Suicide risk levels and polysubstance use among U.S. High school students: a pooled analysis of 2021 and 2023 national YRBS

Background Adolescent suicide risk and substance use often co-occur, but it remains unclear whether higher suicide risk corresponds to heavier current substance use in recent national samples.Methods We pooled the 2021 and 2023 national Youth Risk Behavior Surveys. Past-30-day cigarette, electronic vapor product, alcohol, and marijuana use were grouped as no current use, single-substance use, or use of two or more substances. Suicide risk was classified as no risk, ideation/planning without attempt, and attempt. Weighted multinomial logistic regression accounted for the complex survey design.Results Weighted prevalences were 70.1% for no current use, 13.4% for single-substance use, and 16.5% for use of two or more substances. Compared with no suicide risk, ideation/planning without attempt was associated with higher odds of using two or more substances (AOR = 2.87, 95% CI [2.48, 3.34]); the association was stronger for suicide attempt (AOR = 8.26, 95% CI [6.83, 9.99]).Conclusions Among U.S. high school students, higher suicide risk levels were consistently associated with heavier current substance use patterns, especially polysubstance use. Polysubstance use may therefore serve as a co-occurring risk marker in school-based screening and referral.