Systematic Review and Meta-Analysis: Risk Factors for Suicide in Youth Psychological Autopsy Studies.

OBJECTIVE

Youth suicide is a major public health problem, yet quantitative evidence on risk factors specific to those 25 years of age and younger remains limited. Psychological autopsy studies capture short-term and nuanced risk factors absent from other registries and records-based research. We synthesized psychological autopsy data to identify exposures most strongly associated with youth suicide.

METHOD: We searched PubMed, Embase, PsycINFO, CINAHL, Web of Science, and Global Health from inception to May 15, 2026. We included quantitative psychological autopsy case-control studies of individuals ≤25 years of age with community controls. We excluded qualitative studies, high-risk samples, and non-fatal outcomes. We assessed study quality using the Newcastle-Ottawa Scale and obtained age-stratified data from authors when needed. Risk factors were pooled as odds ratios (ORs) with 95% confidence intervals, using random-effects meta-analysis with Hartung-Knapp adjustment.

RESULTS

We identified 1,809 records and included 19 eligible study samples (958 cases; 1,102 controls; ∼70% male). Of 26 pooled risk factors, 21 were statistically significant. The strongest were suicidal ideation (OR = 16.1, 95% CI = 5.0-51.5), previous suicide attempt (14.2, 6.3-31.8), acute stressful life events (13.7, 9.6-19.5), mood disorders (9.9, 5.3-18.2), and substance abuse (8.9, 6.1-12.9). Study quality was moderate-to-high, and factors showed high heterogeneity (I2 > 75%). Substance and alcohol abuse showed stronger associations in youth than in an adult meta-analysis following the same methodology.

CONCLUSION

Our findings suggest a more impulse-driven and proximal risk profile for suicide in youth. These findings support prevention frameworks that prioritize universal and school-based programs teaching emotional regulation and problem-solving skills, alongside policies reducing access to highly lethal means, given the impulsive nature of many youth suicides.

STUDY REGISTRATION INFORMATION: Systematic review and meta-analysis of psychological autopsy studies on suicide risk factors in adolescents and young adults; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251057274 DIVERSITY & INCLUSION STATEMENT: We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.