{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:41:21Z","timestamp":1792604481178,"version":"4.5.0"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Suicidal behaviors among adolescents are a serious global public health concern and are closely linked to both mental health and everyday lifestyle behaviors. Suicidal ideation, planning, and attempts lie along a spectrum of increasing severity. However, how psychological distress and health-related behaviors interact to influence suicide risk is complex and not yet fully understood. This study aimed to identify key mental health and lifestyle factors associated with different stages of adolescent suicidal behaviors using interpretable machine learning methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were obtained from the 2021 Youth Risk Behavior Surveillance System (YRBS), a nationally representative survey of U.S. high school students. After data cleaning and multiple imputation, 16,946 adolescents aged 14\u201318 years were included in the analysis. Extreme Gradient Boosting (XGBoost) models were developed to predict suicidal ideation, suicide planning, and suicide attempts. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and related metrics. Feature importance was examined using gain-based measures, while SHapley Additive exPlanations (SHAP) and partial dependence plots were used to explore the direction, strength, and nonlinear effects of key predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All three XGBoost models showed satisfactory predictive performance. Mental health factors, particularly persistent feelings of sadness and self-rated mental health, were the strongest predictors across all stages of suicidal behaviors. Lifestyle behaviors, including sleep duration, physical activity, diet, screen time, and substance use, also contributed meaningfully to risk prediction, although their relative importance differed by outcome. SHAP analyses indicated that greater sadness and poorer mental health were strongly associated with higher suicide risk, whereas adequate sleep and higher levels of physical activity were associated with lower predicted risk. Substance use, including alcohol, cigarette, and marijuana use, played an important role in predicting suicide attempts than suicidal ideation or planning. Partial dependence analyses showed nonlinear and threshold effects, especially for sadness, mental health status, and sleep duration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Mental health factors, especially persistent sadness and overall psychological well-being, were among the most prominent factors associated with suicidal behaviors among adolescents, while lifestyle behaviors showed important and stage-specific associations. Interpretable machine learning approaches help identify complex and nonlinear patterns associated with adolescent suicide risk and offer valuable insights to guide targeted, evidence-based prevention efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0358758","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:22:12Z","timestamp":1792603332000},"page":"e0358758","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Investigating the role of mental health and lifestyle behaviours in the risk of adolescent suicidal behaviours through machine learning"],"prefix":"10.1371","volume":"21","author":[{"given":"Yanmei","family":"Ding","sequence":"first","affiliation":[{"name":"Shanghai Civil Aviation College","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4442-8327","authenticated-orcid":true,"given":"Yanzhao","family":"Lei","sequence":"additional","affiliation":[{"name":"Shanghai SIPO Polytechnic","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"key":"pone.0358758.ref001","volume-title":"Suicide worldwide in 2021: global health estimates","author":"World Health Organization","year":"2025"},{"issue":"1","key":"pone.0358758.ref002","doi-asserted-by":"crossref","first-page":"45","DOI":"10.15585\/mmwr.su7201a6","article-title":"Suicidal thoughts and behaviors among high school students - youth risk behavior survey, United States, 2021","volume":"72","author":"EM Gaylor","year":"2023","journal-title":"MMWR Suppl"},{"issue":"3","key":"pone.0358758.ref003","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/S2352-4642(18)30022-1","article-title":"The age of adolescence","volume":"2","author":"SM Sawyer","year":"2018","journal-title":"Lancet Child Adolesc Health"},{"issue":"3","key":"pone.0358758.ref004","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1521\/suli.2007.37.3.264","article-title":"Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. 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Global, regional, and national burden of musculoskeletal disorders, 1990\u20132021: an analysis of the global burden of disease study 2021 and forecast to 2035. 2025;13.","DOI":"10.3389\/fpubh.2025.1562701"},{"issue":"9","key":"pone.0358758.ref017","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1037\/bul0000110","article-title":"Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review","volume":"143","author":"BE Compas","year":"2017","journal-title":"Psychol Bull"},{"issue":"2","key":"pone.0358758.ref018","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1016\/j.jad.2013.01.033","article-title":"Social support as a protective factor in suicide: findings from two nationally representative samples","volume":"150","author":"EM Kleiman","year":"2013","journal-title":"J Affect Disord"},{"issue":"1","key":"pone.0358758.ref019","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s00038-011-0255-7","article-title":"Early substance use initiation and suicide ideation and attempts among students in France and the United States","volume":"57","author":"MH Swahn","year":"2012","journal-title":"Int J Public Health"},{"issue":"7","key":"pone.0358758.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0156348","article-title":"Smoking and Suicide: A Meta-Analysis","volume":"11","author":"J Poorolajal","year":"2016","journal-title":"PLoS One"},{"key":"pone.0358758.ref021","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.jad.2016.02.007","article-title":"A literature review and meta-analyses of cannabis use and suicidality","volume":"195","author":"G Borges","year":"2016","journal-title":"J Affect Disord"},{"issue":"1","key":"pone.0358758.ref022","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/2167702617723376","article-title":"Increases in depressive symptoms, suicide-related outcomes, and suicide rates among U.S. adolescents after 2010 and links to increased new media screen time","volume":"6","author":"JM Twenge","year":"2017","journal-title":"Clin Psychol Sci"},{"issue":"10","key":"pone.0358758.ref023","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.27892","article-title":"Association of Children\u2019s Physical Activity and Screen Time With Mental Health During the COVID-19 Pandemic","volume":"4","author":"PS Tandon","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"8","key":"pone.0358758.ref024","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/j.sleep.2015.03.007","article-title":"Sleep deprivation leads to mood deficits in healthy adolescents","volume":"16","author":"MA Short","year":"2015","journal-title":"Sleep Med"},{"key":"pone.0358758.ref025","doi-asserted-by":"crossref","first-page":"766972","DOI":"10.3389\/fpubh.2021.766972","article-title":"Lifestyle Behaviors and Suicide-Related Behaviors in Adolescents: Cross-Sectional Study Using the 2019 YRBS Data","volume":"9","author":"X Li","year":"2021","journal-title":"Front Public Health"},{"issue":"1","key":"pone.0358758.ref026","doi-asserted-by":"crossref","DOI":"10.1192\/bjo.2020.162","article-title":"Meta-analysis of the strength of exploratory suicide prediction models; from clinicians to computers","volume":"7","author":"M Corke","year":"2021","journal-title":"BJPsych Open"},{"issue":"9","key":"pone.0358758.ref027","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1017\/S0033291719000151","article-title":"Machine learning in mental health: a scoping review of methods and applications","volume":"49","author":"ABR Shatte","year":"2019","journal-title":"Psychol Med"},{"issue":"3","key":"pone.0358758.ref028","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1177\/2167702617691560","article-title":"Predicting risk of suicide attempts over time through machine learning","volume":"5","author":"CG Walsh","year":"2017","journal-title":"Clin Psychol Sci"},{"key":"pone.0358758.ref029","first-page":"4768","article-title":"A unified approach to interpreting model predictions","volume":"30","author":"SM Lundberg","year":"2017","journal-title":"Adv Neural Inf Process Syst"},{"issue":"1","key":"pone.0358758.ref030","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.su7201a1","article-title":"Overview and Methods for the Youth Risk Behavior Surveillance System - United States, 2021","volume":"72","author":"JJ Mpofu","year":"2023","journal-title":"MMWR Suppl"},{"issue":"8","key":"pone.0358758.ref031","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss6708a1","article-title":"Youth risk behavior surveillance - United States, 2017","volume":"67","author":"L Kann","year":"2018","journal-title":"MMWR Surveill Summ"},{"key":"pone.0358758.ref032","first-page":"29","article-title":"Multiple imputation","volume-title":"Flexible imputation of missing data","author":"DB Rubin","year":"2018","edition":"2"},{"key":"pone.0358758.ref033","article-title":"Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls","volume":"338","author":"JAC Sterne","year":"2009","journal-title":"BMJ"},{"key":"pone.0358758.ref034","doi-asserted-by":"crossref","unstructured":"Chen T, Guestrin C. 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