Association Between Substance Use Experience and the Risk of Suicidal Behaviors Among Adolescents Based on Parental Cohabitation, Korea, 2023

OBJECTIVE: Adolescent substance use is an important public health concern associated with suicidal behaviors. Although parental cohabitation is considered protective, limited is known about its role in the relationship between substance use and suicidality. This study examined differences in suicidal behaviors according to substance use experience and parental cohabitation among Korean adolescents. METHODS: We analyzed data from the 2023 Korea Youth Risk Behavior Web-based Survey (N = 52 880). Participants were categorized by lifetime substance use (ever user vs nonuser) and parental cohabitation (living with parents vs not living with parents). Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) and 95% CIs for suicidal ideation, planning, and attempts, controlling for sociodemographic and behavioral factors. RESULTS: Compared with nonusers living with parents, nonusers not living with parents showed increased odds of suicidal ideation, planning, and attempts (AOR = 1.40, 1.92, and 2.91, respectively). Ever users living with parents also had elevated odds (AOR = 2.67, 6.44, and 11.04, respectively). The highest risks were observed among ever users not living with parents (AOR = 3.46, 8.86, and 37.92, respectively). The prevalence of suicide attempts ranged from 3.0% among nonusers living with parents to 61.9% among ever users not living with parents. CONCLUSION: Substance use and absence of parental cohabitation were independently and jointly associated with increased odds of suicidal behaviors. Adolescents with both risk factors exhibited the greatest vulnerability, highlighting the importance of family support and substance use prevention in suicide prevention efforts.