Overestimated body image distortion and suicidal behaviors among South Korean adolescents: a gender-stratified analysis using Korea Youth Risk Behavior Survey data (2019–24)

BACKGROUND: The relationship between body image distortion (BID) and suicidal behaviors remains understudied regarding gender differences. This study examined associations between BID and suicidal behaviors among South Korean adolescents. METHODS: We used the Korea Youth Risk Behavior Survey (2019-24), which included 317 798 adolescents. BID was defined as a discrepancy between the body mass index and perceived body image. Gender-stratified logistic regressions were conducted to examine the associations between BID and suicidal ideation, planning, and attempts. The regression models were adjusted for sociodemographic characteristics. RESULTS: BID was associated with overall suicidal behaviors [adjusted odds ratio (aOR) = 1.36, 95% CI: 1.32-1.40]. Among adolescent girls, BID increased the odds of overall suicidal behaviors (aOR = 1.28, 95% CI: 1.24-1.32), suicidal ideation (aOR = 1.27, 95% CI: 1.22-1.31), suicide planning (aOR = 1.31, 95% CI: 1.24-1.39), and suicide attempts (aOR = 1.35, 95% CI: 1.26-1.44). Among boys, BID increased the odds of overall suicidal behaviors (aOR = 1.16, 95% CI: 1.10-1.22), suicidal ideation (aOR = 1.16, 95% CI: 1.10-1.22), suicide planning (aOR = 1.21, 95% CI: 1.11-1.31), and suicide attempts (aOR = 1.26, 95% CI: 1.13-1.40). CONCLUSION: BID is associated with suicidal behaviors, particularly among girls. Targeted interventions addressing BID may mitigate suicide risk. Adolescent health programs should prioritize gender-sensitive policies and body image education.