Suicidal ideation and suicide attempts among high-school students reporting substance use in Northwest Ethiopia: a multischool cross-sectional study

Background Substance use and suicidal behavior among high-school students are important public health concerns. However, evidence on suicidal behavior among substance-using high-school students in Ethiopia is limited. This study assessed the prevalence and associated factors of suicidal ideation (SI) and suicide attempts (SA) among substance-using high-school students in Northwest Ethiopia. Methods A multicenter cross-sectional study was conducted from 6 January to 14 February 2025 among 405 substance-using high-school students selected from 843 high-school students through multistage sampling. Suicidal behavior and associated factors were assessed using standardized instruments. Bivariable and Firth penalized multivariable logistic regression analyses were performed. Results The prevalence of suicidal ideation (SI) and suicide attempts (SA) was 7.4% (95% CI: 4.9–9.8) and 4.4% (95% CI: 2.5–6.6), respectively. SI was associated with depression symptoms (AOR = 2.34, 95% CI: 1.54–9.89), family history of suicide (AOR = 3.78, 95% CI: 2.12–8.52), and khat chewing (AOR = 1.86, 95% CI: 1.01–4.29). SA was associated with female sex (AOR = 2.21, 95% CI: 1.03–10.12), family history of suicide (AOR = 2.46, 95% CI: 1.43–4.67), chronic medical illness (AOR = 3.60, 95% CI: 1.13–7.25), and stress (AOR = 3.07, 95% CI: 1.18–7.54). Conclusion Suicidal ideation and suicide attempts were reported among substance-using high-school students. Several socio-demographic, clinical, and substance-related factors were associated with suicidal behavior, highlighting the need for further longitudinal research.