This study aims to investigate the roles of decision-making processes and genetics in the co-occurrence of alcohol use and suicidal thoughts/behaviors (STB) in adolescence. We used data from the ABCD® study (abcdstudy.org) and included behavioral (computerized tasks, self-report questionnaires) and genetic (polygenic scores PGS) measures related to cognitive (executive functions) and affective (delay-discounting, risk-taking, impulsivity) processes involved in decision-making. First, we evaluated the latent structure of decision-making in the full sample (N = 11,868) using a split-half exploratory and confirmatory factor analysis. Second, we evaluated the association between alcohol experimentation ( > 1 sip) and STB in three genetically-defined ancestry groups: European (EUR, N = 6080), African (AFR, N = 2085), and the Americas (AMR, N = 2712). We used logistic regressions to examine which PGS and behavioral factors were related to STB and tested the mediational effect of behavioral processes. STB prevalence was between 0.85-4.17%. Decision-making was best represented by three latent factors: cognitive, emotional-impulsivity, and premeditation-perseverance. Regression analyses showed that alcohol experimentation was related to STB in EUR only (OR = 1.44, 95%CI = 1.10;1.89). Lower tendencies on the emotional-impulsivity factor were related to lower STB in all groups (ORs 0.69-0.77), and better premeditation-perseverance were associated with lower STB in EUR (OR = 0.57) and AFR (OR = 0.72). In EUR, the association between alcohol experimentation and STB was mediated by the emotional-impulsivity (15.33%) and premeditation-perseverance (22.60%) latent factors. The associations between PGS for externalizing behaviors and STB also acted through the emotional impulsivity and perseverance-premeditation factors (mediations 6.98-10.30%). These findings suggest that decision-making-related processes may contribute to the alcohol use-STB co-occurrence.
Lannoy et al. (2026) studied this question.