Substance Use and Suicide Attempts in Adolescents: A Comparative Analysis of Clinical and Psychosocial Risk Factors

<b>Background/Objectives</b>: This study aimed to compare clinical and psychosocial characteristics of substance-using adolescents in Türkiye with and without a history of suicide attempts to identify distinguishing risk factors. <b>Methods</b>: A retrospective analysis was conducted using medical records from 140 adolescents (aged 13-18) treated at a specialized Child and Adolescent Substance Use Center in Türkiye between March 2023 and February 2025. Sociodemographic, clinical, and substance use data were collected. Group comparisons were performed using chi-square and <i>t</i>-tests. Logistic regression was used to identify predictors of suicide attempt history. <b>Results</b>: Among the sample, 52 adolescents (37.1%) had a history of suicide attempts. Compared to their counterparts, the substance-using adolescents were more likely to be female (73.1%) and have histories of psychiatric hospitalization, institutional care, criminal behavior, and polysubstance use (<i>p</i> < 0.05). High-frequency use (≥3 days/week) of methamphetamine, stimulants, cannabinoids, and alcohol was significantly more common in this group (all <i>p</i> < 0.01). The Addiction Profile Index-Adolescent form (API-A) scores indicated more severe addiction profiles. Using cross-validated LASSO and confirmatory logistic regression, female gender emerged as the only robust independent predictor of suicide attempt history (OR = 6.84). <b>Conclusions</b>: Adolescents with a history of suicide attempts exhibit more severe substance use, particularly involving cannabinoids, and greater psychosocial adversity. This distinct risk profile underscores the need for early, gender-sensitive, and multidimensional interventions.