A synthesized evidence review exploring risk and protective factors for youth suicide

Risk and Protective Factors of Self-harm and Suicidality in Adolescents: An Umbrella Review with Meta-Analysis

by Rebecca Richardson, Tanya Connell, Mandie Foster, Julie Blamires, Smita Keshoor, Chris Moir and Irene Suilan Zeng

Published 2 April 2024

What's the issue?

Suicide has devastating impacts on individuals, families and the community. It is a significant health concern for young people. Data provided by the Australian Bureau of Statistics for 2022 show that suicide was the leading cause of death for young people aged 15-24 years of age, and is also a leading cause of death for young people internationally.

There is limited high-level research identifying and understanding risk and protective factors for suicidal thoughts and behaviours in young people.

Researchers suggest that analysis of school-based risk and protective factors for young people in school settings is valuable, given that most young people are engaged in the school education system.

What was done?

Researchers examined risk and protective factors for suicide in young people in the context of New Zealand.

Researchers used a systematic review and meta-analysis to review literature published over a 20-year period examining self-harm, suicidal thoughts and behaviours, and suicide in people aged 9-25 years. The researchers also aimed to identify school-based factors that protect against suicide risk. The research approach synthesised the data from the evidence to determine strength of relationship between specific risk and protective factors and suicide.

What was found?

The analysis found a higher number of research studies sharing risk factors for youth suicide and self-harm, and less research sharing protective factors for youth suicide and self-harm.

The risk for suicidal thoughts, suicidal behaviour, and self-harm increased for:

  • Lesbian, gay, bisexual, transgender, queer (or questioning) young people
  • Young people who live with mental health concerns and mental illness
  • Young people who were exposed to or prescribed anti-depressants
  • Young people who displayed problem behaviours such as antisocial behaviour
  • Young people who had experienced childhood maltreatment
  • Young people who have experienced previous suicidal thoughts and behaviours and self-harm
  • Young females
  • Young people who experience bullying, with experience of cyberbullying further increasing risk
  • Young people who experienced sleep disturbances, and school absenteeism.

Protective factors against suicidal thoughts, suicidal behaviour, and self-harm included:

  • Having 8-9 hours of sleep per night
  • School attendance
  • Undertaking school-based interventions targeting suicidal thoughts and behaviours, and
  • Young people who experience school connectedness.

Researchers note that the limited number of protective factors found was unexpected given the emphasis on aspects such as family and peer support, as well as cultural identity as protective factors for suicidality and self-harm advocated by the New Zealand government and other health organisations.

Why are the findings important?

Given that most young people are engaged in the school system, school-based prevention approaches have potential to reach most young people.

Bullying and cyberbullying are identified as key drivers for self-harm and suicide risk, so school-based settings that prevent bullying may support suicide prevention.

School environments that focus on and facilitate school connectedness can support suicide prevention. Programs that improve mental health literacy of teachers and support staff may improve skills to support vulnerable populations.

With sleep disturbances in young people having a significant link to suicidal thoughts and behaviours, researchers suggest that alteration of school start and finish times may provide opportunity for all young people to achieve optimal sleep times to support general wellbeing, and the prevention of suicide and self-harm behaviours.