Adolescent health lifestyles and suicidality: Emerging risks in a latent class analysis

Adolescent suicidal behavior is a major global public health concern. Risks are often shaped not only by individual behaviors alone but also by broader constellations of health lifestyles. We aim to identify distinct adolescent health lifestyles and assess their associations with suicidal ideation and suicide attempts. Using data from the 2022 Luxembourg Health Behaviour in School-aged Children survey, latent class analysis identified five health lifestyle classes based on seven behaviors (diet, physical activity, substance use and problematic social media use). Hierarchical logistic regression was employed to assess associations with past-year suicidal ideation and suicide attempt. Compared to Class 1 (Healthy behaviors), adolescents in Class 2 (High substance use) had significantly higher odds of suicidal ideation (odds ratio [OR] = 2.5, 95% confidence interval [CI]: 2.0-3.1) and suicide attempt (OR = 2.9, 95% CI: 2.2-3.8). Class 3 (Digital vulnerabilities) also showed elevated odds of ideation (OR = 3.0, 95% CI: 2.2-4.0) and attempt (OR = 2.3, 95% CI: 1.6-3.4). Class 4 (High alcohol use) was associated with suicidal ideation only (OR = 1.4, 95% CI: 1.1-1.8). Class 5 (No substance use) showed no significant associations with either outcome. Our findings underscore the importance of considering multidimensional health lifestyles, including emerging risks such as vaping and problematic social media use in adolescent suicide prevention strategies.