Mediating Role of Depression in the Relationship between Substance Use and Suicide Proneness among Adolescents in Underserved Communities in Pakistan

Authors

  • Malak Haseeb Ullah Department of Psychology, Federal Urdu University of Arts, Science & Technology, Karachi, Pakistan https://orcid.org/0009-0004-2756-2561
  • Sabir Shahzad College of Clinical Psychology, Ziauddin University, Karachi, Pakistan https://orcid.org/0009-0005-5135-775X
  • Shahid Iqbal (Ph.D) Department of Psychology, Federal Urdu University of Arts, Science & Technology, Karachi, Pakistan
  • Khan Muhammad Department of Psychology, Federal Urdu University of Arts, Science & Technology, Karachi, Pakistan
  • Nasreen Begum Institute of Clinical Psychology, University of Karachi, Karachi, Pakistan
  • Salman Shahzad (Ph.D) Institute of Clinical Psychology, University of Karachi, Karachi, Pakistan
  • Sohaib Aslam Department of Psychology, Federal Urdu University of Arts, Science & Technology, Karachi, Pakistan https://orcid.org/0009-0002-8427-1707

DOI:

https://doi.org/10.5281/zenodo.18287777

Abstract

Abstract Views: 223

Substance use in children and adolescents is a growing concern among health professionals in Pakistan. This study examined the mediating role of depression between substance use and suicide proneness among adolescents (aged 12 years to 18 years) from underserved communities. Participants were recruited from different places in Karachi, Pakistan using a convenience sampling technique. The Life Attitude Schedule (LAS), Centre for Epidemiologic Studies Depression Scale (CES‑D) and Drug Abuse Screening Test-10 (DAST‑10) were used in Urdu language. Findings revealed that substance use significantly predicted depressive symptoms, which in turn significantly increased suicide proneness. The direct effect of substance use on suicide proneness remained significant, while the indirect effect through depression was also significant, indicating partial mediation. These findings underscore the significance of understanding social, emotional and cognitive domains of children and adolescents, and designing and implementing evidence-based prevention interventions to build resilience which serves as buffer against the mental health issues and other risky behaviours among in vulnerable adolescents. Further, this study signifies how parents can help their children in delaying to use of substance and reducing the risk of mental health problems and suicide among adolescents from underserved communities.

Keywords:

Adolescents, Mental health, Substance use, Suicide proneness, Vulnerable populations

Author Biographies

Malak Haseeb Ullah,

He is a Research Scholar at the Department of Psychology, Federal Urdu University of Arts, Science & Technology, Karachi, Pakistan. He completed his BS Psychology from Federal Urdu University of Arts, Science & Technology, Karachi, Pakistan.

Sabir Shahzad,

He is a Lecturer at the College of Clinical Psychology, Ziauddin University, Karachi, Pakistan. He is currently a PhD Scholar (Clinical Psychology) at the University of Karachi, Karachi, Pakistan.

Shahid Iqbal (Ph.D),

He is an Associate Professor at the Department of Psychology, Federal Urdu University of Arts, Science & Technology, Karachi, Pakistan. He obtained his Post-Doctorate in Clinical Psychology from the University of Queensland, Brisbane, Australia.

Khan Muhammad,

He is a Research Scholar at the Department of Psychology, Federal Urdu University of Arts, Science & Technology, Karachi, Pakistan. He completed his BS Psychology from Federal Urdu University of Arts, Science & Technology, Karachi, Pakistan.

Nasreen Begum,

She is a Research Scholar at the Institute of Clinical Psychology, University of Karachi, Karachi, Pakistan. She completed her Masters of Clinical Psychology from the Virtual University, Karachi Campus, Pakistan.

Salman Shahzad (Ph.D),

He is a Professor at the Institute of Clinical Psychology, University of Karachi, Karachi, Pakistan. He obtained his Doctorate in Clinical Psychology from the Institute of Clinical Psychology, University of Karachi, Karachi, Pakistan.

Sohaib Aslam,

He is a Research Scholar at the Department of Psychology, Federal Urdu University of Arts, Science & Technology, Karachi, Pakistan. He completed his BS Psychology from Federal Urdu University of Arts, Science & Technology, Karachi, Pakistan.

References

Alegría, M., Canino, G., Ríos, R., Vera, M., Calderón, J., Rusch, D., & Ortega, A. N. (2002). Mental health care for Latinos: Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino Whites. Psychiatric Services, 53(12), 1547-1555. https://doi.org/10.1176/appi.ps.53.12.1547

Alegria, M., Vallas, M., & Pumariega, A. (2010). Racial and ethnic disparities in pediatric mental health. Child and Adolescent Psychiatric Clinics of North America, 19(4), 759. https://doi.org/10.1016/j.chc.2010.07.001

Boden, J. M., & Fergusson, D. M. (2011). Alcohol and depression. Addiction, 106(5), 906-914. https://doi.org/10.1111/j.1360-0443.2010.03351.x

Brady, K. T., & Sinha, R. (2005). Co-occurring mental and substance use disorders: the neurobiological effects of chronic stress. American Journal of Psychiatry, 162(8), 1483-1493. https://doi.org/10.1176/appi.ajp.162.8.1483

Esang, M., & Ahmed, S. (2018). A closer look at substance use and suicide. American Journal of Psychiatry Residents' Journal, 13(6), 6-8. https://doi.org/10.1176/appi.ajp-rj.2018.130603

Esposito‐Smythers, C., & Spirito, A. (2004). Adolescent substance use and suicidal behavior: A review with implications for treatment research. Alcoholism: Clinical and Experimental Research, 28, 77S-88S. https://doi.org/10.1097/01.ALC.0000127417.99752.87

Farooq, S., Yousaf, T., & Shahzad, S. (2023). Prevalence of emotional and behavioural problems among adolescents in Pakistan: A cross-sectional study. Journal of Pakistan Psychiatric Society, 20(01), 22-26. https://doi.org/10.63050/jpps.20.01.230

Gaylor, E. M. (2023). Suicidal thoughts and behaviors among high school students—Youth Risk Behavior Survey, United States, 2021. MMWR Suppl2023;72(Suppl-1), 45–54. http://dx.doi.org/10.15585/mmwr.su7201a6

Hertz, M. F., Donato, I., & Wright, J. (2013). Bullying and suicide: A public health approach. The Journal of adolescent health: official publication of the Society for Adolescent Medicine, 53(1 0), S1. https://doi.org/10.1016/j.jadohealth.2013.05.002

Ilgen, M. A., Harris, A. H., Moos, R. H., & Tiet, Q. Q. (2007). Predictors of a suicide attempt one year after entry into substance use disorder treatment. Alcoholism: Clinical and Experimental Research, 31(4), 635-642. https://doi.org/10.1111/j.1530-0277.2007.00348.x

Khan, A., & Shahzad, S. (2020). Psychometric properties of the Urdu translation of Children’s Perception of Parents Scale. Innovation, 70(4), 679-682. https://doi.org/10.5455/JPMA.22379

Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231-244. https://doi.org/10.3109/10673229709030550

Lewinsohn, P. M., Langhinrichsen‐Rohling, J., Langford, R., Rohde, P., Seeley, J. R., & Chapman, J. (1995). The Life Attitudes Schedule: A scale to assess adolescent life‐enhancing and life‐threatening behaviors. Suicide and Life‐Threatening Behavior, 25(4), 458-474. https://doi.org/10.1111/j.1943-278X.1995.tb00239.x

Lin, L. Y., Chien, Y. N., Chen, Y. H., Wu, C. Y., & Chiou, H. Y. (2022). Bullying experiences, depression, and the moderating role of resilience among adolescents. Frontiers in Public Health, 10, 872100. https://doi.org/10.3389/fpubh.2022.872100

Marino, E. N., Jha, M. K., Minhajuddin, A., Ayvaci, E. R., Levinson, S., Pipes, R., ... & Trivedi, M. H. (2024). Problematic substance use in depressed adolescents: Prevalence and clinical correlates. Addictive Behaviors Reports, 19, 100539. https://doi.org/10.1016/j.abrep.2024.100539

Mukhtar, H., & Shahzad, S. (2025). Metacognitive beliefs and suicide risk: The mediating role of cognitive-emotion regulation strategies among students in HEIs in Pakistan. Academy of Education and Social Sciences Review, 5(3), 452-461. https://doi.org/10.5281/zenodo.17047279

Patton, G. C., Sawyer, S. M., Santelli, J. S., Ross, D. A., Afifi, R., Allen, N. B., ... & Viner, R. M. (2016). Our future: a Lancet commission on adolescent health and wellbeing. The Lancet, 387(10036), 2423-2478. https://doi.org/10.1016/S0140-6736(16)00579-1

Pompili, M., Serafini, G., Innamorati, M., Biondi, M., Siracusano, A., Di Giannantonio, M., ... & Möller-Leimkühler, A. M. (2012). Substance abuse and suicide risk among adolescents. European Archives of Psychiatry and Clinical Neuroscience, 262(6), 469-485. https://doi.org/10.1007/s00406-012-0292-0

Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385-401. https://doi.org/10.1177/014662167700100306

Russell, S. T., & Fish, J. N. (2016). Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth. Annual review of clinical psychology, 12(1), 465-487. https://doi.org/10.1146/annurev-clinpsy-021815-093153

Sawyer, S. M., Afifi, R. A., Bearinger, L. H., Blakemore, S. J., Dick, B., Ezeh, A. C., & Patton, G. C. (2012). Adolescence: a foundation for future health. The Lancet, 379(9826), 1630-1640. https://doi.org/10.1016/S0140-6736(12)60072-5

Shahzad, S., Kliewer, W., Ali, M., & Begum, N. (2020). Different risk factors are associated with alcohol use versus problematic use in male Pakistani adolescents. International Journal of Psychology, 55(4), 585-589. https://doi.org/10.1002/ijop.12617

Skinner, H. A. (1982). Guide for using the drug abuse screening test (DAST). Toronto: Centre for Addiction and Mental Health.

Snowden, L. R. (2001). Barriers to effective mental health services for African Americans. Mental Health Services Research, 3(4), 181-187. https://doi.org/10.1023/A:1013172913880

Swahn, M. H., & Bossarte, R. M. (2007). Gender, early alcohol use, and suicide ideation and attempts: findings from the 2005 youth risk behavior survey. Journal of Adolescent Health, 41(2), 175-181. https://doi.org/10.1016/j.jadohealth.2007.03.003

Wang, P. W., & Yen, C. F. (2017). Adolescent substance use behavior and suicidal behavior for boys and girls: a cross-sectional study by latent analysis approach. BMC Psychiatry, 17(1), 392. https://doi.org/10.1186/s12888-017-1546-1

Wilcox, H. C., Conner, K. R., & Caine, E. D. (2004). Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies. Drug and Alcohol Dependence, 76, S11-S19. https://doi.org/10.1016/j.drugalcdep.2004.08.003

Zia, A., & Shahzad, S. (2019). Depression and perceived attachment of adolescents with fathers having substance-abuse disorder. JPMA. The Journal of the Pakistan Medical Association, 69(12), 1855-1859. https://doi.org/10.5455/jpma.15016

Bulletin of Multidisciplinary Studies

Downloads

Published

2025-12-31

How to Cite

Ullah, M. H., Shahzad, S., Iqbal, S., Muhammad, K., Begum, N., Shahzad, S., & Aslam, S. (2025). Mediating Role of Depression in the Relationship between Substance Use and Suicide Proneness among Adolescents in Underserved Communities in Pakistan. Bulletin of Multidisciplinary Studies, 2(4), 405–412. https://doi.org/10.5281/zenodo.18287777

Issue

Vol. 2 No. 4 (2025): October-December

Section

Articles

License

Copyright (c) 2025 Bulletin of Multidisciplinary Studies

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Crossref
Scopus
Google Scholar
Europe PMC

Similar Articles

1 2 > >> 

You may also start an advanced similarity search for this article.