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Abstract
Aims To assess the relationship between self-reported suicidal ideation and alcohol and other substance use among 14-16-year-olds. Design, setting, participants A cross sectional school survey of 16 464 subjects aged 14-16 years in two Finnish regions. Findings Alcohol use frequency and any use of substances other than alcohol were significantly associated with suicidal ideation. Of girls (boys) who reported drinking weekly, 8% (7%) reported severe suicidal ideation compared with 1% (0.7%) of those not drinking. Of girls (boys) who reported use of substances other than alcohol five times or more, 13% (21%) reported severe suicidal ideation, compared with 1.3% (1.1%) of those who had no use of substances other than possibly alcohol. These associations persisted in multivariate analyses controlling for depressive symptoms and sociodemographic background. Conclusions Frequent alcohol use and use of substances other than alcohol independently indicate a risk for adolescent suicidal ideation and may thus represent an early warning signal for attempted suicides. School and health service personnel should pay attention to adolescents who drink frequently or experiment with or use drugs to improve the identification of suicidality and the possibilities for early intervention.