This cross-sectional study investigated relationships between suicide ideation, suicide behavior and emotional self-efficacy in a sample of high school adolescents in grades 9–12 with an age range of 12–18 (n = 3,836) in South Carolina. The hypothesis of the study proposed that low levels of emotional self-efficacy would be significantly associated with higher levels of suicide ideation and suicide attempts for study participants. A brief emotional self-efficacy scale was added to the CDC Youth Risk Behavior Survey to investigate associations with suicide ideation and suicide attempts. Unadjusted and adjusted logistic regression analysis and multivariate models constructed separately for sex and race were employed. Tobacco, alcohol, marijuana, and cocaine use; relationship violence; depressed mood; socioeconomic status; and weapon/gun access were included as covariates in the adjusted models. Nearly all suicide variables were significantly related to emotional self-efficacy in the unadjusted models for the four race/sex groups. In adjusted models, suicide ideation, planning a suicide attempt, attempting suicide and a suicide attempt resulting in injury were associated (α ≤ .05) with reduced emotional self-efficacy for black females. For white males, suicide ideation, attempting suicide and a suicide attempt resulting in injury were associated (α ≤ .05) with reduced emotional self-efficacy. Suicide ideation for black males was associated (α ≤ .05) with reduced emotional self-efficacy. No significant associations were established for white females. Results have implications for health services and suicide prevention programs for adolescents. Measures of emotional self-efficacy as a part of adolescent mental health assessments might be useful for field work, intervention, and program evaluation efforts.