Risk Factors for Suicidal Behavior Among European Youth: A Systematic Review.

INTRODUCTION: Clarifying risk factors for suicidal behavior in European youth is crucial for guiding assessment, prevention, and policy. This study provides a systematic review and synthesis of risk factors associated with suicidal ideation, attempts, and mortality across Europe. METHODS: Following PRISMA guidelines and a PROSPERO-registered protocol, we reviewed studies published between 1976 and 2024 involving European general populations aged 15-35. A total of 10,832 unique records were screened across PubMed, Web of Science, and Scopus, resulting in the inclusion and quality appraisal of 194 studies. RESULTS: Lifetime prevalence estimates ranged from 14-23% for ideation and 6-9% for attempts. The data confirmed a robust gender paradox: higher rates of ideation and attempts in women, but higher mortality in men. Risk factors spanned ten thematic domains: sociodemographic and identity, educational, family, victimization and childhood trauma, social connectedness, individual traits and coping, sleep and physical health, substance use and addictive behaviors, psychopathology and mental health, and prior suicidal behaviors. Research coverage was markedly uneven, with Northern & Western Europe accounting for most included studies. CONCLUSION: These findings highlight suicidal behavior in European youth as a critical, multifactorial public health issue. Compared to other world regions, European research distinctively documents sexual minority status and sleep/physical health correlates as consistent risk domains. Coordinated public policies should integrate suicide prevention into youth health agendas, prioritizing LGBTQ+ inclusive programs, post-self-harm monitoring, and digital risk assessment, alongside gender-sensitive approaches and targeted support for vulnerable groups.