Suicidal Ideation and Substance Use Among Middle and High School Students in Morocco.

: Suicide is a major public health concern with severe consequences for individuals, families, and communities. Each year, approximately 800,000 individuals die by suicide, equating to one suicide-related death every 40 s. This study aims to determine the prevalence of suicidal ideation and psychoactive substance use among middle and high school students in Morocco and to examine the relationship between suicidal ideation, substance use, depression, and early trauma. : From January to June 2023, a cross-sectional study was conducted in the Marrakech region of central Morocco among middle and high school students selected using stratified cluster random sampling. Data were collected through anonymous self-administered questionnaires. The Suicidal Ideation Attributes Scale (SIDAS) was used to assess the frequency of suicidal ideation among participants. The Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria were applied for substance use and depression assessment, while early trauma was evaluated using the Adverse Childhood Experiences (ACE) questionnaire. : A total of 791 students participated in the study. The prevalence of suicidal ideation was 16.66%, while 25% of students reported current psychoactive substance use. Significant positive correlations were found between suicidal ideation and early trauma ( = 0.12; < 0.004), depression ( = 0.52; < 0.001), and substance use ( = 0.12; < 0.001). : The findings highlight the importance of considering multiple risk factors in suicide assessment and prevention. The interplay between these factors often exhibits bidirectional and significant associations. Implementing early screening, management, and treatment strategies for individuals exhibiting suicidal ideation and mental health disorders is crucial to reducing the burden of suicide.