Associations between addictive behaviors (smoking, alcohol use, and smartphone overdependence) and suicidal behaviors among adolescents in South Korea.

BACKGROUND: Suicide is the leading cause of death among adolescents in South Korea. Although substance use has been widely investigated, the roles of smoking, alcohol use, and smartphone overdependence in relation to suicidal thoughts and behaviors among adolescents are less clearly characterized. This study examined the associations between these addictive behaviors and suicidal ideation, planning, and attempts among South Korean adolescents. METHODS: We analyzed data derived from the 2023 Korea Youth Risk Behavior Survey, a nationally representative cross-sectional survey of 52,873 adolescents aged 12-18. We assessed suicidal thoughts and behaviors based on self-reported experiences in the past 12 months. We utilized standardized scales to categorize smoking, alcohol use, and smartphone overdependence by severity. We employed multivariable logistic regression to estimate adjusted odds ratios (ORs), controlling for gender, academic achievement, household income, co-residence with parents, and perceived stress. RESULTS: Suicidal ideation, planning, and attempts were reported by 13.5%, 5.3%, and 3.2% of participants, respectively. All three addictive behaviors were significantly associated with suicidal behaviors. A dose-response pattern was observed as follows: adolescents smoking ≥20 cigarettes/day exhibited ORs of 2.69 (ideation), 4.51 (planning), and 4.54 (attempts); those consuming ≥114.4 g alcohol/occasion exhibited ORs of 1.71 (ideation), 2.59 (planning), and 3.34 (attempts). Moreover, smartphone overdependence was associated with increased ORs of 1.50 (ideation), 1.31 (planning), and 1.32 (attempts). CONCLUSIONS: Smoking, alcohol use, and smartphone overdependence are significantly associated with an increased risk of suicidal thoughts and behaviors among adolescents. These findings highlight the importance of addressing addictive health risk behaviors in youth suicide prevention and underscore the need for additional longitudinal and clinical research.