Suicide is a leading cause of death for teens worldwide and the odds of suicide attempts may be higher when adolescents abuse prescription drugs, a Chinese study suggests.

To explore the connection between suicide risk and misuse of prescription opiates and sedatives, researchers surveyed about 3,300 Chinese teens once when they were about 14 years old and again a year later.

Teens who said they used prescription drugs for non-medical reasons at the start of the study were almost three times as likely to report a suicide attempt a year later and the risk was more than tripled for youth who abused opiates, researchers report in JAMA Pediatrics.

“Baseline opioids misuse, sedatives misuse and nonmedical use of . . . prescription drugs were positively associated with later suicidal ideation,” said lead study author Dr. Lan Guo of Sun Yat-sen University in Guangzhou.

Those thoughts were more likely to turn into suicide attempts with “baseline opioids misuse and nonmedical use of any prescription drugs,” Guo added by email.

It’s not surprising, however, that the same teens who are prone to abusing drugs would also be susceptible to suicidal thoughts, said Dr. Bernard Biermann, a researcher at the University of Michigan’s C.S. Mott Children’s Hospital. “Substance abuse can be associated with causing depression and distress, but it’s also a means of self-medicating,” Biermann, who wasn’t involved in the study, said in a phone interview.

It’s essential that parents keep an eye on teens for changes in behavior that go beyond temporary moodiness to suggest a bigger problem, said Dr. Benjamin Shain, a researcher at the University of Chicago.

“Growing up has always been difficult and life now is even more complicated,” Shain, who wasn’t involved in the study, said by email. “Parents should take seriously severe or persistent distress and changes in behavior, such as isolation or falling grades, and bring their teen to their primary care physician or a mental health professional with any signs.”