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

Youth suicide is a major public health problem, yet quantitative evidence on risk factors specific to those aged 25 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.

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 people aged ≤25 years 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 (CIs) using random-effects meta-analysis with Hartung-Knapp adjustment. (PROSPERO ID: CRD420251057274) 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 four 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.

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.