OBJECTIVE: The purpose of this study was to investigate emotional distress and suicidal ideation among adolescents with and without chronic illness. METHODS: Two groups were compared from the Barcelona Adolescent Health Survey (3,129 students aged 14-19 years) data base. The index group included 162 adolescents with chronic conditions (100 females and 62 males) including those with asthma, diabetes, seizures, or cancer. No differences in prevalence of emotional distress or suicidal ideation were found among the four categories of disease. The control group included 865 subjects (383 females and 482 males). No age differences were evident between the index and control groups. Chi-square and Student's t-test were used for intergroup comparisons, with the criterion value set at p < .01 to reduce the probability of type I error. Analyses were conducted separately by gender. RESULTS: Compared with controls, a significantly greater proportion of females with chronic illness reported emotional problems, feeling in a bad mood, feeling sad, believing nothing amused them, having suicidal thoughts, expressing depressive symptomatology, and having personal problems needing professional help. In contrast, no significant group differences were found for males. No gender differences were found regarding recent contact with a mental health specialist. CONCLUSIONS: Chronic illnesses were associated with substantive emotional distress and suicide ideation in females but not in males. Females with chronic conditions did not, however, seek mental health services more often than their non-chronically ill counterparts. This suggests serious shortcomings in identification of "at-risk" youth and effective outreach to this population.