Background: Suicidal behavior has a significant contribution to the global burden of disease that affects individuals, families and communities at different age groups. Sadly, up to 75% of suicides in the world occur in low-and- middle income countries which have no adequate resource to prevent it. The aim of this study was to assess suicidal behavior and associated factors among community residents with problematic substance use in South Gondar zone, northwest Ethiopia.

Methods: Community based cross-sectional survey was conducted by using a suicidal behavior revised questionnaire from January 15 to March 15, 2019. A total of 4035 participants were screened for problematic substance use by using multi stage cluster sampling and 846 participants were positive for problematic substance use then asked for suicidal behavior. Multiple logistic regression analyses used to see adjusted odd rations (AOR). Multilevel binary logistic regression was used to account for the hierarchical structure of the two-level data within individual and districts level.

Results: The prevalence of suicidal behavior over the last 12 months in problematic substance uses was found to be 41.4% with 95% of confidence interval (CI) (38.2-44.9). Perceived stigma, [AOR = 1.605, 95% CI (1.16-2.23)], family history of suicide [AOR = 3.22, 95% CI (1.46-7.10)], physical illness [AOR = 2.45 95% CI (1.157-3.84)], rural resident [AOR = 1.74, 95% CI (1.16-2.62)], depression [AOR = 4.44, 95% CI (3.15-6.27)] and living alone (AOR = 1.61, 95% CI (1.16-2.24) were risks factors for suicidal behavior.

Conclusion: Suicidal behavior in problematic substance uses found to be high. Health workers should pay attention to decrease suicidal behavior and to control amendable factors.