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Solitary participation in 'choking game' may indicate suicide risk

Youth who participated in the “choking game,” a strangulation activity to achieve euphoric feeling, were more likely to report suicidal ideation and poorer mental health if they participated alone vs. in a group.

“Youth who engage in a strangulation activity, often referred to as the ‘choking game,’ are at risk for significant injury or death. Participation occurs when pressure (using hands/fingers or a ligature such as a belt or tie) is applied to the carotid artery to temporarily limit blood flow and oxygen. The goal is to achieve a euphoric feeling once the flow of oxygen and blood is restored to the brain,” Alexandra P. Ibrahim, MPH, of Hawaii State Department of Health, Honolulu, and colleagues wrote. “This activity puts participants at great risk for injury or death, particularly if they participate alone.”

To compare youth who participate in the choking game alone vs. in a group, researchers studied data from the Oregon Healthy Teens survey for 2011 and 2013 (n = 20,832).

Lifetime prevalence of choking game participation was 3.8% in 2011 and 3.7% in 2013 among youth in eighth grade.

Merged 2011 and 2013 data indicated 17.6% of youth who participated in the choking game participated alone.

Suicide contemplation (OR = 4.58; P < .001) and poorer mental health (OR = 2.13; P < .05) were more common among youth who participated in the choking game alone, compared with those who participated in a group.

“The data presented in this article reveal how, even among a group of youth bearing substantial health risks, those with suicidal ideation and poor mental health have higher rates of solitary participation in the choking game,” the researchers wrote. “These youth could benefit from clear communication from their providers about the risks of participation (particularly alone) and consideration of referrals for mental health services.” – by Amanda Oldt

Disclosure: The researchers reported no relevant financial disclosures.