Exploring sleep difficulties, alcohol, illicit drugs, and suicidal ideation among adolescents with a history of depression

•We explore the associations between sleep difficulties and suicidal ideation among youth with a history of depression, and how these associations are magnified by alcohol or illicit drug dependence/abuse.•Using data from five years an annual cross-sectional representative survey of adolescents with a history of depression in the US, we found that sleep difficulties were associated with thinking about, planning, or attempting suicide – an association that is magnified by alcohol and illicit drug use.•In youth with a history of depression, we observed associations between sleep difficulties and suicidal ideation, which was more robust among those reporting alcohol or illicit drug abuse/dependence. Sleep difficulties and misuse of drugs/alcohol have been associated with suicidal ideation in young people. Using cross-sectional representative surveys of adolescents in the United States, we conducted adjusted logistic regression modeling to assess the relationships between sleep difficulties, substance use, and suicidal ideation among adolescents with a history of depression (n = 38,418) between 2015 and 2020. Sleep difficulties were associated with thinking about (aOR=1.6,95%CI:1.3–1.9), planning (aOR=1.8,95%CI:1.2–2.6), or attempting (aOR=1.7,95%CI:1.2–2.5) suicide. In those reporting alcohol abuse/dependence, sleep difficulties were associated with attempting suicide (aOR=3.1,95%CI:1.2–8.5). In those reporting illicit drug abuse/dependence, sleep difficulties were associated with thinking about (aOR=2.1,95%CI:1.1–4.1) and attempting (aOR=2.2,95%CI:1.2–4.1) suicide.