Suicide ideation and psychotropic recreational drug use by adolescents: a systematic review and meta-analysis

Oliveira Gracini, Cássia Lima de; Nascimento, Gustavo Giacomelli; Vidigal, Maria Tereza Campos; Oliveira, Murilo Navarro de; Herval, Álex Moreira; Blumenberg, Cauane; Vieira, Walbert A.; Lima, Rafael Rodrigues; Paranhos, Luiz Renato

doi:10.1590/1516-3180.2022.0641.R2.23012024

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Brasil

Sao Paulo Medical Journal

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Brasil

Español English

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ORIGINAL ARTICLE • Sao Paulo Med. J. 142 (4) • 2024 • https://doi.org/10.1590/1516-3180.2022.0641.R2.23012024 copy

Suicide ideation and psychotropic recreational drug use by adolescents: a systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND:

Adolescence is characterized by complex and dynamic changes, often involving experimentation, including the use of psychotropic substances. Although it is well-established that recreational psychotropic drugs are associated with suicide ideation in adults, evidence of this association in adolescents remains limited.

OBJECTIVE:

To investigate the relationship between suicide ideation and psychotropic recreational drug use among adolescents.

DESIGN AND SETTING:

Systematic review with meta-analysis developed at Universidade Federal de Uberlândia (UFU) and Universidade Estadual de Campinas (UNICAMP), Brazil.

METHODS:

A search across eight electronic databases for observational studies, without language or publication year restrictions, was conducted. The Joanna Briggs Institute tool was used to assess the risk of bias. Random-effects meta-analyses and odds ratios were used to measure the effects.

RESULTS:

The search yielded 19,732 studies, of which 78 were included in the qualitative synthesis and 32 in the meta-analysis. The findings indicated that suicidal ideation was 1.96 times more likely (95% confidence interval, CI = 1.47; 2.61) for adolescents who used some drug recurrently and 3.32 times more likely (95%CI = 1.86; 5.93) among those who abused drugs. Additionally, adolescents who used cannabis were 1.57 times more likely (95%CI = 1.34; 1.84) to experience suicide ideation compared with non-users, while cocaine users had 2.57 times higher odds (95%CI = 1.47; 4.50).

CONCLUSIONS:

Psychotropic recreational drug use is associated with suicidal ideation among adolescents regardless of current or previous use, abuse, or type of substance used.

SYSTEMATIC REVIEW REGISTRATION:

Registered in the PROSPERO database under the identification number CRD42021232360. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021232360.

KEY WORDS (MeSH terms):
Adolescent; Psychotropic Drugs; Systematic review; Suicide; Substance-related disorders

AUTHORS’ KEYWORDS:
Drug use; Similar predictors; Suicide ideation

Databases	Search Strategy
Main databases
PubMed http://www.ncbi.nlm.nih.gov/pubmed	((( "Psychotropic Drugs" OR "Psychoactive Agents" OR "Psychoactive Drugs" OR "Substance Use" OR "Narcotic" OR "Substance-Related Disorders" OR "Substance Abuse" OR "Drug Abuse") AND ("Suicide" OR "Suicides" OR "Suicidal" OR "Self-harm" OR "Self-Injurious Behavior" OR "Self Destructive Behavior" OR "Suicidal Ideation" OR "Self-Destructive Behavior" OR "Attempted Suicide") AND ("Adolescence" OR "Adolescent" OR "Student" OR "Teen" OR "Teenager" OR "Youth" OR "Young" )))
Embase https://www.embase.com	(("Psychotropic Drugs" OR "Psychoactive Agents" OR "Psychoactive Drugs" OR "Substance Use" OR "Narcotic" OR "Substance-Related Disorders" OR "Substance Abuse" OR "Drug Abuse") AND ("Suicide" OR "Suicides" OR "Suicidal" OR "Self-harm" OR "Self-Injurious Behavior" OR "Self Destructive Behavior" OR "Suicidal Ideation" OR "Self-Destructive Behavior" OR "Attempted Suicide") AND ("Adolescence" OR "Adolescent" OR "Student" OR "School" OR "Teen" OR "Teenager" OR "Youth" OR "Young"))
Web of Science http://apps.webofknowledge.com/	(((("Psychotropic Drugs" OR "Psychoactive Agents" OR "Psychoactive Drugs" OR "Substance Use" OR "Narcotic" OR "Substance-Related Disorders" OR "Substance Abuse" OR "Drug Abuse") AND ("Suicide" OR "Suicides" OR "Suicidal" OR "Self-harm" OR "Self-Injurious Behavior" OR "Self Destructive Behavior" OR "Suicidal Ideation" OR "Self-Destructive Behavior" OR "Attempted Suicide") AND ("Adolescence" OR "Adolescent" OR "Student" OR "School" OR "Teen" OR "Teenager" OR "Youth" OR "Young"))))
SciELO http://www.scielo.org/	(("Psychotropic" OR "Psychoactive Agents") AND ("Suicide" OR "Suicidal") AND ("Adolescent" OR "Teenager" OR "Youth")) (("Drug Abuse" OR "Substance Abuse" OR "Narcotic") AND ("Suicide" OR "Suicidal") AND ("Adolescence" OR "Teen" OR "Young"))
LILACS http://lilacs.bvsalud.org/	(("Psychotropic" OR "Psychoactive Agents") AND ("Suicide" OR "Suicidal") AND ("Adolescent" OR "Teenager" OR "Youth")) AND (instance:" regional") AND ( db:( "LILACS")) tw:((("Drug Abuse" OR "Substance Abuse" OR "Narcotic") AND ("Suicide" OR "Suicidal") AND ("Adolescent" OR "Teenager" OR "Youth" ))) AND (instance:" regional") AND ( db:( "LILACS"))
Scopus http://www.scopus.com	(("Psychotropic Drugs" OR "Psychoactive Agents" OR "Psychoactive Drugs") OR ("Suicide" OR "Suicides" OR "Suicidal" OR "Self-harm") OR ("Adolescence" OR "Adolescent" OR "Student" OR "School" OR "Teen" OR "Teenager" OR "Youth" OR "Young")) (("Narcotic" OR "Substance-Related Disorders" OR "Substance Abuse" OR "Drug Abuse") OR ("Self-Injurious Behavior" OR "Self Destructive Behavior" OR "Suicidal Ideation" OR "Self-Destructive Behavior" OR "Attempted Suicide") OR ("Adolescence" OR "Adolescent" OR "Teen" OR "Teenager"))
Gray literature
OpenThesis https://oatd.org	(("Substance Use") AND ("Suicide") AND ("Adolescent"))
OpenGrey http://www.opengrey.eu/	(("Substance Use" OR "Drug Abuse" OR "Substance Abuse") AND ("Suicide" OR "Suicidal" OR "Self-harm" OR "Self-Injurious Behavior" OR "Self-Destructive Behavior") AND ("Adolescent" OR "Teenager" OR "Adolescence" OR "Teen" OR "Young"))

Author, year^ref	Country	Age (years)	Average age	n	Data source
Kandel et al., 1991²⁹29. Kandel DB, Raveis VH, Davies M. Suicidal ideation in adolescence: Depression, substance use, and other risk factors. J Youth Adol. 1991;20(2):289-309. PMID: 24265011; https://doi.org/10.1007/BF01537613. https://doi.org/10.1007/BF01537613...	USA	NR	NR	593 (NR♂;NR♀)	Self-administered questionnaire
Felts et al., 1992³⁰30. Felts WM, Chernier T, Barnes R. Drug use and suicide ideation and behavior among North Carolina public school students. Am J Public Health. 1992;82(6):870–2. PMID: 1585967; https://doi.org/10.2105/ajph.82.6.870. https://doi.org/10.2105/ajph.82.6.870...	USA	NR	NR	3,064 (NR♂;NR♀)	North Carolina Youth Risk Behavior Survey (1990)
Garrison et al., 1993³¹31. Garrison CZ, McKeown RE, Valois RF, Vincent ML. Aggression, substance use, and suicidal behaviors in high school students. Am J Public Health. 1993;83(2):179–84. PMID: 8427319; https://doi.org/10.2105/ajph.83.2.179. https://doi.org/10.2105/ajph.83.2.179...	USA	NR	NR	3,674 (1,702♂;2,062♀)	South Carolina Youth Risk Behavior Survey (1990)
Vega et al., 1993³²32. Vega WA, Gil A, Warheit G, Apospori E, Zimmerman R. The relationship of drug use to suicide ideation and attempts among African American, Hispanic, and white non-Hispanic male adolescents. Suicide Life-threat Behav. 1993;23(2):110–9. PMID: 8342210; https://doi.org/10.1111/j.1943-278X.1993.tb00375.x. https://doi.org/10.1111/j.1943-278X.1993...	USA	NR	NR	5,303 (NR♂;NR♀>)	Self-administered questionnaire
Madianos et al., 1994³³33. Madianos MG, Gefou-Madianou D, Stefanis CN. Symptoms of depression, suicidal behaviour and use of substances in Greece: a nationwide general population survey. Acta Psyc Scandinav. 1994;89(3):159–66. PMID: 8178673; https://doi.org/10.1111/j.1600-0447.1994.tb08086.x. https://doi.org/10.1111/j.1600-0447.1994...	Greece	12-17	NR	4,291(1,940♂;2,351♀)	Self-administered questionnaire
Burge et al., 1995³⁴34. Burge V, Felts M, Chenier T, Parrillo AV. Drug use, sexual activity, and suicidal behavior in U.S. high school students. J School Health. 1995;65(6):222–7. PMID: 7564284; https://doi.org/10.1111/j.1746-1561.1995.tb03366.x. https://doi.org/10.1111/j.1746-1561.1995...	USA	NR	NR	11,631 (5,676♂;5,955♀)	1990 Youth Risk Behavior Survey (USA)
Lopez et al., 1995³⁵35. López L, Elsa K, Medina M, et al. La relación entre la ideación suicida y el abuso de sustancias tóxicas: resultado de una encuesta en la población estudiantil. Salud ment. 1995;18(4):25-32. Available from: http://www.revistasaludmental.mx/index.php/salud_mental/article/view/573. Accessed in 2022 (Dec. 12). http://www.revistasaludmental.mx/index.p...	Mexico	13-19	NR	3,459 (1,764♂;1,695♀)	National High-School Survey – Mexico 1992
Windle and Windle, 1997³⁶36. Windle RC, Windle M. An investigation of adolescents’ substance use behaviors, depressed affect, and suicidal behaviors. J Child Psychol Psychiatry. 1997;38(8):921–9. PMID: 9413792; https://doi.org/10.1111/j.1469-7610.1997.tb01611.x. https://doi.org/10.1111/j.1469-7610.1997...	USA	n.r.	15.54 ± 0.66	975 (458♂;517♀)	Self-administered questionnaire
Simon and Crosby, 2000³⁷37. Simon TR, Crosby AE. Suicide planning among high school students who report attempting suicide. Suicide Life Threat Behav. 2000;30(3):213–21. PMID: 11079635.	USA	NR	NR	16,296 (NR♂;NR♀)	1993 National School-Based Youth Risk Behavior Survey (YRBS)
Perkins and Hartless, 2002³⁸38. Perkins DF, Glen H. An ecological risk-factor examination of suicide ideation and behavior of adolescents. J Adoles Research. 2002;17(1):3-26. https://doi.org/10.1177/0743558402171001. https://doi.org/10.1177/0743558402171001...	USA	12-17	NR	14,922 (NR♂;NR♀)	Self-administered questionnaire
Vermeiren et al., 2003³⁹39. Vermeiren R, Schwab-Stone M, Ruchkin VV, et al. Suicidal behavior and violence in male adolescents: a school-based study. J Am Acad Child Adolesc Psychiatry. 2003;42(1):41–8. PMID: 12500075; https://doi.org/10.1097/00004583-200301000-00009. https://doi.org/10.1097/00004583-2003010...	Belgium	12-18	14.9 ± 1.9	794 (794♂;0♀)	Self-administered questionnaire
Hallfors et al., 2004⁴⁰40. Hallfors DD, Waller MW, Ford CA, et al. Adolescent depression and suicide risk: association with sex and drug behavior. Am J Prev Med. 2004;27(3):224–31. PMID: 15450635; https://doi.org/10.1016/j.amepre.2004.06.001. https://doi.org/10.1016/j.amepre.2004.06...	USA	15-19	NR	18,922 (9,288♂;9,634♀)	Wave-I in-home contractual data set of Add Health (1994)
Wu et al., 2004⁴¹41. Wu P, Hoven CW, Liu X, et al. Substance use, suicidal ideation and attempts in children and adolescents. Suicide Life Threat Behav. 2004;34(4):408–20. PMID: 15585462; https://doi.org/10.1521/suli.34.4.408.53733. https://doi.org/10.1521/suli.34.4.408.53...	USA	9-17	NR	1,458 (NR♂;NR♀)	NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study and The Westchester Study
Yip et al., 2004⁴²42. Yip PS, Liu KY, Lam TH, et al. Suicidality among high school students in Hong Kong, SAR. Suicide Life Threat Behav. 2004;34(3):284–97. PMID: 15385183; https://doi.org/10.1521/suli.34.3.284.42772. https://doi.org/10.1521/suli.34.3.284.42...	China	15-24	15.8	2,586 (306♂;42♀)	Hong Kong Youth Sexuality Survey - 2001
Spremo and Loga, 2005⁴³43. Spremo M, Loga S. The relationship between suicidal thoughts and psychoactive substances. Bosn J Basic Med Sci. 2005;5(3):35-8. PMID: 16351579; https://doi.org/10.17305/bjbms.2005.3268. https://doi.org/10.17305/bjbms.2005.3268...	Bosnia-Herzegovina	16-18	NR	202 (51♂;151♀)	Self-administered questionnaire
Ulusoy et al., 2005⁴⁴44. Ulusoy MD, Demir NO. Suicidal ideation in Turkish adolescents. Soc Behav Pers. 2005;33(6):541-52. https://doi.org/10.2224/sbp.2005.33.6.541. https://doi.org/10.2224/sbp.2005.33.6.54...	Turkey	17-18	NR	726 (306♂;420♀)	Self-administered questionnaire
Chabrol et al., 2008⁴⁶46. Chabrol H, Chauchard E, Girabet J. Cannabis use and suicidal behaviours in high-school students. Addict Behav. 2008;33(1):152–5. PMID: 17537584; https://doi.org/10.1016/j.addbeh.2007.04.029. https://doi.org/10.1016/j.addbeh.2007.04...	France	15-20	16.7 ± 1.3 (♂) 17 ± 1.3 (♀)	248 (76♂;172♀)	Self-administered questionnaire
Dunn et al., 2008⁴⁵45. Dunn MS, Goodrow B, Givens C, Austin S. Substance use behavior and suicide indicators among rural middle school students. J School Health. 2008;78(1):26–31. PMID: 18177297; https://doi.org/10.1111/j.1746-1561.2007.00262.x. https://doi.org/10.1111/j.1746-1561.2007...	USA	NR	12.9 ± 2.64 (♂) 12.8 ± 2.61 (♀)	10,273 (5,126♂;5,146♀	Self-administered questionnaire
Luncheon et al., 2008⁴⁷47. Luncheon C, Bae S, Gonzalez A, Lurie S, Singh KP. Hispanic female adolescents’ use of illicit drugs and the risk of suicidal thoughts. Am J Health Behav. 2008;32(1):52–9. PMID: 18021033; https://doi.org/10.5555/ajhb.2008.32.1.52. https://doi.org/10.5555/ajhb.2008.32.1.5...	USA	NR	NR	7,544 (0♂;7,544♀)	2003 Youth Risk Behavioral Surveillance System
Peltzer et al., 2008⁴⁸48. Peltzer K, Kleintjes S, Van Wyk B, Thompson EA, Mashego T. Correlates of suicide risk among secondary school students in Cape Town. Soc Behav Pers. 2008;36(4):493-502. https://doi.org/10.2224/sbp.2008.36.4.493. https://doi.org/10.2224/sbp.2008.36.4.49...	South Africa	NR	15.78 ± 1.58	1,157 (358♂;79♀)	Self-administered questionnaire
Epstein and Spirito, 2009⁴⁹49. Epstein JA, Spirito A. Risk factors for suicidality among a nationally representative sample of high school students. Suicide Life Threat Behav. 2009;39(3):241–51. PMID: 19606917; https://doi.org/10.1521/suli.2009.39.3.241. https://doi.org/10.1521/suli.2009.39.3.2...	USA	NR	NR	10,273 (5,126♂;5,146♀)	Youth Risk Behavior with probability proportional to school enroll Surveillance (United States, 2005)
Peter and Roberts, 2010⁵⁰50. Peter T, Roberts LW. ‘Bad’ boys and ‘sad’ girls? Examining internalizing and externalizing effects on parasuicides among youth. J Youth Adol. 2010;39(5):495–503. PMID: 20043194; https://doi.org/10.1007/s10964-009-9498-5. https://doi.org/10.1007/s10964-009-9498-...	Canada	15	NR	2,499 (1,222♂;1,277♀)	National Longitudinal Survey of Children and Youth – Waves 3 to 6
Pickles et al., 2009⁵¹51. Pickles A, Aglan A, Collishaw S, et al. Predictors of suicidality across the life span: the Isle of Wight study. Psych Med. 2010;40(9):1453–66. PMID: 19939326; https://doi.org/10.1017/S0033291709991905. https://doi.org/10.1017/S003329170999190...	England	NR	NR	2,226 (NR♂>;NR♀	Baseline of the Isle of Wight study, an epidemiological sample of adolescents assessed in 1968
Florenzano et al., 2010⁵²52. Florenzano R, Cáceres E, Valdés M, et al. Comparación de frecuencia de conductas de riesgo, problemas juveniles y estilos de crianza, en estudiantes adolescentes de tres ciudades chilenas. Cuad Méd Soc. 2010;50(2):115-23.	Chile	NR	NR	2,322 (1,026♂;1,296♀)	Self-administered questionnaire
Page et al., 2011⁵³53. Page RM, West JH, Hall PC. Psychosocial distress and suicide ideation in Chinese and Philippine adolescents. Asia Pac J Public Health. 2011;23(5):774–91. PMID: 21118858; https://doi.org/10.1177/1010539509353113. https://doi.org/10.1177/1010539509353113...	China and Philippines	11-17	NR	16,353 (7,450♂;8,725♀)	Global School Health Survey (2003) – Data from China and Philippines
Souza et al., 2010⁵⁴54. Souza LD, Ores L, Oliveira GT, et al. Ideação suicida na adolescência: prevalência e fatores associados. J Bras Psiq. 2010;59(4):286-92. https://doi.org/10.1590/S0047-20852010000400004. https://doi.org/10.1590/S0047-2085201000...	Brazil	11-15	NR	1,039 (501♂;538♀)	Self-administered questionnaire
Wolitzky-Taylor et al., 2010⁵⁵55. Wolitzky-Taylor KB, Ruggiero KJ, McCart MR, et al. Has adolescent suicidality decreased in the United States? Data from two national samples of adolescents interviewed in 1995 and 2005. J Clin Child Adolesc Psychol. 2010;39(1):64–76. PMID: 20390799; https://doi.org/10.1080/15374410903401146. https://doi.org/10.1080/1537441090340114...	USA	12-17	NR	7,637 (NR♂;NR♀)	National Survey of Adolescents (1995/2005)
Alwan et al., 2011⁵⁶56. Alwan H, Viswanathan B, Rousson V, Paccaud F, Bovet P. Association between substance use and psychosocial characteristics among adolescents of the Seychelles. BMC Ped. 2011;11:85. PMID: 21985036; https://doi.org/10.1186/1471-2431-11-85. https://doi.org/10.1186/1471-2431-11-85...	Seychelles	11-17	14 ± 1.4	1,432 (NR♂;NR♀)	Self-administered questionnaire
Carvalho et al. 2011⁵⁷57. Carvalho PD, Barros MV, Lima RA, Santos CM, Mélo EN. Condutas de risco à saúde e indicadores de estresse psicossocial em adolescentes estudantes do Ensino Médio. Cad Saúde Pública. 2011;27(11):2095–105. PMID: 22124487; https://doi.org/10.1590/s0102-311x2011001100003. https://doi.org/10.1590/s0102-311x201100...	Brazil	14-19	NR	4,201 (1,688♂;2,513♀)	Self-administered questionnaire
Eaton et al., 2011⁵⁸58. Eaton DK, Foti K, Brener ND, et al. Associations between risk behaviors and suicidal ideation and suicide attempts: do racial/ethnic variations in associations account for increased risk of suicidal behaviors among Hispanic/Latina 9th- to 12th-grade female students? Arch Suicide Res. 2011;15(2):113–26. PMID: 21541858; https://doi.org/10.1080/13811118.2011.565268. https://doi.org/10.1080/13811118.2011.56...	USA	NR	NR	6,322 (0♂;6,322♀)	Youth Risk Behavior Survey (2007)
Kim et al., 2011⁵⁹59. Kim J, Fan B, Liu X, Kerner N, Wu P. Ecstasy use and suicidal behavior among adolescents: findings from a national survey. Suicide Life Threat Behav. 2011;41(4):435–44. PMID: 21631573; https://doi.org/10.1111/j.1943-278X.2011.00043.x. https://doi.org/10.1111/j.1943-278X.2011...	USA	12-17	NR	19,301 (NR♂;NR♀)	2000 National Household Survey on Drug Abuse (NHSDA)
Miller et al., 2011⁶⁰60. Miller M, Borges G, Orozco R, et al. Exposure to alcohol, drugs and tobacco and the risk of subsequent suicidality: findings from the Mexican Adolescent Mental Health Survey. Drug Alcohol Depend. 2011;113(2-3):110–7. PMID: 20801585; https://doi.org/10.1016/j.drugalcdep.2010.07.016. https://doi.org/10.1016/j.drugalcdep.201...	Mexico	12-17	NR	3,005 (NR♂;NR♀)	Mexican Adolescent Mental Health Survey (MAMHS)
Swahn et al., 2011⁶¹61. Swahn MH, Bossarte RM, Choquet M, et al. Early substance use initiation and suicide ideation and attempts among students in France and the United States. Int J Public Health. 2012;57(1):95–105. PMID: 21523616; https://doi.org/10.1007/s00038-011-0255-7. https://doi.org/10.1007/s00038-011-0255-...	USA and France	11-19	NR	28,323 (13,895♂;14,398♀)	2003 European School Survey Project on Alcohol and Other Drugs (France) and 2003 Youth Risk Behavior Survey (USA)
Ahmad et al., 2012⁶²62. Ahmad N, Cheong SM, Ibrahim N, Rosman A. Suicidal ideation among Malaysian adolescents. Asia Pac J Public Health. 2012;26(5 Suppl):63S–9S. PMID: 25005932; https://doi.org/10.1177/1010539514540746. https://doi.org/10.1177/1010539514540746...	Malaysia	12-17	NR	25,507 (12,498♂;13,009♀)	2012 Malaysia Global School-based Student Health Survey
Bakken and Gunter, 2012⁶³63. Bakken NW, Gunter WD. Self-cutting and suicidal ideation among adolescents: Gender differences in the causes and correlates of self-injury. Deviant Behav. 2012;33(5):339–56. https://doi.org/10.1080/01639625.2011.584054. https://doi.org/10.1080/01639625.2011.58...	USA	NR	NR	2,548 (1,274♂;1,274♀)	Delaware High School Youth Risk Behavior Survey (YRBS-H)
Kokkevi et al., 2012⁶⁴64. Kokkevi A, Rotsika V, Arapaki A, Richardson C. Adolescents’ self-reported suicide attempts, self-harm thoughts and their correlates across 17 European countries. J Child Psychol Psychiatry. 2012;53(4):381–9. PMID: 21895649; https://doi.org/10.1111/j.1469-7610.2011.02457.x. https://doi.org/10.1111/j.1469-7610.2011...	17 European countries	15-16	NR	45,806 (NR♂;NR♀)	European School Survey Project on Alcohol and Other Drugs (ESPAD) - 2007
Peltzer and Pengpid, 2012⁶⁵65. Peltzer K, Pengpid S. Suicidal ideation and associated factors among school-going adolescents in Thailand. Int J Environ Res Public Health. 2012;9(2):462–73. PMID: 22470303; https://doi.org/10.3390/ijerph9020462. https://doi.org/10.3390/ijerph9020462...	Thailand	12-15	NR	2,758 (1,364♂;1,394♀)	Thailand Global School-Based Health Survey (2008)
Wilson et al., 2012⁶⁶66. Wilson ML, Dunlavy AC, Viswanathan B, Bovet P. Suicidal expression among school-attending adolescents in a middle-income sub-Saharan country. Int J Environ Res Public Health. 2012;9(11):4122–34. PMID: 23202835; https://doi.org/10.3390/ijerph9114122. https://doi.org/10.3390/ijerph9114122...	Seychelles	11-17	NR	1,432 (687♂;745♀)	Global School-based Student Health Survey – Data from Seychelles
Arenliu et al., 2013⁶⁷67. Arenliu A, Kaltrina K, Mytaher H, Teuta H, Ercan C. Drug use and reported suicide ideation and attempt among Kosovar adolescents. J Substance Use. 2014;19(5):358-63. https://doi.org/10.3109/14659891.2013.820803. https://doi.org/10.3109/14659891.2013.82...	Kosovo	15-16	15.65 ± 0.68 (♂) 15.63 ± 0.69 (♀)	4,709 (2,112♂;2,597♀)	2011 European School Survey Project on Alcohol and other Drugs (ESPAD)
Consoli et al. 2013⁶⁸68. Consoli A, Peyre H, Speranza M, Hassler C, Falissard B, Touchette E, et al. Suicidal behaviors in depressed adolescents: role of perceived relationships in the family. Child Adolesc Psychiatry Ment Health. 2013;7(1):8. PMID: 23497551; https://doi.org/10.1186/1753-2000-7-8. https://doi.org/10.1186/1753-2000-7-8...	France	17	NR	36,757 (18,164♂;18,593♀)	Self-administered questionnaire
Delfabbro et al., 2013⁶⁹69. Delfabbro PH, Winefield HR, Winefield AH. Life-time and current suicide-ideation in Australian secondary school students: Socio-demographic, health and psychological predictors. J Affect Disord. 2013;151(2):514–24. PMID: 23871389; https://doi.org/10.1016/j.jad.2013.06.036. https://doi.org/10.1016/j.jad.2013.06.03...	Australia	14-16	15.2 ± 0.5	2,552 (1,041♂;1,485♀)	Self-administered questionnaire
Govender et al., 2013⁷⁰70. Govender K, Naicker SN, Meyer-Weitz A, et al. Associations between perceptions of school connectedness and adolescent health risk behaviors in South African high school learners. J School Health. 2013;83(9):614–22. PMID: 23879780; https://doi.org/10.1111/josh.12073. https://doi.org/10.1111/josh.12073...	South Africa	13-17	14.7 ± 0.74	239 (112♂;127♀)	Self-administered questionnaire
Rasic et al., 2013⁷¹71. Rasic D, Weerasinghe S, Asbridge M, Langille DB. Longitudinal associations of cannabis and illicit drug use with depression, suicidal ideation and suicidal attempts among Nova Scotia high school students. Drug Alcohol Depend. 2013;129(1-2):49–53. PMID: 23041136; https://doi.org/10.1016/j.drugalcdep.2012.09.009. https://doi.org/10.1016/j.drugalcdep.201...	Canada	NR	NR	976 (486♂;490♀)	Self-administered questionnaire
Shilubane et al., 2013⁷²72. Shilubane HN, Ruiter RA, van den Borne B, et al. Suicide and related health risk behaviours among school learners in South Africa: results from the 2002 and 2008 national youth risk behaviour surveys. BMC Public Health. 2013;13:926. PMID: 24093214; https://doi.org/10.1186/1471-2458-13-926. https://doi.org/10.1186/1471-2458-13-926...	South Africa	13-19	NR	20,646 (9,878♂;10,768♀)	2002 and 2008 South African Youth Risk Behaviour Surveys
Van Ours et al., 2013⁷⁴74. Van Ours JC, Williams J, Fergusson D, Horwood LJ. Cannabis use and suicidal ideation. J Health Economics. 2013;32(3):524–37. PMID: 23518573; https://doi.org/10.1016/j.jhealeco.2013.02.002. https://doi.org/10.1016/j.jhealeco.2013....	New Zealand	10-24	NR	938 (459♂;479♀)	Christchurch Health and Development Study (CHDS)
Wong et al., 2013⁷³73. Wong JP. Structural Violence & Men’s Health. Presentation to Global Health & Health Equity Forum. Toronto: Ryerson University; 2013.	USA	NR	NR	73,183 (37,104♂;36,079♀)	Data from the 2001 to 2009 Youth Risk Behavior Survey
Chabrol et al., 2014⁷⁵75. Chabrol H, Melioli T, Goutaudier N. Cannabis use and suicidal ideations in high-school students. Addictive Behav. 2014;39(12):1766–8. PMID: 25123343; https://doi.org/10.1016/j.addbeh.2014.06.008. https://doi.org/10.1016/j.addbeh.2014.06...	France	NR	17.1 ± 1.2 (♂) 16.7 ± 1 (♀)	972 (594♂;378♀)	Self-administered questionnaire
Lowry et al., 2014⁷⁶76. Lowry R, Crosby AE, Brener ND, Kann L. Suicidal thoughts and attempts among u.s. High school students: trends and associated health-risk behaviors, 1991-2011. J Adolesc Health. 2014;54(1):100–8. PMID: 24035267; https://doi.org/10.1016/j.jadohealth.2013.07.024. https://doi.org/10.1016/j.jadohealth.201...	USA	NR	NR	14,000 (NR♂;NR♀)	11 national Youth Risk Behavior Surveys conducted biennially between 1991 and 2011
Randall et al., 2014⁷⁷77. Randall JR, Doku D, Wilson ML, Peltzer K. Suicidal behaviour and related risk factors among school-aged youth in the Republic of Benin. PloS one. 2014;9(2):e88233. PMID: 24505443; https://doi.org/10.1371/journal.pone.0088233. https://doi.org/10.1371/journal.pone.008...	Benin	12-16	NR	2,690 (NR♂;NR♀)	Global School-based Health Survey (2009) – Data from Benin
Zhang and Wu, 2014⁷⁸78. Zhang X, Wu LT. Suicidal ideation and substance use among adolescents and young adults: a bidirectional relation?. Drug Alcohol Depend. 2014;142:63–73. PMID: 24969957; https://doi.org/10.1016/j.drugalcdep.2014.05.025. https://doi.org/10.1016/j.drugalcdep.201...	USA	11-21	NR	3,342 (NR♂;NR♀)	Public-use Add Health – Wave 1
Delfabbro et al., 2015⁷⁹79. Delfabbro HP, Malvaso C, Winefield HA, Winefield RH. Socio-demographic, health, and psychological correlates of suicidality severity in Australian adolescents. Aust J Psychol. 2015;68(4):261-269. https://doi.org/10.1111/ajpy.12104. https://doi.org/10.1111/ajpy.12104...	Australia	14-16	15.2 ± 0.5	2,552 (1,041♂;1,485♀)	Self-administered questionnaire
Dunlavy et al., 2015⁸⁰80. Dunlavy AC, Aquah EO, Wilson ML. Suicidal ideation among school-attending adolescents in Dar es Salaam, Tanzania. Tanzan J Health Res. 2015;17(1):1-7. Available from: https://www.ajol.info/index.php/thrb/article/view/102996. Accessed in 2022 (Dec. 12). https://www.ajol.info/index.php/thrb/art...	Tanzania	11-16	NR	2,154 (1,034♂;1,120♀)	Global School-Based Student Health Survey (2006) – Data from Dar el Salaam
Gart and Kelly, 2015⁸¹81. Gart R, Kelly S. How Illegal Drug Use, Alcohol Use, Tobacco Use, and Depressive Symptoms Affect Adolescent Suicidal Ideation: A Secondary Analysis of the 2011 Youth Risk Behavior Survey. Issues Ment Health Nurs. 2015;36(8):614–20. PMID: 26379135; https://doi.org/10.3109/01612840.2015.1015697. https://doi.org/10.3109/01612840.2015.10...	USA	NR	16 ± 1.2	15,363 (7,655♂;7,708♀)	2011 Youth Risk Behavior Survey
Lee and Choi, 2015⁸²82. Lee GY, Choi YJ. Association of school, family, and mental health characteristics with suicidal ideation among Korean adolescents. Res Nurs Health. 2015;38(4):301–10. PMID: 25917791; https://doi.org/10.1002/nur.21661. https://doi.org/10.1002/nur.21661...	South Korea	13-18	NR	72,435 (35,655♂;35,780♀)	2013 Online Survey of Youth Health Behavior in Korea
Peltzer and Pengpid, 2015¹⁷17. Peltzer K, Pengpid S. Early Substance Use Initiation and Suicide Ideation and Attempts among School-Aged Adolescents in Four Pacific Island Countries in Oceania. Int J Environment Res Public Health. 2015;12(10):12291–303. PMID: 26437423; https://doi.org/10.3390/ijerph121012291. https://doi.org/10.3390/ijerph121012291...	4 countries of Oceania	13-16	NR	6,540 (2,846♂;3,534♀)	Global School-Based Health Survey (2011) – Data from Samoa, Kiribati, Salomon Island, and Vanuatu
Sampasa-Kanyinga et al., 2015⁸³83. Sampasa-Kanyinga H, Dupuis LC, Ray R. Prevalence and correlates of suicidal ideation and attempts among children and adolescents. Int J Adolesc Med Health. 2017;29(2)20150053. PMID: 26556839; https://doi.org/10.1515/ijamh-2015-0053. https://doi.org/10.1515/ijamh-2015-0053...	Canada	11-20	14.4 ± 1.9	1,922 (883♂;3,534♀)	Ontario Student Drug Use and Health Survey (2009/2011/2013)
Sharma et al., 2015⁸⁴84. Sharma B, Nam EW, Kim HY, Kim JK. Factors Associated with Suicidal Ideation and Suicide Attempt among School-Going Urban Adolescents in Peru. Int J Environ Res Public Health. 2015;12(11):14842–56. PMID: 26610536; https://doi.org/10.3390/ijerph121114842. https://doi.org/10.3390/ijerph121114842...	Peru	12-18	NR	916 (425♂;491♀)	Self-administered questionnaire
Dudovitz et al., 2015⁸⁵85. Dudovitz RN, McCoy K, Chung PJ. At-school substance use as a marker for serious health risks. Academic Ped. 2015;15(1):41–6. PMID: 25528124; https://doi.org/10.1016/j.acap.2014.06.022. https://doi.org/10.1016/j.acap.2014.06.0...	EUA	NR	NR	15,698 (7,656♂;8,042♀)	2011 Youth Risk Behaviors Survey
Ammerman et al., 2016⁸⁶86. Ammerman BA, Steinberg L, McCloskey MS. Risk-Taking Behavior and Suicidality: The Unique Role of Adolescent Drug Use. J Clin Child Adolesc Psychol. 2018;47(1):131–41. PMID: 27732082; https://doi.org/10.1080/15374416.2016.1220313. https://doi.org/10.1080/15374416.2016.12...	USA	NR	NR	4,834 (2,315♂;2,419♀)	Longitudinal Study of Adolescent Health (2009)
DeCamp and Bakken, 2016⁸⁷87. DeCamp W, Bakken NW. Self-injury, suicide ideation, and sexual orientation: differences in causes and correlates among high school students. J Inj Violence Res. 2016;8(1):15–24. PMID: 26401756; https://doi.org/10.5249/jivr.v8i1.545. https://doi.org/10.5249/jivr.v8i1.545...	USA	NR	NR	4,834 (2,315♂;2,419♀)	2005, 2007, and 2009 Delaware High School Youth Risk Behavior Survey (YRBS-H)
Price and Khubchandani, 2016⁸⁸88. Price JH, Khubchandani J. Latina Adolescents Health Risk Behaviors and Suicidal Ideation and Suicide Attempts: Results from the National Youth Risk Behavior Survey 2001-2013. J Immigr Minor Health. 2017;19(3):533–42. PMID: 27286882; https://doi.org/10.1007/s10903-016-0445-8. https://doi.org/10.1007/s10903-016-0445-...	USA	NR	NR	13,721 (NR♂;NR♀)	Youth Risk Behavior Survey (2001/03)
Weeks and Colman, 2016⁹⁰90. Weeks M, Colman I. Predictors of Suicidal Behaviors in Canadian Adolescents with No Recent History of Depression. Arch Suic Research. 2017;21(2):354–64. PMID: 27587262; https://doi.org/10.1080/13811118.2016.1193076. https://doi.org/10.1080/13811118.2016.11...	Canada	12-17	NR	6,788 (3,287♂;3,501♀)	National Longitudinal Survey of Children and Youth
Agrawal et al., 2017⁹¹91. Agrawal A, Tillman R, Grucza RA, et al. Reciprocal relationships between substance use and disorders and suicidal ideation and suicide attempts in the Collaborative Study of the Genetics of Alcoholism. J Affect Disord. 2017;213:96–104. PMID: 28213124; https://doi.org/10.1016/j.jad.2016.12.060. https://doi.org/10.1016/j.jad.2016.12.06...	USA	12-22	NR	3,277 (NR♂;NR♀)	Baseline of the Collaborative Study of the Genetics of Alcoholism
Asante et al., 2017⁹²92. Asante KO, Kugbey N, Osafo J, Quarshie EN, Sarfo JO. The prevalence and correlates of suicidal behaviours (ideation, plan and attempt) among adolescents in senior high schools in Ghana. SSM Popul Health. 2017;3:427–34. PMID: 29349236; https://doi.org/10.1016/j.ssmph.2017.05.005. https://doi.org/10.1016/j.ssmph.2017.05....	Ghana	NR	NR	1,973 (1,065♂;908♀	Ghana Global School-based Student Health Survey (2012)
Janssen et al., 2017⁹³93. Janssen E, Spilka S, Beck F. Suicide, santé mentale et usages de substances psychoactives chez les adolescents français en 2014. Rev Epidemiol Sante Publique. 2017;65(6):409-17. PMID: 29096995; https://doi.org/10.1016/j.respe.2017.06.004. https://doi.org/10.1016/j.respe.2017.06....	France	17	NR	22,023 (11,034♂;10,989♀)	Self-administered questionnaire
Wang and Yen, 2017⁹⁴94. Wang PW, Yen CF. Adolescent substance use behavior and suicidal behavior for boys and girls: a cross-sectional study by latent analysis approach. BMC Psych. 2017;17(1):392. PMID: 29216850; https://doi.org/10.1186/s12888-017-1546-1. https://doi.org/10.1186/s12888-017-1546-...	Taiwan	12-19	14.75 ± 1.77	13,985 (NR♂;NR♀)	2004 Project for the Health of Adolescents in Southern Taiwan
El Kazdouh et al., 2018⁹⁵95. El Kazdouh H, El-Ammari A, Bouftini S, El Fakir S, El Achhab Y. Potential risk and protective factors of substance use among school adolescents in Morocco: A cross-sectional study. J Subst Use. 2019;24(2):176-83. https://doi.org/10.1080/14659891.2018.1535003. https://doi.org/10.1080/14659891.2018.15...	Morocco	14-19	NR	800 (374♂;426♀)	Self-administered questionnaire
Haskuka et al., 2018⁹⁶96. Haskuka M, Aliriza A, Kaltrina K. The relationship between substance use and suicidal behaviour among adolescents in selected European countries: A test of normalisation theory. Drugs. 2018;25(5):413-21. https://doi.org/10.1080/09687637.2017.1308468. https://doi.org/10.1080/09687637.2017.13...	18 European countries	15	NR	105,000 (NR♂;NR♀)	European School Survey Project on Alcohol and Other Drugs (ESPAD – 2011)
Subica and Wu, 2018⁹⁷97. Subica AM, Wu LT. Substance Use and Suicide in Pacific Islander, American Indian, and Multiracial Youth. Am J Prev Med. 2018;54(6):795–805. PMID: 29656915; https://doi.org/10.1016/j.amepre.2018.02.003. https://doi.org/10.1016/j.amepre.2018.02...	USA	12-18	NR	184,494 (NR♂;NR♀)	1991 – 2015 Combined National Youth Behavioral Risk Surveys
Chadi et al., 2019⁹⁸98. Chadi N, Li G, Cerda N, Weitzman ER. Depressive Symptoms and Suicidality in Adolescents Using e-Cigarettes and Marijuana: A Secondary Data Analysis From the Youth Risk Behavior Survey. J Addict Med. 2019;13(5):362–5. PMID: 30688723; https://doi.org/10.1097/ADM.0000000000000506. https://doi.org/10.1097/ADM.000000000000...	USA	NR	NR	26,821 (13,062♂;13,749♀)	Two waves (2015 and 2017) of the national Youth Risk Behavior Survey
Dema et al., 2019⁹⁹99. Dema T, Tripathy JP, Thinley S, et al. Suicidal ideation and attempt among school going adolescents in Bhutan - a secondary analysis of a global school-based student health survey in Bhutan 2016. BMC Public Health. 2019;19(1):1605. PMID: 31791280; https://doi.org/10.1186/s12889-019-7791-0. https://doi.org/10.1186/s12889-019-7791-...	Bhutan	13-17	NR	5,809 (2,554♂;3,255♀)	Global School-Based Student Health Survey (2016) – Data from Bhutan
Georgiades et al., 2019¹⁰⁰100. Georgiades K, Boylan K, Duncan L, et al. Prevalence and Correlates of Youth Suicidal Ideation and Attempts: Evidence from the 2014 Ontario Child Health Study. Canadian journal of psychiatry. Can J Psychiatry. 2019;64(4):265–74. PMID: 30978144; https://doi.org/10.1177/0706743719830031. https://doi.org/10.1177/0706743719830031...	Canada	14-17	NR	2,396 (1,189♂;1,207♀)	2014 Ontario Child Health Study
Jung et al., 2019¹⁰¹101. Jung JS, Park SJ, Kim EY, et al. Prediction models for high risk of suicide in Korean adolescents using machine learning techniques. PloS one. 2019;14(6):e0217639. PMID: 31170212; https://doi.org/10.1371/journal.pone.0217639. https://doi.org/10.1371/journal.pone.021...	South Korea	NR	NR	59,984 (30,384♂;29,600♀)	Korea Youth Risk Behavior Web-based Survey (2017)
Baiden et al., 2020¹⁸18. Baiden P, LaBrenz CA, Asiedua-Baiden G, Muehlenkamp JJ. Examining the intersection of race/ethnicity and sexual orientation on suicidal ideation and suicide attempt among adolescents: Findings from the 2017 Youth Risk Behavior Survey. J Psych Res. 2020;125:13-20. PMID: 32179279; https://doi.org/10.1016/j.jpsychires.2020.02.029. https://doi.org/10.1016/j.jpsychires.202...	USA	NR	NR	13,697 (6,609♂;7,088♀)	2017 Youth Risk Behavior Survey (YRBS)
Greene et al., 2020¹⁰²102. Greene N, Tomedi L, Reno J, Green D. The Role of Substance Use and Resiliency Factors on Suicidal Ideation among Middle School Students. J Sch Health. 2020;90(2):73–80. PMID: 31828795; https://doi.org/10.1111/josh.12854. https://doi.org/10.1111/josh.12854...	USA	NR	NR	16,390 (8,149♂;8,187♀)	2013 New Mexico Youth Risk and Resiliency Survey (NM-YRRS)
Khan et al., 2020¹⁰³103. Khan M, Rahman MM, Islam MR, et al. Suicidal behavior among school-going adolescents in Bangladesh: findings of the global school-based student health survey. Soc Psychiatry Psychiatr Epidemiol. 2020;55(11):1491–502. PMID: 32239265; https://doi.org/10.1007/s00127-020-01867-z. https://doi.org/10.1007/s00127-020-01867...	Bangladesh	11-18	NR	2,989 (1,952♂;1,037♀)	Global School-based Student Health Survey (2014) – Data from Bangladesh
Kim et al., 2020⁸⁹89. Kim EM, Kim H, Park E. How are depression and suicidal ideation associated with multiple health risk behaviours among adolescents? A secondary data analysis using the 2016 Korea Youth Risk Behavior Web-based Survey. J Psychiatr Ment Health Nurs. 2020;27(5):595–606. PMID: 31999868; https://doi.org/10.1111/jpm.12610. https://doi.org/10.1111/jpm.12610...	South Korea	12-17	15.9 ± 0.02	65,528 (33,803♂;31,725♀)	2016 Korea Youth Risk Behavior Web-based Survey (KYRBS)
Sakamoto et al., 2020¹⁰⁴104. Sakamoto JL, Shibanuma A, Jimba M. Depressed mood, suicidal behaviors, and health risk behaviors among youths in the Commonwealth of the Northern Mariana Islands: the 2017 CNMI Youth Risk Behavior Survey. BMC Public Health. 2020;20(1):489. PMID: 32293384; https://doi.org/10.1186/s12889-020-08663-z. https://doi.org/10.1186/s12889-020-08663...	USA	14-18	NR	1,943 (982♂;951♀)	Youth Risk Behavior Survey (2017) – Data from the Northern Mariana Islands

Author^ref	Main outcomes
Kandel et al. ²⁹29. Kandel DB, Raveis VH, Davies M. Suicidal ideation in adolescence: Depression, substance use, and other risk factors. J Youth Adol. 1991;20(2):289-309. PMID: 24265011; https://doi.org/10.1007/BF01537613. https://doi.org/10.1007/BF01537613...	There was a strong association between psychotropic recreational drug use and suicidal ideation in female adolescents.
Felts et al. ³⁰30. Felts WM, Chernier T, Barnes R. Drug use and suicide ideation and behavior among North Carolina public school students. Am J Public Health. 1992;82(6):870–2. PMID: 1585967; https://doi.org/10.2105/ajph.82.6.870. https://doi.org/10.2105/ajph.82.6.870...	Drug use, particularly crack and cocaine, was associated with suicidal ideation.
Garrison et al. ³¹31. Garrison CZ, McKeown RE, Valois RF, Vincent ML. Aggression, substance use, and suicidal behaviors in high school students. Am J Public Health. 1993;83(2):179–84. PMID: 8427319; https://doi.org/10.2105/ajph.83.2.179. https://doi.org/10.2105/ajph.83.2.179...	Illicit psychotropic recreational drug use was significantly associated with suicidal ideation.
Vega et al. ³²32. Vega WA, Gil A, Warheit G, Apospori E, Zimmerman R. The relationship of drug use to suicide ideation and attempts among African American, Hispanic, and white non-Hispanic male adolescents. Suicide Life-threat Behav. 1993;23(2):110–9. PMID: 8342210; https://doi.org/10.1111/j.1943-278X.1993.tb00375.x. https://doi.org/10.1111/j.1943-278X.1993...	Illicit psychotropic recreational drug use was consistently related to higher levels of suicidal ideation.
Madianos et al. ³³33. Madianos MG, Gefou-Madianou D, Stefanis CN. Symptoms of depression, suicidal behaviour and use of substances in Greece: a nationwide general population survey. Acta Psyc Scandinav. 1994;89(3):159–66. PMID: 8178673; https://doi.org/10.1111/j.1600-0447.1994.tb08086.x. https://doi.org/10.1111/j.1600-0447.1994...	The severity and frequency of substance use influenced the prevalence of suicidal ideation in the sample analyzed.
Burge et al. ³⁴34. Burge V, Felts M, Chenier T, Parrillo AV. Drug use, sexual activity, and suicidal behavior in U.S. high school students. J School Health. 1995;65(6):222–7. PMID: 7564284; https://doi.org/10.1111/j.1746-1561.1995.tb03366.x. https://doi.org/10.1111/j.1746-1561.1995...	Psychotropic recreational substance use showed a positive association with suicidal ideation.
Lopez et al. ³⁵35. López L, Elsa K, Medina M, et al. La relación entre la ideación suicida y el abuso de sustancias tóxicas: resultado de una encuesta en la población estudiantil. Salud ment. 1995;18(4):25-32. Available from: http://www.revistasaludmental.mx/index.php/salud_mental/article/view/573. Accessed in 2022 (Dec. 12). http://www.revistasaludmental.mx/index.p...	Psychotropic recreational drug use represented a risk factor for suicidal ideation among the students.
Windle and Windle ³⁶36. Windle RC, Windle M. An investigation of adolescents’ substance use behaviors, depressed affect, and suicidal behaviors. J Child Psychol Psychiatry. 1997;38(8):921–9. PMID: 9413792; https://doi.org/10.1111/j.1469-7610.1997.tb01611.x. https://doi.org/10.1111/j.1469-7610.1997...	Psychotropic recreational drug use did not show a significant relationship with suicidal ideation, but it did with suicide attempts.
Simon and Crosby ³⁷37. Simon TR, Crosby AE. Suicide planning among high school students who report attempting suicide. Suicide Life Threat Behav. 2000;30(3):213–21. PMID: 11079635.	There was a relationship between psychotropic recreational substance use and suicidal ideation and thoughts.
Perkins and Hartless ³⁸38. Perkins DF, Glen H. An ecological risk-factor examination of suicide ideation and behavior of adolescents. J Adoles Research. 2002;17(1):3-26. https://doi.org/10.1177/0743558402171001. https://doi.org/10.1177/0743558402171001...	There was a relevant association between the use of hard psychotropic recreational drugs and suicidal ideation.
Vermeiren et al. ³⁹39. Vermeiren R, Schwab-Stone M, Ruchkin VV, et al. Suicidal behavior and violence in male adolescents: a school-based study. J Am Acad Child Adolesc Psychiatry. 2003;42(1):41–8. PMID: 12500075; https://doi.org/10.1097/00004583-200301000-00009. https://doi.org/10.1097/00004583-2003010...	Psychotropic recreational substance use did not show a significant association with suicidal ideation.
Hallfors et al. ⁴⁰40. Hallfors DD, Waller MW, Ford CA, et al. Adolescent depression and suicide risk: association with sex and drug behavior. Am J Prev Med. 2004;27(3):224–31. PMID: 15450635; https://doi.org/10.1016/j.amepre.2004.06.001. https://doi.org/10.1016/j.amepre.2004.06...	Psychotropic recreational drug use, particularly injectable drugs, presented a significant association with suicidal ideation.
Wu et al. ⁴¹41. Wu P, Hoven CW, Liu X, et al. Substance use, suicidal ideation and attempts in children and adolescents. Suicide Life Threat Behav. 2004;34(4):408–20. PMID: 15585462; https://doi.org/10.1521/suli.34.4.408.53733. https://doi.org/10.1521/suli.34.4.408.53...	The association between psychotropic recreational substance use and abuse was not significant after controlling adolescent depression.
Yip et al. ⁴²42. Yip PS, Liu KY, Lam TH, et al. Suicidality among high school students in Hong Kong, SAR. Suicide Life Threat Behav. 2004;34(3):284–97. PMID: 15385183; https://doi.org/10.1521/suli.34.3.284.42772. https://doi.org/10.1521/suli.34.3.284.42...	Illicit psychotropic recreational drug use was not considered an important risk factor for suicidal ideation.
Spremo and Loga ⁴³43. Spremo M, Loga S. The relationship between suicidal thoughts and psychoactive substances. Bosn J Basic Med Sci. 2005;5(3):35-8. PMID: 16351579; https://doi.org/10.17305/bjbms.2005.3268. https://doi.org/10.17305/bjbms.2005.3268...	Psychoactive substance use presented an important connection to the presence of suicidal ideation in the adolescents studied.
Ulusoy et al. ⁴⁴44. Ulusoy MD, Demir NO. Suicidal ideation in Turkish adolescents. Soc Behav Pers. 2005;33(6):541-52. https://doi.org/10.2224/sbp.2005.33.6.541. https://doi.org/10.2224/sbp.2005.33.6.54...	There was no significant association between illicit psychotropic recreational drug use and suicidal ideation, but adolescents who smoke cigarettes were more prone to ideation.
Chabrol et al. ⁴⁶46. Chabrol H, Chauchard E, Girabet J. Cannabis use and suicidal behaviours in high-school students. Addict Behav. 2008;33(1):152–5. PMID: 17537584; https://doi.org/10.1016/j.addbeh.2007.04.029. https://doi.org/10.1016/j.addbeh.2007.04...	There were significant associations between psychotropic recreational substance use and suicidal ideation among adolescents attending rural schools.
Dunn et al. ⁴⁵45. Dunn MS, Goodrow B, Givens C, Austin S. Substance use behavior and suicide indicators among rural middle school students. J School Health. 2008;78(1):26–31. PMID: 18177297; https://doi.org/10.1111/j.1746-1561.2007.00262.x. https://doi.org/10.1111/j.1746-1561.2007...	Cannabis use by adolescents was significantly associated with suicidal behavior (including suicidal ideation).
Luncheon et al. ⁴⁷47. Luncheon C, Bae S, Gonzalez A, Lurie S, Singh KP. Hispanic female adolescents’ use of illicit drugs and the risk of suicidal thoughts. Am J Health Behav. 2008;32(1):52–9. PMID: 18021033; https://doi.org/10.5555/ajhb.2008.32.1.52. https://doi.org/10.5555/ajhb.2008.32.1.5...	Illicit psychotropic recreational drugs were seriously associated with suicidal ideation and thoughts.
Peltzer et al. ⁴⁸48. Peltzer K, Kleintjes S, Van Wyk B, Thompson EA, Mashego T. Correlates of suicide risk among secondary school students in Cape Town. Soc Behav Pers. 2008;36(4):493-502. https://doi.org/10.2224/sbp.2008.36.4.493. https://doi.org/10.2224/sbp.2008.36.4.49...	The involvement with psychotropic recreational drugs was not associated with suicide risk (including suicidal ideation).
Epstein and Spirito ⁴⁹49. Epstein JA, Spirito A. Risk factors for suicidality among a nationally representative sample of high school students. Suicide Life Threat Behav. 2009;39(3):241–51. PMID: 19606917; https://doi.org/10.1521/suli.2009.39.3.241. https://doi.org/10.1521/suli.2009.39.3.2...	Sniffing glue had no significant relationship with suicidal ideation, but injecting drugs showed a high association with suicidal ideation.
Peter and Roberts ⁵⁰50. Peter T, Roberts LW. ‘Bad’ boys and ‘sad’ girls? Examining internalizing and externalizing effects on parasuicides among youth. J Youth Adol. 2010;39(5):495–503. PMID: 20043194; https://doi.org/10.1007/s10964-009-9498-5. https://doi.org/10.1007/s10964-009-9498-...	Cannabis use did not show a significant relationship with suicidal ideation.
Pickles et al. ⁵¹51. Pickles A, Aglan A, Collishaw S, et al. Predictors of suicidality across the life span: the Isle of Wight study. Psych Med. 2010;40(9):1453–66. PMID: 19939326; https://doi.org/10.1017/S0033291709991905. https://doi.org/10.1017/S003329170999190...	Problems with psychotropic recreational substance use were considered risk factors for the increase in suicidal behavior.
Florenzano et al. ⁵²52. Florenzano R, Cáceres E, Valdés M, et al. Comparación de frecuencia de conductas de riesgo, problemas juveniles y estilos de crianza, en estudiantes adolescentes de tres ciudades chilenas. Cuad Méd Soc. 2010;50(2):115-23.	There was a high correlation between psychotropic recreational substance use and suicidal behavior (including suicidal ideation) and depression.
Page et al. ⁵³53. Page RM, West JH, Hall PC. Psychosocial distress and suicide ideation in Chinese and Philippine adolescents. Asia Pac J Public Health. 2011;23(5):774–91. PMID: 21118858; https://doi.org/10.1177/1010539509353113. https://doi.org/10.1177/1010539509353113...	Psychotropic recreational drug use is significantly associated with higher levels of suicidal ideation.
Souza et al. ⁵⁴54. Souza LD, Ores L, Oliveira GT, et al. Ideação suicida na adolescência: prevalência e fatores associados. J Bras Psiq. 2010;59(4):286-92. https://doi.org/10.1590/S0047-20852010000400004. https://doi.org/10.1590/S0047-2085201000...	Illicit psychotropic recreational drug use was one of the factors related to suicidal ideation among adolescents.
Wolitzky-Taylor et al. ⁵⁵55. Wolitzky-Taylor KB, Ruggiero KJ, McCart MR, et al. Has adolescent suicidality decreased in the United States? Data from two national samples of adolescents interviewed in 1995 and 2005. J Clin Child Adolesc Psychol. 2010;39(1):64–76. PMID: 20390799; https://doi.org/10.1080/15374410903401146. https://doi.org/10.1080/1537441090340114...	Psychotropic recreational substance use was significantly associated with an increased risk of suicidal ideation in adolescents in both years of the study.
Alwan et al. ⁵⁶56. Alwan H, Viswanathan B, Rousson V, Paccaud F, Bovet P. Association between substance use and psychosocial characteristics among adolescents of the Seychelles. BMC Ped. 2011;11:85. PMID: 21985036; https://doi.org/10.1186/1471-2431-11-85. https://doi.org/10.1186/1471-2431-11-85...	Psychotropic recreational substance use was strongly associated with suicidal ideation among adolescents.
Carvalho et al. ⁵⁷57. Carvalho PD, Barros MV, Lima RA, Santos CM, Mélo EN. Condutas de risco à saúde e indicadores de estresse psicossocial em adolescentes estudantes do Ensino Médio. Cad Saúde Pública. 2011;27(11):2095–105. PMID: 22124487; https://doi.org/10.1590/s0102-311x2011001100003. https://doi.org/10.1590/s0102-311x201100...	Psychotropic recreational drug use was directly associated with suicidal ideation and planning among adolescents.
Eaton et al. ⁵⁸58. Eaton DK, Foti K, Brener ND, et al. Associations between risk behaviors and suicidal ideation and suicide attempts: do racial/ethnic variations in associations account for increased risk of suicidal behaviors among Hispanic/Latina 9th- to 12th-grade female students? Arch Suicide Res. 2011;15(2):113–26. PMID: 21541858; https://doi.org/10.1080/13811118.2011.565268. https://doi.org/10.1080/13811118.2011.56...	There was a significant association between psychotropic recreational drug use and suicidal ideation among adolescents.
Kim et al. ⁵⁹59. Kim J, Fan B, Liu X, Kerner N, Wu P. Ecstasy use and suicidal behavior among adolescents: findings from a national survey. Suicide Life Threat Behav. 2011;41(4):435–44. PMID: 21631573; https://doi.org/10.1111/j.1943-278X.2011.00043.x. https://doi.org/10.1111/j.1943-278X.2011...	The use of ecstasy and other psychotropic recreational drugs presented a significant association with suicidal ideation.
Miller et al. ⁶⁰60. Miller M, Borges G, Orozco R, et al. Exposure to alcohol, drugs and tobacco and the risk of subsequent suicidality: findings from the Mexican Adolescent Mental Health Survey. Drug Alcohol Depend. 2011;113(2-3):110–7. PMID: 20801585; https://doi.org/10.1016/j.drugalcdep.2010.07.016. https://doi.org/10.1016/j.drugalcdep.201...	There was an association between psychotropic recreational substance use and suicidal ideation, and this relationship started with adolescents aged 13 years and increased according to age.
Swahn et al. ⁶¹61. Swahn MH, Bossarte RM, Choquet M, et al. Early substance use initiation and suicide ideation and attempts among students in France and the United States. Int J Public Health. 2012;57(1):95–105. PMID: 21523616; https://doi.org/10.1007/s00038-011-0255-7. https://doi.org/10.1007/s00038-011-0255-...	The early drug initiation of adolescents showed an association with suicidal ideation in both countries analyzed.
Ahmad et al. ⁶²62. Ahmad N, Cheong SM, Ibrahim N, Rosman A. Suicidal ideation among Malaysian adolescents. Asia Pac J Public Health. 2012;26(5 Suppl):63S–9S. PMID: 25005932; https://doi.org/10.1177/1010539514540746. https://doi.org/10.1177/1010539514540746...	The use of hard psychotropic recreational drugs was significantly related to suicidal ideation.
Bakken and Gunter ⁶³63. Bakken NW, Gunter WD. Self-cutting and suicidal ideation among adolescents: Gender differences in the causes and correlates of self-injury. Deviant Behav. 2012;33(5):339–56. https://doi.org/10.1080/01639625.2011.584054. https://doi.org/10.1080/01639625.2011.58...	Psychotropic recreational substance use showed a significant relationship with suicidal behavior and ideation among the adolescents participating in the study.
Kokkevi et al.^64>	Psychotropic recreational substance use was associated with suicidal ideation.
Peltzer and Pengpid. ⁶⁵65. Peltzer K, Pengpid S. Suicidal ideation and associated factors among school-going adolescents in Thailand. Int J Environ Res Public Health. 2012;9(2):462–73. PMID: 22470303; https://doi.org/10.3390/ijerph9020462. https://doi.org/10.3390/ijerph9020462...	Psychotropic recreational substance use did not show a strong association with suicidal ideation.
Wilson et al. ⁶⁶66. Wilson ML, Dunlavy AC, Viswanathan B, Bovet P. Suicidal expression among school-attending adolescents in a middle-income sub-Saharan country. Int J Environ Res Public Health. 2012;9(11):4122–34. PMID: 23202835; https://doi.org/10.3390/ijerph9114122. https://doi.org/10.3390/ijerph9114122...	There was a strong association between suicidal ideation and illicit psychotropic recreational substance use for men.
Arenliu et al. ⁶⁷67. Arenliu A, Kaltrina K, Mytaher H, Teuta H, Ercan C. Drug use and reported suicide ideation and attempt among Kosovar adolescents. J Substance Use. 2014;19(5):358-63. https://doi.org/10.3109/14659891.2013.820803. https://doi.org/10.3109/14659891.2013.82...	Substance use was associated with higher levels of suicide risk (including suicidal ideation), without differences between the sexes.
Consoli et al. ⁶⁸68. Consoli A, Peyre H, Speranza M, Hassler C, Falissard B, Touchette E, et al. Suicidal behaviors in depressed adolescents: role of perceived relationships in the family. Child Adolesc Psychiatry Ment Health. 2013;7(1):8. PMID: 23497551; https://doi.org/10.1186/1753-2000-7-8. https://doi.org/10.1186/1753-2000-7-8...	Psychotropic recreational substance use by adolescents was potentially related to higher rates of suicidal ideation and attempts.
Delfabbro et al. ⁶⁹69. Delfabbro PH, Winefield HR, Winefield AH. Life-time and current suicide-ideation in Australian secondary school students: Socio-demographic, health and psychological predictors. J Affect Disord. 2013;151(2):514–24. PMID: 23871389; https://doi.org/10.1016/j.jad.2013.06.036. https://doi.org/10.1016/j.jad.2013.06.03...	Psychotropic recreational substance abuse was positively correlated with suicidal ideation.
Govender et al. ⁷⁰70. Govender K, Naicker SN, Meyer-Weitz A, et al. Associations between perceptions of school connectedness and adolescent health risk behaviors in South African high school learners. J School Health. 2013;83(9):614–22. PMID: 23879780; https://doi.org/10.1111/josh.12073. https://doi.org/10.1111/josh.12073...	Illicit psychotropic recreational drug use was significantly associated with high levels of suicidal ideation among the adolescents in the study.
Rasic et al. ⁷¹71. Rasic D, Weerasinghe S, Asbridge M, Langille DB. Longitudinal associations of cannabis and illicit drug use with depression, suicidal ideation and suicidal attempts among Nova Scotia high school students. Drug Alcohol Depend. 2013;129(1-2):49–53. PMID: 23041136; https://doi.org/10.1016/j.drugalcdep.2012.09.009. https://doi.org/10.1016/j.drugalcdep.201...	Psychotropic recreational substance use by the adolescents analyzed showed a significant association with suicidal ideation.
Shilubane et al. ⁷²72. Shilubane HN, Ruiter RA, van den Borne B, et al. Suicide and related health risk behaviours among school learners in South Africa: results from the 2002 and 2008 national youth risk behaviour surveys. BMC Public Health. 2013;13:926. PMID: 24093214; https://doi.org/10.1186/1471-2458-13-926. https://doi.org/10.1186/1471-2458-13-926...	Psychotropic recreational substance abuse was a strong risk factor for suicidal ideation and behavior, and this association increases with specific illicit drugs and the concomitant use of several substances.
Van Ours et al. ⁷⁴74. Van Ours JC, Williams J, Fergusson D, Horwood LJ. Cannabis use and suicidal ideation. J Health Economics. 2013;32(3):524–37. PMID: 23518573; https://doi.org/10.1016/j.jhealeco.2013.02.002. https://doi.org/10.1016/j.jhealeco.2013....	Intensive cannabis use led to higher levels of suicidal ideation in men.
Wong et al. ⁷³73. Wong JP. Structural Violence & Men’s Health. Presentation to Global Health & Health Equity Forum. Toronto: Ryerson University; 2013.	The levels of suicidal ideation were significantly higher among female adolescents with mental health problems and psychotropic recreational substance use and abuse.
Chabrol et al. ⁷⁵75. Chabrol H, Melioli T, Goutaudier N. Cannabis use and suicidal ideations in high-school students. Addictive Behav. 2014;39(12):1766–8. PMID: 25123343; https://doi.org/10.1016/j.addbeh.2014.06.008. https://doi.org/10.1016/j.addbeh.2014.06...	Cannabis use was not a significant independent predictor of suicidal ideation after adjusting the confounding factors of the total sample and subsample of cannabis users.
Lowry et al. ⁷⁶76. Lowry R, Crosby AE, Brener ND, Kann L. Suicidal thoughts and attempts among u.s. High school students: trends and associated health-risk behaviors, 1991-2011. J Adolesc Health. 2014;54(1):100–8. PMID: 24035267; https://doi.org/10.1016/j.jadohealth.2013.07.024. https://doi.org/10.1016/j.jadohealth.201...	Psychotropic recreational substance use was significantly associated with the increased risk of suicide (including suicidal ideation) among the students.
Randall et al. ⁷⁷77. Randall JR, Doku D, Wilson ML, Peltzer K. Suicidal behaviour and related risk factors among school-aged youth in the Republic of Benin. PloS one. 2014;9(2):e88233. PMID: 24505443; https://doi.org/10.1371/journal.pone.0088233. https://doi.org/10.1371/journal.pone.008...	There was an association between illicit psychotropic recreational drug use and suicidal ideation.
Zhang and Wu ⁷⁸78. Zhang X, Wu LT. Suicidal ideation and substance use among adolescents and young adults: a bidirectional relation?. Drug Alcohol Depend. 2014;142:63–73. PMID: 24969957; https://doi.org/10.1016/j.drugalcdep.2014.05.025. https://doi.org/10.1016/j.drugalcdep.201...	Psychotropic recreational drug use did not increase the risk of suicidal ideation, but suicidal ideation increased the risk of psychotropic recreational drug use.
Delfabbro et al. ⁷⁹79. Delfabbro HP, Malvaso C, Winefield HA, Winefield RH. Socio-demographic, health, and psychological correlates of suicidality severity in Australian adolescents. Aust J Psychol. 2015;68(4):261-269. https://doi.org/10.1111/ajpy.12104. https://doi.org/10.1111/ajpy.12104...	Cannabis use did not show a significant association with suicidal ideation, but it was related to suicidal planning by adolescents.
Dunlavy et al. ⁸⁰80. Dunlavy AC, Aquah EO, Wilson ML. Suicidal ideation among school-attending adolescents in Dar es Salaam, Tanzania. Tanzan J Health Res. 2015;17(1):1-7. Available from: https://www.ajol.info/index.php/thrb/article/view/102996. Accessed in 2022 (Dec. 12). https://www.ajol.info/index.php/thrb/art...	Illicit psychotropic recreational drug use was associated with suicidal ideation and planning.
Gart and Kelly ⁸¹81. Gart R, Kelly S. How Illegal Drug Use, Alcohol Use, Tobacco Use, and Depressive Symptoms Affect Adolescent Suicidal Ideation: A Secondary Analysis of the 2011 Youth Risk Behavior Survey. Issues Ment Health Nurs. 2015;36(8):614–20. PMID: 26379135; https://doi.org/10.3109/01612840.2015.1015697. https://doi.org/10.3109/01612840.2015.10...	Cannabis and cocaine use showed a significant relationship with suicidal ideation.
Lee and Choi ⁸²82. Lee GY, Choi YJ. Association of school, family, and mental health characteristics with suicidal ideation among Korean adolescents. Res Nurs Health. 2015;38(4):301–10. PMID: 25917791; https://doi.org/10.1002/nur.21661. https://doi.org/10.1002/nur.21661...	The use of psychoactive recreational drugs was associated with suicidal ideation among the different sexes and age groups of adolescents.
Peltzer and Pengpid ¹⁷17. Peltzer K, Pengpid S. Early Substance Use Initiation and Suicide Ideation and Attempts among School-Aged Adolescents in Four Pacific Island Countries in Oceania. Int J Environment Res Public Health. 2015;12(10):12291–303. PMID: 26437423; https://doi.org/10.3390/ijerph121012291. https://doi.org/10.3390/ijerph121012291...	Psychotropic recreational substance use was one of the factors associated with suicidal ideation for the adolescents studied.
Sampasa-Kanyinga et al. ⁸³83. Sampasa-Kanyinga H, Dupuis LC, Ray R. Prevalence and correlates of suicidal ideation and attempts among children and adolescents. Int J Adolesc Med Health. 2017;29(2)20150053. PMID: 26556839; https://doi.org/10.1515/ijamh-2015-0053. https://doi.org/10.1515/ijamh-2015-0053...	Adolescents who reported early psychotropic recreational drug use were more likely to report suicidal ideation.
Sharma et al. ⁸⁴84. Sharma B, Nam EW, Kim HY, Kim JK. Factors Associated with Suicidal Ideation and Suicide Attempt among School-Going Urban Adolescents in Peru. Int J Environ Res Public Health. 2015;12(11):14842–56. PMID: 26610536; https://doi.org/10.3390/ijerph121114842. https://doi.org/10.3390/ijerph121114842...	Cannabis use was positively associated with suicidal ideation.
Dudovitz et al. ⁸⁵85. Dudovitz RN, McCoy K, Chung PJ. At-school substance use as a marker for serious health risks. Academic Ped. 2015;15(1):41–6. PMID: 25528124; https://doi.org/10.1016/j.acap.2014.06.022. https://doi.org/10.1016/j.acap.2014.06.0...	Illicit psychotropic recreational substance use did not show a significant association with suicidal ideation.
Ammerman et al. ⁸⁶86. Ammerman BA, Steinberg L, McCloskey MS. Risk-Taking Behavior and Suicidality: The Unique Role of Adolescent Drug Use. J Clin Child Adolesc Psychol. 2018;47(1):131–41. PMID: 27732082; https://doi.org/10.1080/15374416.2016.1220313. https://doi.org/10.1080/15374416.2016.12...	Psychotropic recreational substance use showed a higher association with suicidal ideation than other risk behaviors.
DeCamp and Bakken ⁸⁷87. DeCamp W, Bakken NW. Self-injury, suicide ideation, and sexual orientation: differences in causes and correlates among high school students. J Inj Violence Res. 2016;8(1):15–24. PMID: 26401756; https://doi.org/10.5249/jivr.v8i1.545. https://doi.org/10.5249/jivr.v8i1.545...	Psychotropic recreational substance use (cannabis and hard drugs) is significantly correlated with suicidal ideation among female heterosexual adolescents.
Price and Khubchandani ⁸⁸88. Price JH, Khubchandani J. Latina Adolescents Health Risk Behaviors and Suicidal Ideation and Suicide Attempts: Results from the National Youth Risk Behavior Survey 2001-2013. J Immigr Minor Health. 2017;19(3):533–42. PMID: 27286882; https://doi.org/10.1007/s10903-016-0445-8. https://doi.org/10.1007/s10903-016-0445-...	Psychotropic recreational substance abuse was associated with high levels of suicidal ideation.
Weeks and Colman ⁹⁰90. Weeks M, Colman I. Predictors of Suicidal Behaviors in Canadian Adolescents with No Recent History of Depression. Arch Suic Research. 2017;21(2):354–64. PMID: 27587262; https://doi.org/10.1080/13811118.2016.1193076. https://doi.org/10.1080/13811118.2016.11...	There was a positive relationship between psychotropic recreational substance use and suicidal ideation.
Agrawal et al. ⁹¹91. Agrawal A, Tillman R, Grucza RA, et al. Reciprocal relationships between substance use and disorders and suicidal ideation and suicide attempts in the Collaborative Study of the Genetics of Alcoholism. J Affect Disord. 2017;213:96–104. PMID: 28213124; https://doi.org/10.1016/j.jad.2016.12.060. https://doi.org/10.1016/j.jad.2016.12.06...	Psychotropic recreational substance use by adolescents without a history of depression increases the risk of suicidal ideation.
Asante et al. ⁹²92. Asante KO, Kugbey N, Osafo J, Quarshie EN, Sarfo JO. The prevalence and correlates of suicidal behaviours (ideation, plan and attempt) among adolescents in senior high schools in Ghana. SSM Popul Health. 2017;3:427–34. PMID: 29349236; https://doi.org/10.1016/j.ssmph.2017.05.005. https://doi.org/10.1016/j.ssmph.2017.05....	Early psychotropic recreational substance use by adolescents was not associated with suicidal ideation.
Janssen et al. ⁹³93. Janssen E, Spilka S, Beck F. Suicide, santé mentale et usages de substances psychoactives chez les adolescents français en 2014. Rev Epidemiol Sante Publique. 2017;65(6):409-17. PMID: 29096995; https://doi.org/10.1016/j.respe.2017.06.004. https://doi.org/10.1016/j.respe.2017.06....	Psychotropic recreational substance use was not considered a risk factor for suicidal ideation.
Wang and Yen ⁹⁴94. Wang PW, Yen CF. Adolescent substance use behavior and suicidal behavior for boys and girls: a cross-sectional study by latent analysis approach. BMC Psych. 2017;17(1):392. PMID: 29216850; https://doi.org/10.1186/s12888-017-1546-1. https://doi.org/10.1186/s12888-017-1546-...	The regular use of psychoactive substances presented a significant association with suicidal behavior (including suicidal ideation). This relationship was measured based on the mental health of adolescents.
El Kazdouh et al. ⁹⁵95. El Kazdouh H, El-Ammari A, Bouftini S, El Fakir S, El Achhab Y. Potential risk and protective factors of substance use among school adolescents in Morocco: A cross-sectional study. J Subst Use. 2019;24(2):176-83. https://doi.org/10.1080/14659891.2018.1535003. https://doi.org/10.1080/14659891.2018.15...	Psychotropic recreational substance use by adolescents was significantly associated with suicidal ideation, without differences between the sexes.
Haskuka et al. ⁹⁶96. Haskuka M, Aliriza A, Kaltrina K. The relationship between substance use and suicidal behaviour among adolescents in selected European countries: A test of normalisation theory. Drugs. 2018;25(5):413-21. https://doi.org/10.1080/09687637.2017.1308468. https://doi.org/10.1080/09687637.2017.13...	Psychotropic recreational substance use was significantly associated with suicidal ideation for male adolescents, and this relationship increased with age.
Subica and Wu ⁹⁷97. Subica AM, Wu LT. Substance Use and Suicide in Pacific Islander, American Indian, and Multiracial Youth. Am J Prev Med. 2018;54(6):795–805. PMID: 29656915; https://doi.org/10.1016/j.amepre.2018.02.003. https://doi.org/10.1016/j.amepre.2018.02...	Cannabis use presented a relationship with suicidal ideation in three of the 13 countries participating in the study.
Chadi et al. ⁹⁸98. Chadi N, Li G, Cerda N, Weitzman ER. Depressive Symptoms and Suicidality in Adolescents Using e-Cigarettes and Marijuana: A Secondary Data Analysis From the Youth Risk Behavior Survey. J Addict Med. 2019;13(5):362–5. PMID: 30688723; https://doi.org/10.1097/ADM.0000000000000506. https://doi.org/10.1097/ADM.000000000000...	Cannabis use showed a relationship with suicidal ideation only for some of the ethnic groups studied.
Dema et al., 2019 ⁹⁹99. Dema T, Tripathy JP, Thinley S, et al. Suicidal ideation and attempt among school going adolescents in Bhutan - a secondary analysis of a global school-based student health survey in Bhutan 2016. BMC Public Health. 2019;19(1):1605. PMID: 31791280; https://doi.org/10.1186/s12889-019-7791-0. https://doi.org/10.1186/s12889-019-7791-...	Marijuana use was associated with a higher likelihood of suicidal ideation and depressive symptoms.
Georgiades et al. ¹⁰⁰100. Georgiades K, Boylan K, Duncan L, et al. Prevalence and Correlates of Youth Suicidal Ideation and Attempts: Evidence from the 2014 Ontario Child Health Study. Canadian journal of psychiatry. Can J Psychiatry. 2019;64(4):265–74. PMID: 30978144; https://doi.org/10.1177/0706743719830031. https://doi.org/10.1177/0706743719830031...	Psychotropic recreational drug abuse and the impulse to consume drugs were considered risk factors for suicidal ideation.
Jung et al. ¹⁰¹101. Jung JS, Park SJ, Kim EY, et al. Prediction models for high risk of suicide in Korean adolescents using machine learning techniques. PloS one. 2019;14(6):e0217639. PMID: 31170212; https://doi.org/10.1371/journal.pone.0217639. https://doi.org/10.1371/journal.pone.021...	The use of cannabis and other illicit substances did not show a significant association with suicidal ideation, but it did with suicide attempts.
Baiden et al. ¹⁸18. Baiden P, LaBrenz CA, Asiedua-Baiden G, Muehlenkamp JJ. Examining the intersection of race/ethnicity and sexual orientation on suicidal ideation and suicide attempt among adolescents: Findings from the 2017 Youth Risk Behavior Survey. J Psych Res. 2020;125:13-20. PMID: 32179279; https://doi.org/10.1016/j.jpsychires.2020.02.029. https://doi.org/10.1016/j.jpsychires.202...	Psychotropic recreational substance use was one of the factors associated with suicidal ideation.
Greene et al. ¹⁰²102. Greene N, Tomedi L, Reno J, Green D. The Role of Substance Use and Resiliency Factors on Suicidal Ideation among Middle School Students. J Sch Health. 2020;90(2):73–80. PMID: 31828795; https://doi.org/10.1111/josh.12854. https://doi.org/10.1111/josh.12854...	Illicit psychotropic recreational substance use was one of the factors associated with suicidal ideation, as well as a history of sexual abuse, bullying, and tobacco consumption.
Khan et al. ¹⁰³103. Khan M, Rahman MM, Islam MR, et al. Suicidal behavior among school-going adolescents in Bangladesh: findings of the global school-based student health survey. Soc Psychiatry Psychiatr Epidemiol. 2020;55(11):1491–502. PMID: 32239265; https://doi.org/10.1007/s00127-020-01867-z. https://doi.org/10.1007/s00127-020-01867...	Psychotropic recreational substance use showed a significant association with suicidal ideation for both sexes.
Kim et al. ⁸⁹89. Kim EM, Kim H, Park E. How are depression and suicidal ideation associated with multiple health risk behaviours among adolescents? A secondary data analysis using the 2016 Korea Youth Risk Behavior Web-based Survey. J Psychiatr Ment Health Nurs. 2020;27(5):595–606. PMID: 31999868; https://doi.org/10.1111/jpm.12610. https://doi.org/10.1111/jpm.12610...	Adolescents who used psychotropic recreational drugs were more likely to present suicidal behavior (including suicidal ideation).
Sakamoto et al. ¹⁰⁴104. Sakamoto JL, Shibanuma A, Jimba M. Depressed mood, suicidal behaviors, and health risk behaviors among youths in the Commonwealth of the Northern Mariana Islands: the 2017 CNMI Youth Risk Behavior Survey. BMC Public Health. 2020;20(1):489. PMID: 32293384; https://doi.org/10.1186/s12889-020-08663-z. https://doi.org/10.1186/s12889-020-08663...	The use of hard psychotropic recreational drugs by male adolescents was associated with suicidal ideation.

Author^ref	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	% Yes	Risk
Kandel et al.²⁹29. Kandel DB, Raveis VH, Davies M. Suicidal ideation in adolescence: Depression, substance use, and other risk factors. J Youth Adol. 1991;20(2):289-309. PMID: 24265011; https://doi.org/10.1007/BF01537613. https://doi.org/10.1007/BF01537613...	--	√	--	√	√	√	--	√	62,5	Moderate
Felts et al.³⁰30. Felts WM, Chernier T, Barnes R. Drug use and suicide ideation and behavior among North Carolina public school students. Am J Public Health. 1992;82(6):870–2. PMID: 1585967; https://doi.org/10.2105/ajph.82.6.870. https://doi.org/10.2105/ajph.82.6.870...	√	√	√	√	--	--	√	√	75	Moderate
Garrison et al.³¹31. Garrison CZ, McKeown RE, Valois RF, Vincent ML. Aggression, substance use, and suicidal behaviors in high school students. Am J Public Health. 1993;83(2):179–84. PMID: 8427319; https://doi.org/10.2105/ajph.83.2.179. https://doi.org/10.2105/ajph.83.2.179...	√	√	√	√	√	√	√	√	100	Low
Vega et al.³²32. Vega WA, Gil A, Warheit G, Apospori E, Zimmerman R. The relationship of drug use to suicide ideation and attempts among African American, Hispanic, and white non-Hispanic male adolescents. Suicide Life-threat Behav. 1993;23(2):110–9. PMID: 8342210; https://doi.org/10.1111/j.1943-278X.1993.tb00375.x. https://doi.org/10.1111/j.1943-278X.1993...	√	√	√	√	--	--	√	√	75	Moderate
Madianos et al.³³33. Madianos MG, Gefou-Madianou D, Stefanis CN. Symptoms of depression, suicidal behaviour and use of substances in Greece: a nationwide general population survey. Acta Psyc Scandinav. 1994;89(3):159–66. PMID: 8178673; https://doi.org/10.1111/j.1600-0447.1994.tb08086.x. https://doi.org/10.1111/j.1600-0447.1994...	√	√	√	√	√	√	--	√	87,5	Low
Burge et al.³⁴34. Burge V, Felts M, Chenier T, Parrillo AV. Drug use, sexual activity, and suicidal behavior in U.S. high school students. J School Health. 1995;65(6):222–7. PMID: 7564284; https://doi.org/10.1111/j.1746-1561.1995.tb03366.x. https://doi.org/10.1111/j.1746-1561.1995...	√	√	√	√	--	--	√	√	75	Moderate
Lopez et al.³⁵35. López L, Elsa K, Medina M, et al. La relación entre la ideación suicida y el abuso de sustancias tóxicas: resultado de una encuesta en la población estudiantil. Salud ment. 1995;18(4):25-32. Available from: http://www.revistasaludmental.mx/index.php/salud_mental/article/view/573. Accessed in 2022 (Dec. 12). http://www.revistasaludmental.mx/index.p...	√	v	--	√	√	√	√	√	87,5	Low
Windle and Windle³⁶36. Windle RC, Windle M. An investigation of adolescents’ substance use behaviors, depressed affect, and suicidal behaviors. J Child Psychol Psychiatry. 1997;38(8):921–9. PMID: 9413792; https://doi.org/10.1111/j.1469-7610.1997.tb01611.x. https://doi.org/10.1111/j.1469-7610.1997...	√	√	√	√	--	--	√	√	75	Moderate
Simon and Crosby³⁷37. Simon TR, Crosby AE. Suicide planning among high school students who report attempting suicide. Suicide Life Threat Behav. 2000;30(3):213–21. PMID: 11079635.	√	√	√	√	√	√	√	√	100	Low
Perkins and Hartless³⁸38. Perkins DF, Glen H. An ecological risk-factor examination of suicide ideation and behavior of adolescents. J Adoles Research. 2002;17(1):3-26. https://doi.org/10.1177/0743558402171001. https://doi.org/10.1177/0743558402171001...	--	√	√	√	√	√	√	√	87,5	Low
Vermeiren et al.³⁹39. Vermeiren R, Schwab-Stone M, Ruchkin VV, et al. Suicidal behavior and violence in male adolescents: a school-based study. J Am Acad Child Adolesc Psychiatry. 2003;42(1):41–8. PMID: 12500075; https://doi.org/10.1097/00004583-200301000-00009. https://doi.org/10.1097/00004583-2003010...	√	√	√	√	√	√	√	√	100	Low
Hallfors et al.⁴⁰40. Hallfors DD, Waller MW, Ford CA, et al. Adolescent depression and suicide risk: association with sex and drug behavior. Am J Prev Med. 2004;27(3):224–31. PMID: 15450635; https://doi.org/10.1016/j.amepre.2004.06.001. https://doi.org/10.1016/j.amepre.2004.06...	√	--	√	√	√	√	√	√	87,5	Low
Wu et al.⁴¹41. Wu P, Hoven CW, Liu X, et al. Substance use, suicidal ideation and attempts in children and adolescents. Suicide Life Threat Behav. 2004;34(4):408–20. PMID: 15585462; https://doi.org/10.1521/suli.34.4.408.53733. https://doi.org/10.1521/suli.34.4.408.53...	√	√	√	√	√	√	√	√	100	Low
Yip et al.⁴²42. Yip PS, Liu KY, Lam TH, et al. Suicidality among high school students in Hong Kong, SAR. Suicide Life Threat Behav. 2004;34(3):284–97. PMID: 15385183; https://doi.org/10.1521/suli.34.3.284.42772. https://doi.org/10.1521/suli.34.3.284.42...	√	√	√	√	√	√	√	√	100	Low
Spremo and Loga⁴³43. Spremo M, Loga S. The relationship between suicidal thoughts and psychoactive substances. Bosn J Basic Med Sci. 2005;5(3):35-8. PMID: 16351579; https://doi.org/10.17305/bjbms.2005.3268. https://doi.org/10.17305/bjbms.2005.3268...	--	√	√	√	--	--	√	√	62,5	Moderate
Ulusoy et al.⁴⁴44. Ulusoy MD, Demir NO. Suicidal ideation in Turkish adolescents. Soc Behav Pers. 2005;33(6):541-52. https://doi.org/10.2224/sbp.2005.33.6.541. https://doi.org/10.2224/sbp.2005.33.6.54...	√	√	√	√	--	--	√	√	75	Moderate
Chabrol et al.⁴⁶46. Chabrol H, Chauchard E, Girabet J. Cannabis use and suicidal behaviours in high-school students. Addict Behav. 2008;33(1):152–5. PMID: 17537584; https://doi.org/10.1016/j.addbeh.2007.04.029. https://doi.org/10.1016/j.addbeh.2007.04...	--	√	√	√	√	√	√	√	87,5	Low
Dunn et al.⁴⁵45. Dunn MS, Goodrow B, Givens C, Austin S. Substance use behavior and suicide indicators among rural middle school students. J School Health. 2008;78(1):26–31. PMID: 18177297; https://doi.org/10.1111/j.1746-1561.2007.00262.x. https://doi.org/10.1111/j.1746-1561.2007...	--	√	√	√	--	--	√	√	62,5	Moderate
Luncheon et al.⁴⁷47. Luncheon C, Bae S, Gonzalez A, Lurie S, Singh KP. Hispanic female adolescents’ use of illicit drugs and the risk of suicidal thoughts. Am J Health Behav. 2008;32(1):52–9. PMID: 18021033; https://doi.org/10.5555/ajhb.2008.32.1.52. https://doi.org/10.5555/ajhb.2008.32.1.5...	√	√	√	√	√	√	√	√	100	Low
Peltzer et al.⁴⁸48. Peltzer K, Kleintjes S, Van Wyk B, Thompson EA, Mashego T. Correlates of suicide risk among secondary school students in Cape Town. Soc Behav Pers. 2008;36(4):493-502. https://doi.org/10.2224/sbp.2008.36.4.493. https://doi.org/10.2224/sbp.2008.36.4.49...	√	√	√	√	--	--	√	√	75	Moderate
Epstein and Spirito⁴⁹49. Epstein JA, Spirito A. Risk factors for suicidality among a nationally representative sample of high school students. Suicide Life Threat Behav. 2009;39(3):241–51. PMID: 19606917; https://doi.org/10.1521/suli.2009.39.3.241. https://doi.org/10.1521/suli.2009.39.3.2...	√	√	√	√	√	√	√	√	100	Low
Peter and Roberts⁵⁰50. Peter T, Roberts LW. ‘Bad’ boys and ‘sad’ girls? Examining internalizing and externalizing effects on parasuicides among youth. J Youth Adol. 2010;39(5):495–503. PMID: 20043194; https://doi.org/10.1007/s10964-009-9498-5. https://doi.org/10.1007/s10964-009-9498-...	√	√	√	√	√	√	√	√	100	Low
Pickles et al.⁵¹51. Pickles A, Aglan A, Collishaw S, et al. Predictors of suicidality across the life span: the Isle of Wight study. Psych Med. 2010;40(9):1453–66. PMID: 19939326; https://doi.org/10.1017/S0033291709991905. https://doi.org/10.1017/S003329170999190...	√	√	√	√	√	√	√	√	100	Low
Florenzano et al.⁵²52. Florenzano R, Cáceres E, Valdés M, et al. Comparación de frecuencia de conductas de riesgo, problemas juveniles y estilos de crianza, en estudiantes adolescentes de tres ciudades chilenas. Cuad Méd Soc. 2010;50(2):115-23.	--	√	√	√	--	--	√	√	62,5	Moderate
Page et al.⁵³53. Page RM, West JH, Hall PC. Psychosocial distress and suicide ideation in Chinese and Philippine adolescents. Asia Pac J Public Health. 2011;23(5):774–91. PMID: 21118858; https://doi.org/10.1177/1010539509353113. https://doi.org/10.1177/1010539509353113...	√	√	√	√	√	√	√	√	100	Low
Souza et al.⁵⁴54. Souza LD, Ores L, Oliveira GT, et al. Ideação suicida na adolescência: prevalência e fatores associados. J Bras Psiq. 2010;59(4):286-92. https://doi.org/10.1590/S0047-20852010000400004. https://doi.org/10.1590/S0047-2085201000...	√	√	√	√	√	√	√	√	100	Low
Wolitzky-Taylor et al.⁵⁵55. Wolitzky-Taylor KB, Ruggiero KJ, McCart MR, et al. Has adolescent suicidality decreased in the United States? Data from two national samples of adolescents interviewed in 1995 and 2005. J Clin Child Adolesc Psychol. 2010;39(1):64–76. PMID: 20390799; https://doi.org/10.1080/15374410903401146. https://doi.org/10.1080/1537441090340114...	√	√	√	√	√	√	√	√	100	Low
Alwan et al.⁵⁶56. Alwan H, Viswanathan B, Rousson V, Paccaud F, Bovet P. Association between substance use and psychosocial characteristics among adolescents of the Seychelles. BMC Ped. 2011;11:85. PMID: 21985036; https://doi.org/10.1186/1471-2431-11-85. https://doi.org/10.1186/1471-2431-11-85...	√	√	√	√	√	√	√	√	100	Low
Carvalho et al.⁵⁷57. Carvalho PD, Barros MV, Lima RA, Santos CM, Mélo EN. Condutas de risco à saúde e indicadores de estresse psicossocial em adolescentes estudantes do Ensino Médio. Cad Saúde Pública. 2011;27(11):2095–105. PMID: 22124487; https://doi.org/10.1590/s0102-311x2011001100003. https://doi.org/10.1590/s0102-311x201100...	√	√	√	√	√	√	√	√	100	Low
Eaton et al.⁵⁸58. Eaton DK, Foti K, Brener ND, et al. Associations between risk behaviors and suicidal ideation and suicide attempts: do racial/ethnic variations in associations account for increased risk of suicidal behaviors among Hispanic/Latina 9th- to 12th-grade female students? Arch Suicide Res. 2011;15(2):113–26. PMID: 21541858; https://doi.org/10.1080/13811118.2011.565268. https://doi.org/10.1080/13811118.2011.56...	√	√	√	√	√	√	√	√	100	Low
Kim et al.⁵⁹59. Kim J, Fan B, Liu X, Kerner N, Wu P. Ecstasy use and suicidal behavior among adolescents: findings from a national survey. Suicide Life Threat Behav. 2011;41(4):435–44. PMID: 21631573; https://doi.org/10.1111/j.1943-278X.2011.00043.x. https://doi.org/10.1111/j.1943-278X.2011...	--	√	√	√	√	√	√	√	87,5	Low
Miller et al.⁶⁰60. Miller M, Borges G, Orozco R, et al. Exposure to alcohol, drugs and tobacco and the risk of subsequent suicidality: findings from the Mexican Adolescent Mental Health Survey. Drug Alcohol Depend. 2011;113(2-3):110–7. PMID: 20801585; https://doi.org/10.1016/j.drugalcdep.2010.07.016. https://doi.org/10.1016/j.drugalcdep.201...	√	√	√	√	√	√	√	√	100	Low
Swahn et al.⁶¹61. Swahn MH, Bossarte RM, Choquet M, et al. Early substance use initiation and suicide ideation and attempts among students in France and the United States. Int J Public Health. 2012;57(1):95–105. PMID: 21523616; https://doi.org/10.1007/s00038-011-0255-7. https://doi.org/10.1007/s00038-011-0255-...	√	√	√	√	√	√	√	√	100	Low
Ahmad et al.⁶²62. Ahmad N, Cheong SM, Ibrahim N, Rosman A. Suicidal ideation among Malaysian adolescents. Asia Pac J Public Health. 2012;26(5 Suppl):63S–9S. PMID: 25005932; https://doi.org/10.1177/1010539514540746. https://doi.org/10.1177/1010539514540746...	√	√	√	√	√	√	--	√	87,5	Low
Bakken and Gunter⁶³63. Bakken NW, Gunter WD. Self-cutting and suicidal ideation among adolescents: Gender differences in the causes and correlates of self-injury. Deviant Behav. 2012;33(5):339–56. https://doi.org/10.1080/01639625.2011.584054. https://doi.org/10.1080/01639625.2011.58...	√	√	√	√	√	√	--	√	87,5	Low
Kokkevi et al.⁶⁴64. Kokkevi A, Rotsika V, Arapaki A, Richardson C. Adolescents’ self-reported suicide attempts, self-harm thoughts and their correlates across 17 European countries. J Child Psychol Psychiatry. 2012;53(4):381–9. PMID: 21895649; https://doi.org/10.1111/j.1469-7610.2011.02457.x. https://doi.org/10.1111/j.1469-7610.2011...	√	√	√	√	√	√	√	√	100	Low
Peltzer and Pengpid⁶⁵65. Peltzer K, Pengpid S. Suicidal ideation and associated factors among school-going adolescents in Thailand. Int J Environ Res Public Health. 2012;9(2):462–73. PMID: 22470303; https://doi.org/10.3390/ijerph9020462. https://doi.org/10.3390/ijerph9020462...	√	√	√	√	√	√	√	√	100	Low
Wilson et al.⁶⁶66. Wilson ML, Dunlavy AC, Viswanathan B, Bovet P. Suicidal expression among school-attending adolescents in a middle-income sub-Saharan country. Int J Environ Res Public Health. 2012;9(11):4122–34. PMID: 23202835; https://doi.org/10.3390/ijerph9114122. https://doi.org/10.3390/ijerph9114122...	√	√	√	√	√	√	√	√	100	Low
Arenliu et al.⁶⁷67. Arenliu A, Kaltrina K, Mytaher H, Teuta H, Ercan C. Drug use and reported suicide ideation and attempt among Kosovar adolescents. J Substance Use. 2014;19(5):358-63. https://doi.org/10.3109/14659891.2013.820803. https://doi.org/10.3109/14659891.2013.82...	√	√	√	√	√	√	√	√	100	Low
Consoli et al.⁶⁸68. Consoli A, Peyre H, Speranza M, Hassler C, Falissard B, Touchette E, et al. Suicidal behaviors in depressed adolescents: role of perceived relationships in the family. Child Adolesc Psychiatry Ment Health. 2013;7(1):8. PMID: 23497551; https://doi.org/10.1186/1753-2000-7-8. https://doi.org/10.1186/1753-2000-7-8...	√	√	√	√	--	--	√	√	75	Moderate
Delfabbro et al.⁶⁹69. Delfabbro PH, Winefield HR, Winefield AH. Life-time and current suicide-ideation in Australian secondary school students: Socio-demographic, health and psychological predictors. J Affect Disord. 2013;151(2):514–24. PMID: 23871389; https://doi.org/10.1016/j.jad.2013.06.036. https://doi.org/10.1016/j.jad.2013.06.03...	√	√	√	√	√	√	√	√	100	Low
Govender et al.⁷⁰70. Govender K, Naicker SN, Meyer-Weitz A, et al. Associations between perceptions of school connectedness and adolescent health risk behaviors in South African high school learners. J School Health. 2013;83(9):614–22. PMID: 23879780; https://doi.org/10.1111/josh.12073. https://doi.org/10.1111/josh.12073...	--	√	√	√	√	√	√	√	87,5	Low
Rasic et al.⁷¹71. Rasic D, Weerasinghe S, Asbridge M, Langille DB. Longitudinal associations of cannabis and illicit drug use with depression, suicidal ideation and suicidal attempts among Nova Scotia high school students. Drug Alcohol Depend. 2013;129(1-2):49–53. PMID: 23041136; https://doi.org/10.1016/j.drugalcdep.2012.09.009. https://doi.org/10.1016/j.drugalcdep.201...	√	√	√	√	√	√	√	√	100	Low
Shilubane et al.⁷²72. Shilubane HN, Ruiter RA, van den Borne B, et al. Suicide and related health risk behaviours among school learners in South Africa: results from the 2002 and 2008 national youth risk behaviour surveys. BMC Public Health. 2013;13:926. PMID: 24093214; https://doi.org/10.1186/1471-2458-13-926. https://doi.org/10.1186/1471-2458-13-926...	√	√	√	√	√	√	√	√	100	Low
Van Ours et al.⁷⁴74. Van Ours JC, Williams J, Fergusson D, Horwood LJ. Cannabis use and suicidal ideation. J Health Economics. 2013;32(3):524–37. PMID: 23518573; https://doi.org/10.1016/j.jhealeco.2013.02.002. https://doi.org/10.1016/j.jhealeco.2013....	√	√	√	√	√	√	√	√	100	Low
Wong et al.⁷³73. Wong JP. Structural Violence & Men’s Health. Presentation to Global Health & Health Equity Forum. Toronto: Ryerson University; 2013.	√	√	√	√	√	√	√	√	100	Low
Chabrol et al.⁷⁵75. Chabrol H, Melioli T, Goutaudier N. Cannabis use and suicidal ideations in high-school students. Addictive Behav. 2014;39(12):1766–8. PMID: 25123343; https://doi.org/10.1016/j.addbeh.2014.06.008. https://doi.org/10.1016/j.addbeh.2014.06...	--	√	√	√	√	√	√	√	87,5	Low
Lowry et al.⁷⁶76. Lowry R, Crosby AE, Brener ND, Kann L. Suicidal thoughts and attempts among u.s. High school students: trends and associated health-risk behaviors, 1991-2011. J Adolesc Health. 2014;54(1):100–8. PMID: 24035267; https://doi.org/10.1016/j.jadohealth.2013.07.024. https://doi.org/10.1016/j.jadohealth.201...	√	√	√	√	√	√	√	√	100	Low
Randall et al.⁷⁷77. Randall JR, Doku D, Wilson ML, Peltzer K. Suicidal behaviour and related risk factors among school-aged youth in the Republic of Benin. PloS one. 2014;9(2):e88233. PMID: 24505443; https://doi.org/10.1371/journal.pone.0088233. https://doi.org/10.1371/journal.pone.008...	√	√	√	√	√	√	√	√	100	Low
Zhang and Wu⁷⁸78. Zhang X, Wu LT. Suicidal ideation and substance use among adolescents and young adults: a bidirectional relation?. Drug Alcohol Depend. 2014;142:63–73. PMID: 24969957; https://doi.org/10.1016/j.drugalcdep.2014.05.025. https://doi.org/10.1016/j.drugalcdep.201...	√	√	√	√	√	√	√	√	100	Low
Delfabbro et al.⁷⁹79. Delfabbro HP, Malvaso C, Winefield HA, Winefield RH. Socio-demographic, health, and psychological correlates of suicidality severity in Australian adolescents. Aust J Psychol. 2015;68(4):261-269. https://doi.org/10.1111/ajpy.12104. https://doi.org/10.1111/ajpy.12104...	√	√	√	√	√	√	√	√	100	Low
Dunlavy et al.⁸⁰80. Dunlavy AC, Aquah EO, Wilson ML. Suicidal ideation among school-attending adolescents in Dar es Salaam, Tanzania. Tanzan J Health Res. 2015;17(1):1-7. Available from: https://www.ajol.info/index.php/thrb/article/view/102996. Accessed in 2022 (Dec. 12). https://www.ajol.info/index.php/thrb/art...	√	√	√	√	√	√	√	√	100	Low
Gart and Kelly⁸¹81. Gart R, Kelly S. How Illegal Drug Use, Alcohol Use, Tobacco Use, and Depressive Symptoms Affect Adolescent Suicidal Ideation: A Secondary Analysis of the 2011 Youth Risk Behavior Survey. Issues Ment Health Nurs. 2015;36(8):614–20. PMID: 26379135; https://doi.org/10.3109/01612840.2015.1015697. https://doi.org/10.3109/01612840.2015.10...	√	√	√	√	√	√	√	√	100	Low
Lee and Choi⁸²82. Lee GY, Choi YJ. Association of school, family, and mental health characteristics with suicidal ideation among Korean adolescents. Res Nurs Health. 2015;38(4):301–10. PMID: 25917791; https://doi.org/10.1002/nur.21661. https://doi.org/10.1002/nur.21661...	√	√	√	√	√	√	√	√	100	Low
Peltzer and Pengpid¹⁷17. Peltzer K, Pengpid S. Early Substance Use Initiation and Suicide Ideation and Attempts among School-Aged Adolescents in Four Pacific Island Countries in Oceania. Int J Environment Res Public Health. 2015;12(10):12291–303. PMID: 26437423; https://doi.org/10.3390/ijerph121012291. https://doi.org/10.3390/ijerph121012291...	√	√	√	√	√	√	--	√	87,5	Low
Sampasa-Kanyinga et al.⁸³83. Sampasa-Kanyinga H, Dupuis LC, Ray R. Prevalence and correlates of suicidal ideation and attempts among children and adolescents. Int J Adolesc Med Health. 2017;29(2)20150053. PMID: 26556839; https://doi.org/10.1515/ijamh-2015-0053. https://doi.org/10.1515/ijamh-2015-0053...	√	√	√	√	√	√	√	√	100	Low
Sharma et al.⁸⁴84. Sharma B, Nam EW, Kim HY, Kim JK. Factors Associated with Suicidal Ideation and Suicide Attempt among School-Going Urban Adolescents in Peru. Int J Environ Res Public Health. 2015;12(11):14842–56. PMID: 26610536; https://doi.org/10.3390/ijerph121114842. https://doi.org/10.3390/ijerph121114842...	√	√	√	√	√	√	√	√	100	Low
Dudovitz et al.⁸⁵85. Dudovitz RN, McCoy K, Chung PJ. At-school substance use as a marker for serious health risks. Academic Ped. 2015;15(1):41–6. PMID: 25528124; https://doi.org/10.1016/j.acap.2014.06.022. https://doi.org/10.1016/j.acap.2014.06.0...	√	√	√	√	√	√	√	√	100	Low
Ammerman et al.⁸⁶86. Ammerman BA, Steinberg L, McCloskey MS. Risk-Taking Behavior and Suicidality: The Unique Role of Adolescent Drug Use. J Clin Child Adolesc Psychol. 2018;47(1):131–41. PMID: 27732082; https://doi.org/10.1080/15374416.2016.1220313. https://doi.org/10.1080/15374416.2016.12...	√	√	√	√	√	√	√	√	100	Low
DeCamp and Bakken⁸⁷87. DeCamp W, Bakken NW. Self-injury, suicide ideation, and sexual orientation: differences in causes and correlates among high school students. J Inj Violence Res. 2016;8(1):15–24. PMID: 26401756; https://doi.org/10.5249/jivr.v8i1.545. https://doi.org/10.5249/jivr.v8i1.545...	√	√	√	√	--	--	√	√	75	Moderate
Price and Khubchandani⁸⁸88. Price JH, Khubchandani J. Latina Adolescents Health Risk Behaviors and Suicidal Ideation and Suicide Attempts: Results from the National Youth Risk Behavior Survey 2001-2013. J Immigr Minor Health. 2017;19(3):533–42. PMID: 27286882; https://doi.org/10.1007/s10903-016-0445-8. https://doi.org/10.1007/s10903-016-0445-...	√	√	√	√	√	√	√	√	100	Low
Weeks and Colman⁹⁰90. Weeks M, Colman I. Predictors of Suicidal Behaviors in Canadian Adolescents with No Recent History of Depression. Arch Suic Research. 2017;21(2):354–64. PMID: 27587262; https://doi.org/10.1080/13811118.2016.1193076. https://doi.org/10.1080/13811118.2016.11...	√	√	√	√	√	√	√	√	100	Low
Agrawal et al.⁹¹91. Agrawal A, Tillman R, Grucza RA, et al. Reciprocal relationships between substance use and disorders and suicidal ideation and suicide attempts in the Collaborative Study of the Genetics of Alcoholism. J Affect Disord. 2017;213:96–104. PMID: 28213124; https://doi.org/10.1016/j.jad.2016.12.060. https://doi.org/10.1016/j.jad.2016.12.06...	√	√	√	√	√	√	√	√	100	Low
Asante et al.⁹²92. Asante KO, Kugbey N, Osafo J, Quarshie EN, Sarfo JO. The prevalence and correlates of suicidal behaviours (ideation, plan and attempt) among adolescents in senior high schools in Ghana. SSM Popul Health. 2017;3:427–34. PMID: 29349236; https://doi.org/10.1016/j.ssmph.2017.05.005. https://doi.org/10.1016/j.ssmph.2017.05....	√	√	√	√	√	√	√	√	100	Low
Janssen et al⁹³93. Janssen E, Spilka S, Beck F. Suicide, santé mentale et usages de substances psychoactives chez les adolescents français en 2014. Rev Epidemiol Sante Publique. 2017;65(6):409-17. PMID: 29096995; https://doi.org/10.1016/j.respe.2017.06.004. https://doi.org/10.1016/j.respe.2017.06....	√	√	√	√	√	√	√	√	100	Low
Wang and Yen⁹⁴94. Wang PW, Yen CF. Adolescent substance use behavior and suicidal behavior for boys and girls: a cross-sectional study by latent analysis approach. BMC Psych. 2017;17(1):392. PMID: 29216850; https://doi.org/10.1186/s12888-017-1546-1. https://doi.org/10.1186/s12888-017-1546-...	√	√	√	√	√	√	√	√	100	Low
El Kazdouh et al.⁹⁵95. El Kazdouh H, El-Ammari A, Bouftini S, El Fakir S, El Achhab Y. Potential risk and protective factors of substance use among school adolescents in Morocco: A cross-sectional study. J Subst Use. 2019;24(2):176-83. https://doi.org/10.1080/14659891.2018.1535003. https://doi.org/10.1080/14659891.2018.15...	√	√	√	√	√	√	√	√	100	Low
Haskuka et al.⁹⁶96. Haskuka M, Aliriza A, Kaltrina K. The relationship between substance use and suicidal behaviour among adolescents in selected European countries: A test of normalisation theory. Drugs. 2018;25(5):413-21. https://doi.org/10.1080/09687637.2017.1308468. https://doi.org/10.1080/09687637.2017.13...	√	√	√	√	√	√	√	√	100	Low
Subica and Wu⁹⁷97. Subica AM, Wu LT. Substance Use and Suicide in Pacific Islander, American Indian, and Multiracial Youth. Am J Prev Med. 2018;54(6):795–805. PMID: 29656915; https://doi.org/10.1016/j.amepre.2018.02.003. https://doi.org/10.1016/j.amepre.2018.02...	√	√	√	√	√	√	√	√	100	Low
Chadi et al.⁹⁸98. Chadi N, Li G, Cerda N, Weitzman ER. Depressive Symptoms and Suicidality in Adolescents Using e-Cigarettes and Marijuana: A Secondary Data Analysis From the Youth Risk Behavior Survey. J Addict Med. 2019;13(5):362–5. PMID: 30688723; https://doi.org/10.1097/ADM.0000000000000506. https://doi.org/10.1097/ADM.000000000000...	√	√	√	√	√	√	√	√	100	Low
Dema et al., 2019⁹⁹99. Dema T, Tripathy JP, Thinley S, et al. Suicidal ideation and attempt among school going adolescents in Bhutan - a secondary analysis of a global school-based student health survey in Bhutan 2016. BMC Public Health. 2019;19(1):1605. PMID: 31791280; https://doi.org/10.1186/s12889-019-7791-0. https://doi.org/10.1186/s12889-019-7791-...	√	√	√	√	√	√	√	√	100	Low
Georgiades et al.¹⁰⁰100. Georgiades K, Boylan K, Duncan L, et al. Prevalence and Correlates of Youth Suicidal Ideation and Attempts: Evidence from the 2014 Ontario Child Health Study. Canadian journal of psychiatry. Can J Psychiatry. 2019;64(4):265–74. PMID: 30978144; https://doi.org/10.1177/0706743719830031. https://doi.org/10.1177/0706743719830031...	√	√	√	√	√	√	√	√	100	Low
Jung et al.¹⁰¹101. Jung JS, Park SJ, Kim EY, et al. Prediction models for high risk of suicide in Korean adolescents using machine learning techniques. PloS one. 2019;14(6):e0217639. PMID: 31170212; https://doi.org/10.1371/journal.pone.0217639. https://doi.org/10.1371/journal.pone.021...	√	√	√	√	√	√	√	√	100	Low
Baiden et al.¹⁸18. Baiden P, LaBrenz CA, Asiedua-Baiden G, Muehlenkamp JJ. Examining the intersection of race/ethnicity and sexual orientation on suicidal ideation and suicide attempt among adolescents: Findings from the 2017 Youth Risk Behavior Survey. J Psych Res. 2020;125:13-20. PMID: 32179279; https://doi.org/10.1016/j.jpsychires.2020.02.029. https://doi.org/10.1016/j.jpsychires.202...	√	√	√	√	√	√	√	√	100	Low
Greene et al.¹⁰²102. Greene N, Tomedi L, Reno J, Green D. The Role of Substance Use and Resiliency Factors on Suicidal Ideation among Middle School Students. J Sch Health. 2020;90(2):73–80. PMID: 31828795; https://doi.org/10.1111/josh.12854. https://doi.org/10.1111/josh.12854...	√	√	√	√	√	√	√	√	100	Low
Khan et al.¹⁰³103. Khan M, Rahman MM, Islam MR, et al. Suicidal behavior among school-going adolescents in Bangladesh: findings of the global school-based student health survey. Soc Psychiatry Psychiatr Epidemiol. 2020;55(11):1491–502. PMID: 32239265; https://doi.org/10.1007/s00127-020-01867-z. https://doi.org/10.1007/s00127-020-01867...	√	√	√	√	√	√	√	√	100	Low
Kim et al.⁸⁹89. Kim EM, Kim H, Park E. How are depression and suicidal ideation associated with multiple health risk behaviours among adolescents? A secondary data analysis using the 2016 Korea Youth Risk Behavior Web-based Survey. J Psychiatr Ment Health Nurs. 2020;27(5):595–606. PMID: 31999868; https://doi.org/10.1111/jpm.12610. https://doi.org/10.1111/jpm.12610...	√	√	√	√	√	√	√	√	100	Low
Sakamoto et al.¹⁰⁴104. Sakamoto JL, Shibanuma A, Jimba M. Depressed mood, suicidal behaviors, and health risk behaviors among youths in the Commonwealth of the Northern Mariana Islands: the 2017 CNMI Youth Risk Behavior Survey. BMC Public Health. 2020;20(1):489. PMID: 32293384; https://doi.org/10.1186/s12889-020-08663-z. https://doi.org/10.1186/s12889-020-08663...	√	√	√	√	√	√	√	√	100	Low

Certainty assessment							Effect	Certainty
Number of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Relative (95% CI)	Certainty
Current use of any illicit drug vs. no use
10	observational studies	not serious	serious^a a high unexplained statistical heterogeneity (I2 ＞ 50%) and/or no overlapping of effect estimates – Rated down by one level;	not serious	not serious	Publication bias detected	OR 1.96 (1.47 to 2.61)	⨁◯◯◯VERY LOW
Ever used any illicit drug vs. no use
4	observational studies	not serious	serious^a a high unexplained statistical heterogeneity (I2 ＞ 50%) and/or no overlapping of effect estimates – Rated down by one level;	not serious	very serious^b b confidence interval suggests trivial no association in one extreme and strong association in another – Rated down by two levels;	none^d d publication bias was not assessed due to the low number of studies.	OR 1.65 (0.54 to 4.99)	⨁◯◯◯VERY LOW
Any illicit drug abuse vs. no use
5	observational studies	not serious	serious^a a high unexplained statistical heterogeneity (I2 ＞ 50%) and/or no overlapping of effect estimates – Rated down by one level;	not serious	serious^c c confidence interval suggests trivial association in one extreme and strong association in another – Rated down by one level;	none^d d publication bias was not assessed due to the low number of studies.	OR 3.32 (1.86 to 5.93)	⨁◯◯◯VERY LOW
Current cannabis use vs. no use
15	observational studies	not serious	serious^a a high unexplained statistical heterogeneity (I2 ＞ 50%) and/or no overlapping of effect estimates – Rated down by one level;	not serious	not serious	Publication bias detected	OR 1.57(1.34 to 1.84)	⨁◯◯◯VERY LOW
Ever used cocaine vs. no use
3	observational studies	not serious	serious^a a high unexplained statistical heterogeneity (I2 ＞ 50%) and/or no overlapping of effect estimates – Rated down by one level;	not serious	serious^c c confidence interval suggests trivial association in one extreme and strong association in another – Rated down by one level;	none^d d publication bias was not assessed due to the low number of studies.	OR 2.57(1.47 to 4.50)	⨁◯◯◯VERY LOW

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[1] Address for correspondence: Professor Luiz Renato Paranhos, Departamento de Odontologia Preventiva e Social, Universidade Federal de Uberlândia (UFU), Campus Umuarama, Av. Pará 1720, Bloco 2G, Sala 1, Uberlândia (MG), Brazil., Tel: (+55 34) 3225-8145, E-mail: paranhos.lrp@gmail.com