Risk and protective factors of self-harm and suicidality in adolescents: an Umbrella Review

Suicide remains the second most common cause of death in young people aged 10–24 years and is a growing concern globally. The literature reports a vast number of factors that can predispose an adolescent to suicidality at an individual, relational, community, or societal level. There is limited high-level research in identifying and understanding these risk and protective factors of suicidality in adolescents.

Aims

To use a systematic method to synthesise recent review literature on adolescent mental health outcomes (self-harm and suicidality) and their risk and protective factors.

Methods

An umbrella review method and meta-analysis was used to synthesize evidence from the literature in the past 20 years on risk and protective factors of self-harm and suicidal attempts in adolescents. It derived the population attributable fraction (PAF) of the identified exposure based on the data synthesis.

Results

Bullying victimization was the most attributed environmental exposure with PAF 22.16% for suicide ideation and 31.12% for suicide attempts, the pooled odds ratio for suicide attempt was 3.0 (95% C.I. 2.58-3.53, <.0001). The other significant school and individual factors were sleeping disturbance, school absenteeism, and exposure to antidepressant. Several major vulnerable young populations were identified with significant higher prevalence of suicide attempts and ideation, including LGBT youth and those with mental health disorder, problem behaviours, previous suicidality, self-harm, and gender (female).

Discussion

Health professionals working in population health, school settings and community mental health should consider these risk factors when assessing and treating vulnerable young people. A person-centered approach with an emphasis on connectiveness and bully-free school environments, should be a priority focus for schools, health professionals and public health policy makers.

Conclusion

To reduce the suicide behaviour and ideation in adolescents and youth, it is vital to create bully-free environments, eradicate school related exposures, and provide protective interventions within schools.