, it nevertheless remains possible that psilocybin lowers odds of STBs by way of alleviating harmful and severe mental health conditions that give rise to STBs. Future studies that can control for a wider range of mental disorders and can assess the clinical severity of participants can overcome this limitation. Finally, multicollinearity—high levels of intercorrelation between independent variables in a given model—represents a possible limitation to our findings as well. However, the impact of multicollinearity on our results is likely minimal. The main effect of multicollinearity is to increase the standard errors within a given model, widening confidence intervals and making it less likely for statistical tests to reach significance; however, such an effect is mitigated in large sample sizes like the one included in this study Thus, although our independent variables may correlate with one another, one can remain confident in the observed findings, particularly given that they align with prior work in this research area Given the association between LSD use and increased odds of STBs in our study, LSD and other classic psychedelics may have caused harm at the individual or group level within our sample. Additionally, since these associations follow a pattern of results from other populations based research on classic psychedelics 26 , future research should be aimed at better understanding the link between naturalistic psychedelic use and adverse outcomes in both adolescents and adults. The need to study the potential harm of psychedelics is especially relevant as these substances are increasingly explored as potential treatments within clinical research. Although future research is needed, there are known risks associated with psychedelic use that may lead to increased odds of STBs. First, a risk associated with psychedelic use is that adolescent substance use is linked to the onset of substance use disorders, a key risk factor for suicide. For instance, epidemiological research has illustrated that individuals who start drinking at 11—12 years of age have nearly double the rate of problematic alcohol use than do individuals who begin drinking at age 21 Generally, young people have higher rates of substance abuse than those who are older as well Hence, adolescent psychedelic users may be at increased risk for problematic use of these substances and ultimately may be at higher risk for STBs. Future research should examine whether earlier psychedelic use is associated with increased risk of substance use disorders and STBs. Furthermore, adolescents might be less equipped to manage the distress engendered from bad trips, as research has demonstrated that younger individuals may be less successful at regulating their emotions Thus, adolescents may be at particular risk for STBs as a result of adverse psychedelic experiences. Psychedelic use is also reported to increase the risk of psychosis, although evidence on this link is equivocal Some historical studies have suggested that psychedelics engender an earlier onset of a psychotic break in individuals with premorbid mental illness Given that episodes of psychosis are a risk factor for STBs 42 , classic psychedelics could thereby also increase the odds of STBs in adolescents by increasing the risk of an early psychotic episode Our study also presents non-causal associations between psilocybin and lowered odds of STBs in adolescents that builds on previous work by Jones and Nock a linking psilocybin use with reduced odds of past year suicidal thinking in adults. Several mechanisms may underlie our findings linking psilocybin use to lowered odds of STBs in adolescents, although the below mechanisms remain speculative. For one, psilocybin use could have been associated with lowered odds of STBs in our sample because of demographic differences between adolescents who have versus have not used psilocybin. Future studies that examine the associations between demographics, LSD use, and STBs can shed light on these potential mechanisms. Additionally, there may be pre-drug differences between individuals who have versus have not used classic psychedelics, as previous work has found personality differences between psychedelic-using and psychedelic-naive adults that could extend to adolescent populations. Erritzoe et al. Thus, future work should further examine pre-drug differences associated with those who have versus have not used psychedelics, as investigations such as these may further explain our observed associations between psychedelics and STBs. Finally, there may be clinically-relevant third variable factors that also underlie these findings as well. For instance, there is robust evidence indicating that perceived social support from peers and school teachers is associated with STBs in adolescents, with greater support being linked to lowered odds of STBs 46 , If such differences exist within adolescent populations who have used psilocybin—such that adolescents who have used psilocybin spend more time with supportive peers or go to school in more supportive environments—these clinically relevant third variable factors may also underlie our observed findings. Better understanding the relationship between such factors and psilocybin use may further clarify the link between psilocybin and lowered odds of adolescent STBs. There are potential pharmacological explanations for our observed findings, although these mechanisms remain purely speculative. For instance, psilocybin may lower odds of STBs via interacting with and downregulating serotoninergic 5-HT2A receptors 48 , Suicidal behavior has been linked to alterations in the serotonergic system 50 , 51 and the activation of 5-HT2A receptors has been found to reduce markers of inflammation in adults that are linked to STBs and related mental health disorders Additionally, many mainline antidepressants and antipsychotics potentiate their effects through 5-HT2A receptors as well 53 , Thus, it is plausible that psilocybin could have lowered odds of STBs among our sample population through interactions with 5-HT2A receptors 50 , However, as none of the pharmacological mechanisms of psilocybin have been explored in adolescents, future pharmacological work is needed to better understand the link between psychedelic use and STBs in young people. These investigations can also further elucidate the mechanisms underlying any potential harm that may be associated with adolescent psychedelic use as well. Although classic psychedelic use among adolescents has been rising, and more attention has been given to the therapeutic and clinical potential of classic psychedelics in adults, we still know very little about how these drugs affect adolescent mental health. This study represents an important step forward to better understanding the relationship of psychedelic use to STBs in adolescents and highlights the importance of future cross-sectional, longitudinal, and clinical investigations within this research area. He has been a paid consultant in the past year for Microsoft Corporation, the Veterans Health Administration, Cerebral, and for legal cases regarding deaths by suicide. He is an unpaid scientific advisor for Empatica, Koko, and TalkLife. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Sci Rep. Find articles by Grant Jones. Find articles by Diego Arias. Find articles by Matthew Nock. Received May 1; Accepted Dec 2; Collection date Demographic of those who have versus have not used classic psychedelics. Open in a new tab. Significant values indicating lowered odds of STBs are in bold. Supplementary Information. Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Self-reported engagement in risky behavior.

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