Suicidal Ideation in Adolescents: A Systematic Review

Suicidal Ideation in Adolescents: A Systematic Review

Nur Amalia Rezki, Evan Bastian

Universitas Muhammadiyah Malang, Indonesia

DOI: https://dx.doi.org/10.47772/IJRISS.2024.807101

Received: 28 June 2024; Accepted: 03 July 2024; Published: 06 August 2024

ABSTRACT

Suicidal ideation refers to thoughts or considerations about committing suicide. This can include thoughts about ways to harm oneself or planning to end one’s life. Adolescents are considered a vulnerable population for suicidal ideation because adolescence is a transitional age to adulthood, referred to as early adulthood. The purpose of this systematic review is to identify predictor variables of suicidal ideation in adolescents based on 11 international journals with topics similar to this study. The research question for this study was formulated using the systematic literature review framework PCC (Population, Concept, Context). The search was conducted in the Scopus, Google Scholar, PubMed, and Web of Science databases. This review found diverse predictors from the 11 international journal articles following are the strongest predictors of suicidal ideation is spiritual well-being, family support, peer support, depressive symptoms, loneliness, drug use, negative thinking, self-esteem.

Keywords: adolescents; suicidal ideation; predictors

INTRODUCTION

As an individual ages, the process of aging brings along increased demands or social expectations. Adolescents are often considered a group of individuals with light responsibilities. Contrary to this belief, adolescents are viewed as an age group with more complex situations compared to other age groups (Santrock, 2018; Thahir, 2018). Due to this complexity, adolescents are not yet able to make independent decisions. They often make irrational decisions and tend to behave impulsively (Aulia, Yulastri, Sasmita, 2019). Therefore, adolescents are considered unstable individuals because their responsibilities do not match their developmental stage. During this phase, adolescents experience significant emotional changes. Additionally, they face high academic pressure, such as needing to achieve high grades in school. Late adolescents who are pursuing undergraduate education face the same high pressure as other adolescents. Late adolescents encounter new cultures on campus, such as individualism, independence, different learning methods compared to previous schools, and social pressure from peers, including difficulty finding compatible friends and participating in peer social activities (Tandiono et al., 2020; Salsabhilla et al., 2019).

Jobes (2023) explains that suicide is a multifactorial phenomenon involving the interaction of biological, psychological, social, and environmental factors. Suicide is a severe issue both in Indonesia and globally. According to data from the National Criminal Information Center of the Indonesian Police, there were 971 suicide cases in Indonesia up to October 2023 (Tim Pusiknas, 2023). Salsabhilla and Panjaitan (2019) state that the most vulnerable population for suicide attempts and suicidal ideation is the young population. The American Psychiatric Association (APA) explains that suicide is an act where an individual harms and kills themselves, with causes including depression or other mental illnesses (APA, 2018). Globally, the number of deaths from suicide is much higher than deaths from war and homicide (John & Rizk, 2020).

In the process of reaching the act of suicide, an individual goes through thoughts of committing suicide. This is referred to as suicidal ideation. Klonsky and Saffer (2017) explain that suicidal ideation is influenced by interpersonal factors within an individual’s relationships with others. Klonsky, Luinenburg, and May (2021) mention that the latest theory explaining the progression from suicidal ideation to suicidal action is the three-step theory of suicide. This theory suggests that suicidal ideation can be caused by a combination of unbearable pain and hopelessness. Suicidal ideation becomes strong when an individual’s pain exceeds or overwhelms their connections. The transition from suicidal ideation to suicide attempts is facilitated by dispositional contributions.

Based on previous research by Borges et al. (2019) with a sample of 56,877 people in Mexico, it was found that 2.3% of the subjects had thoughts of committing suicide, 0.8% had plans, and 0.7% reported attempting suicide. The study also explained that female participants were twice as likely as male participants to experience these three conditions. Among subjects aged 50-65, the occurrence of suicidal thoughts, plans, and actions was rare. The study indicated that suicide attempts were more common in urban areas than in rural areas. Another study by Schlagbaum et al. (2021) explained that adolescents with higher levels of depressive symptoms, impulsivity, and hostility, a family history of suicidal behavior, and peers with suicidal thoughts or behaviors were more likely to have suicidal thoughts or ideation.

Adolescents have one final stage, which is the transition phase from adolescence to adulthood. The developmental task during this period is the development of new relationships with society. According to Erikson (in Feist et al., 2017) the transitional period from adolescence to adulthood has two basic demands: identity vs. identity confusion, which requires individuals to find ther future identity, and intimacy vs. isolation, which requires individuals to have healthy relationships with their environment. According to Santrock (2011), adolescents are individuals who tend to be impulsive. This is due to the brain’s development, which is not yet fully mature, resulting in ongoing development of self-control and decision-making skills.Based on the previous research described above, suicidal ideation in adolescents is a phenomenon that requires more attention due to its high prevalence. Therefore, this study aims to identify the predictor variables of suicidal ideation in adolescents as an effort to reduce or prevent suicidal thoughts that can lead to suicidal behavior. This study uses a systematic literature review by deeply analyzing 11 international journals that discuss predictors of suicidal ideation in adolescents.

This study aims to complement previous research, which has various shortcomings such as focusing only on specific variables like parenting. Previous studies have been limited to identifying predictors like depression, anxiety, and loneliness. This study encompasses research from the last five years, making it a substantial update to previous research (McClelland, et al., 2020; Li, et al., 2022; Riera-Serra, et al., 2023).

METHODOLOGY

The method used in this paper is a systematic literature review following several steps. According to Francis and Baldesari (2006), the steps in a systematic literature review include formulating research questions, conducting a literature search, screening and selecting suitable research articles, analyzing and synthesizing findings, applying quality control to the literature, and compiling the final report. The purpose of the systematic literature review method is to collect journals with relevant focus topics, which will then be systematically evaluated to find journals that meet the criteria. After the evaluation process, the authors will conduct an in-depth analysis of these journals to answer the research questions. Planning for the review was conducted by the author (NAR), the research question for this study is formulated using the PCC (Population, Concept, Context) framework of systematic literature review questions. After planning, the authors (NAR) created a literature search protocol, which was then comprehensively developed to include other terms derived from the initial search terms. The resulting keywords include suicidal ideation, suicidal thought, suicidal thinking, suicide ideation, suicide thought, adolescent, teenager, teen, and youth.

The criteria for this review include: 1) journals discussing suicidal ideation as the dependent variable, 2) subjects who are adolescents or first-year university students within the adolescent age range, 3) both quantitative and qualitative research studies, 4) journals published in English, 5) studies conducted within the last five years, from 2019 to 2024, to ensure modern and relevant literature, 6) journals related to psychology or mental health. Exclusion criteria include: 1) journals discussing predictors of suicidal ideation with non-significant results, 2) journals not written in English, 3) review articles, reports, books, literature reviews, and studies with unclear or inadequately detailed methods.

The search was conducted in the databases Scopus, Google Scholar, PubMed, and Web of Science, yielding 200 literature results from Scopus, 996 from Google Scholar, 356 from PubMed, and 56 from Web of Science. After obtaining literature that matched the keywords, the authors (EB) performed a duplication check using Rayyan, resulting in 303 duplicated literature entries. The next step was screening based on titles and abstracts relevant to this study’s objectives, the autors (EB) conducted screening resulting in 93 literature entries. The autors (NAR) conducted further screening based on full-text reviews (from title to conclusion) identified 11 literature entries discussing predictor variables of suicidal ideation in adolescents. This article selection process followed the PRISMA diagram procedure.

Figure 1. PRISMA Flow Diagram for Article Selection Procedure

RESULT AND DISCUSSION

Here is the translation of the table describing the subject criteria and sample sizes from the 11 reviewed journals in this study, so that the author can confirm that all subjects reviewed fall into the adolescent category:

Table 1. Subject Criteria

Here are the measurement instruments used to assess suicidal ideation in adolescents, employing both qualitative and quantitative approaches in the journals reviewed in this study:

Table 2. Suicidal Ideation Measurement Instruments

Here are the predictor analysis methods used in the journals reviewed in this study:

Table 3. Predictor Analysis Methods and Findings

This systematic review aims to understand these predictors, assess their consistency and strength of evidence, provide recommendations for interventions and policies to reduce suicidal ideation risk among adolescents, and offer valuable information for mental health professionals, educators, and policymakers to develop effective prevention strategies. The study reviews 11 international journal articles, identifying diverse predictors including spiritual wellbeing, family support, peer influence, depression symptoms, loneliness, school environment, health behaviors, domestic violence, socioeconomic status, neuroticism, sexual victimization, drug use, negative thoughts, self-esteem, sexual orientation, and help-seeking beliefs.

Spiritual wellbeing is crucial in predicting suicidal ideation, as individuals with high spirituality often adhere strictly to religious commandments, such as in Islam where suicide is forbidden. This fosters positive feelings, behaviors, and thoughts, enhancing relationships with oneself, others, nature, and God (Litaqia & Permana, 2019; Tumanggor & Suharyanto, 2020). Family support is also pivotal in forecasting suicidal ideation among adolescents, providing them with love, affirmation, and decision-making support (Ibrahim et al., 2019; Bracic et al., 2019). Conversely, absence of parental support or familial discord can lead to negative behaviors (Widiarta & Megaputri, 2021; Bulat et al., 2024).

Peer influence among adolescents can manifest through direct interactions and online media, influencing behaviors and social norms, including attitudes towards suicide as a response to pressure (Schlagbaum et al., 2021). Depending on how adolescents perceive their peers’ behaviors, peer influence can either significantly impact or minimally affect their lives (Permata & Nasution, 2022). Depression symptoms are strongly associated with suicidal ideation among adolescents, with studies reporting that a substantial proportion of adolescents experiencing depression also contemplate suicide (Bracic et al., 2019; Desi, Felita, Kinasih, 2020; Chong & Wu, 2020; Hatchel et al., 2019; Secundino et al., 2020). Depression’s severe negative impacts heighten suicide risk by shaping adolescents’ perceptions that suicide is the sole solution to their challenges.

Loneliness is not merely an assessment of social support but also encompasses an individual’s perceived status within society, influencing their self-esteem and susceptibility to suicidal thoughts (Bracic et al., 2019; Elfaza & Rizal, 2020; Cong & Wu, 2020). Adolescents experiencing loneliness often strive to enhance their relationships with others and themselves, crucially impacting their self-esteem and mental health. The school environment serves as a crucial setting for understanding and addressing suicidal ideation among adolescents, offering opportunities for prevention and support through initiatives that foster safety, inclusivity, and positive social interactions (Pfledderer et al., 2019; Marx et al., 2019).

Health behaviors such as physical activity, sleep patterns, and drug use significantly influence suicidal ideation among adolescents, with poor health behaviors correlating with increased suicidal thoughts (Bracic et al., 2019; Pfledderer et al., 2019; Marx et al., 2019; Secundino-Guadarrama et al., 2021; Sellers et al., 2019). High levels of neuroticism, characterized by emotional instability and stress responsiveness, contribute to adolescents’ challenges in managing life stressors and emotional balance, increasing their vulnerability to suicidal ideation (Bulat et al., 2024).

Sexual victimization, involving unwanted sexual behaviors or assaults, significantly heightens adolescents’ risk of experiencing suicidal thoughts (Marx et al., 2019). Negative thoughts, which skew perceptions towards pessimism and hopelessness, play a critical role in predicting suicidal ideation by shaping how adolescents interpret events and interact with others (Secundino-Guadarrama et al., 2021; Pollak et al., 2021). Beliefs about seeking help from professionals during crises are a key predictor of lower suicidal ideation among adolescents, highlighting the importance of supportive help-seeking behaviors in mitigating suicide risk (Hatchel et al., 2019).

CONCLUSION

This systematic review aims to comprehensively examine and integrate research findings concerning factors that influence suicidal ideation in adolescents. It endeavors to explore and analyze these predictors, evaluate the robustness and consistency of available evidence, provide recommendations for interventions and policies aimed at reducing the risk of suicidal ideation, and furnish valuable insights for mental health professionals, educators, and policymakers. The review encompasses an analysis of 11 international journal articles, encompassing diverse predictors including spiritual wellbeing, family support, peer influence, depression symptoms, loneliness, school environment, health behaviors, domestic violence, socioeconomic status, neuroticism, sexual victimization, drug use, negative thoughts, self-esteem, sexual orientation, and attitudes towards seeking help.

Spiritual wellbeing is crucial as it predicts suicidal ideation, especially among those adhering to religious prohibitions against suicide, such as in Islam (Ibrahim et al., 2019). Family support, depression symptoms, loneliness, and school environment also emerged as significant predictors. Health behaviors, including drug use, neuroticism, sexual victimization, negative thoughts, and help-seeking beliefs, were also highlighted. The results of this review provide valuable information for mental health professionals, educators, and policymakers to develop effective intervention strategies in preventing and reducing suicidal ideation among adolescents. The development of safe and supportive school environments and a better understanding of risk factors are also crucial focuses. By understanding these factors deeply, it is hoped that efforts in prevention and intervention can be enhanced to effectively address the issue of suicidal ideation among adolescents.

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