# Substance Use and Suicide Attempts in Adolescents: A Comparative Analysis of Clinical and Psychosocial Risk Factors

## TL;DR

Adolescents with suicide attempts show higher rates of female sex and frequent use of drugs like cannabinoids and stimulants compared to those without.

## Contribution

The study identifies female sex and high-frequency polysubstance use as key differentiators in adolescents with suicide attempt histories.

## Key findings

- Female sex is a strong independent predictor of suicide attempt history (OR = 6.84).
- High-frequency use of cannabinoids and stimulants is significantly more common in adolescents with suicide attempts.
- Addiction severity and functional impairment are more closely linked to suicide attempts than craving intensity.

## Abstract

What are the main findings?
Female sex and high-frequency polysubstance use, particularly involving cannabinoids and stimulants, strongly differentiate adolescents with suicide attempts from those without.Addiction severity and functional impairment, rather than craving intensity alone, are closely associated with suicide attempt history.

Female sex and high-frequency polysubstance use, particularly involving cannabinoids and stimulants, strongly differentiate adolescents with suicide attempts from those without.

Addiction severity and functional impairment, rather than craving intensity alone, are closely associated with suicide attempt history.

What are the implications of the main findings?
Synthetic cannabinoid and stimulant use should be systematically screened in suicide risk assessments among substance-using adolescents.Prevention and treatment strategies should be trauma-informed, gender-responsive, and focused on the psychosocial consequences of severe substance use.

Synthetic cannabinoid and stimulant use should be systematically screened in suicide risk assessments among substance-using adolescents.

Prevention and treatment strategies should be trauma-informed, gender-responsive, and focused on the psychosocial consequences of severe substance use.

Background/Objectives: This study aimed to compare clinical and psychosocial characteristics of substance-using adolescents in Türkiye with and without a history of suicide attempts to identify distinguishing risk factors. Methods: A retrospective analysis was conducted using medical records from 140 adolescents (aged 13–18) treated at a specialized Child and Adolescent Substance Use Center in Türkiye between March 2023 and February 2025. Sociodemographic, clinical, and substance use data were collected. Group comparisons were performed using chi-square and t-tests. Logistic regression was used to identify predictors of suicide attempt history. Results: Among the sample, 52 adolescents (37.1%) had a history of suicide attempts. Compared to their counterparts, the substance-using adolescents were more likely to be female (73.1%) and have histories of psychiatric hospitalization, institutional care, criminal behavior, and polysubstance use (p < 0.05). High-frequency use (≥3 days/week) of methamphetamine, stimulants, cannabinoids, and alcohol was significantly more common in this group (all p < 0.01). The Addiction Profile Index–Adolescent form (API-A) scores indicated more severe addiction profiles. Using cross-validated LASSO and confirmatory logistic regression, female gender emerged as the only robust independent predictor of suicide attempt history (OR = 6.84). Conclusions: Adolescents with a history of suicide attempts exhibit more severe substance use, particularly involving cannabinoids, and greater psychosocial adversity. This distinct risk profile underscores the need for early, gender-sensitive, and multidimensional interventions.