Behavioural addictions in early adulthood and subsequent suicidality: Evidence from a population-based cohort of young Swiss men

Although suicidality is a major public health concern, the clinical relevance of behavioural addictions (BAs) with respect to suicide risk remains poorly understood. Guided by the ideation-to-action framework, we examined whether six BAs (gambling disorder, gaming disorder, problematic internet use, problematic pornography use, problematic smartphone use, work addiction) at age 25 were prospectively associated with a) the onset and recurrence of suicidal ideation and suicide attempts at age 28 and b) the likelihood of a suicide attempt versus ideation only. We also assessed whether these associations overlapped with co-occurring risk factors, including substance use disorders (SUDs), other mental health problems (MHPs) and psychological distress (PD). Using a population-based longitudinal design, a non-self-selected sample of 5,611 young Swiss men completed baseline (age 25) and follow-up (age 28) questionnaires. Measurements included BAs, SUDs, MHPs, PD, lifetime suicidality at baseline and 12-month suicidality at follow-up. Logistic regression models tested associations between BAs and suicidality. Overlaps with co-occurring SUDs, MHPs and PDs were quantified using the Karlson–Holm–Breen method. Results revealed that all BAs were significantly prospectively associated with the onset of suicidal ideation or a suicide attempt; only some BAs were associated with the recurrence of ideation (gaming disorder, work addiction, having ≥ 1 BA) or an attempt (gambling disorder). Baseline gambling disorder, problematic pornography use and having ≥ 1 BA were associated with reporting a suicide attempt rather than ideation-only among participants reporting suicidal ideation at follow-up. Adjusting for co-occurring factors attenuated BAs’ associations with onset and recurrence but not for suicide attempts versus ideation only. Overall, BAs showed consistent longitudinal associations with suicidality, with relationships frequently persisting after adjustment for co-occurring risk factors. These findings underscore the clinical relevance of BAs and the importance of systematic screening and prevention efforts within mental health and suicide risk assessment, alongside evidence-based interventions.