Violent, Psychosocial, and Behavioral Factors Associated with Suicidal Ideation Among High School Students in Puerto Rico: A Cross-Sectional Analysis of the 2019 YRBSS

Weapon carrying and violent behaviors during adolescence are associated with increased risk of injuries and have been linked to suicidal ideation. However, little is known about these associations among Puerto Rican high school students. This cross-sectional study analyzed 2019 Puerto Rico Youth Risk Behavior Surveillance System (YRBSS) data from students in grades 9–12. Survey-weighted descriptive statistics summarized prevalence, and multivariable logistic regression examined associations between suicidal ideation and sociodemographic, violent behavior, and psychosocial variables. Among Puerto Rican high school students, 52% were female, and 12% reported suicidal ideation. Bivariate analyses showed significant associations between suicidal ideation and sex, age, weapon carrying, bullying victimization, persistent sadness/hopelessness, and cigarette use (p < 0.05). In the fully adjusted model, persistent sadness/hopelessness was the strongest factor associated with suicidal ideation (AOR = 8.88, 95% CI: 4.91–16.03). Bullying victimization and cigarette use also remained independently associated with higher odds of suicidal ideation. Weapon carrying was not independently associated with suicidal ideation after adjustment for psychosocial factors. Persistent sadness/hopelessness, bullying victimization, and cigarette use were independently associated with suicidal ideation, highlighting the multifactorial nature of adolescent suicide risk. These findings underscore the importance of comprehensive mental health screening and interventions that address emotional distress, social stressors, and behavioral risk factors among Puerto Rican adolescents.