Overestimated body image distortion and suicidal behaviors among South Korean adolescents: a gender-stratified analysis using Korea Youth Risk Behavior Survey data (2019–24)

Background The relationship between body image distortion (BID) and suicidal behaviors remains understudied regarding gender differences. This study examined associations between BID and suicidal behaviors among South Korean adolescents. Methods We used the Korea Youth Risk Behavior Survey (2019–24), which included 317 798 adolescents. BID was defined as a discrepancy between the body mass index and perceived body image. Gender-stratified logistic regressions were conducted to examine the associations between BID and suicidal ideation, planning, and attempts. The regression models were adjusted for sociodemographic characteristics. Results BID was associated with overall suicidal behaviors [adjusted odds ratio (aOR) = 1.36, 95% CI: 1.32–1.40]. Among adolescent girls, BID increased the odds of overall suicidal behaviors (aOR = 1.28, 95% CI: 1.24–1.32), suicidal ideation (aOR = 1.27, 95% CI: 1.22–1.31), suicide planning (aOR = 1.31, 95% CI: 1.24–1.39), and suicide attempts (aOR = 1.35, 95% CI: 1.26–1.44). Among boys, BID increased the odds of overall suicidal behaviors (aOR = 1.16, 95% CI: 1.10–1.22), suicidal ideation (aOR = 1.16, 95% CI: 1.10–1.22), suicide planning (aOR = 1.21, 95% CI: 1.11–1.31), and suicide attempts (aOR = 1.26, 95% CI: 1.13–1.40). Conclusion BID is associated with suicidal behaviors, particularly among girls. Targeted interventions addressing BID may mitigate suicide risk. Adolescent health programs should prioritize gender-sensitive policies and body image education.