In this study, we found that the prevalence of suicidal ideation among Chinese adolescents was 22.1%. Our findings indicate that female sex, anxiety symptoms, lacking family support, having a troubled parental relationship, and using electronic devices for more than 5 hours weekly were associated with an increased risk of suicidal ideation. Moreover, older age, higher annual household income, and spending less than 5 hours per week using electronic devices were linked to a lower severity of suicide ideation. However, female sex and anxiety symptoms were associated with a higher severity of suicidal ideation.
The prevalence of suicidal ideation among Chinese adolescents was found to be 22.1% in our study. It is important to note that the research on the prevalence of suicidal ideation among adolescents has yielded inconsistent findings across different cultural backgrounds, countries, and periods. For instance, according to Peng et al., the prevalence of suicidal ideation among Chinese adolescents was 23.5% [31]. The prevalence of self-reported suicidal ideation in Polish adolescents was 24.66% [7], and in Tunisian adolescents was 26.9% [16]. A study examining the prevalence of suicidal ideation among U.S. adolescents from 1991 to 2019 found that it ranged from 19.4–15.8% [32]. A meta-analysis examining data from 1989 to 2018 found that the 12-month prevalence of suicidal ideation among adolescents was estimated to be 18% [33]. During COVID-19, the prevalence ranged from 29.7–31.3% [34]. Although these results vary, these alarming statistics highlight the urgent need for effective strategies to prevent and address suicidal ideation in this vulnerable group.
One important finding of our study is the association of female sex with suicidal ideation. Specifically, females were found to have a higher risk of experiencing more severe suicidal ideation. This result aligns with previous research indicating that females are more vulnerable to suicidal ideation [35–37]. Several previous studies have reported possible mechanisms by which females are more susceptible to suicidal ideation. For example, Ho et al. reported that hormonal changes and social stressors during puberty are particularly important for neurobiologically sensitive female adolescents [38]. Giletta et al. reported that the response of the hypothalamic–pituitary–adrenal axis to stressors emerged as a risk factor for suicidal ideation in female adolescents [39]. These two studies provide a more comprehensive understanding of the association between female sex and suicidal ideation, particularly in terms of neurobiological and psychosocial factors. Nevertheless, understanding the risk factors associated with more severe suicidal ideation in females remains complex, underscoring the need for continued research to explore the underlying factors contributing to this gender difference.
Anxiety symptoms were also identified as a significant risk factor for both suicidal ideation and severity of suicidal ideation. This association is consistent with the existing literature on the comorbidity between anxiety and suicidal ideation in adolescents [13, 40, 41]. A study involving 7054 adolescents, with an average age of 15.8 years, found a significant association between generalized anxiety symptoms and suicidal ideation [42]. Another cross-sectional study, conducted among senior high school students, revealed a moderate correlation between anxiety symptoms and suicidal ideation [43]. Moreover, a systematic review and meta-analysis demonstrated a significant association between higher levels of social anxiety and more frequent occurrences of suicidal ideation [40]. Multiple multilevel analyzed studies have consistently highlighted a significant correlation between learning anxiety and suicidal ideation [44]. Furthermore, studies investigating the relationship between anxiety symptoms and suicidal ideation consistently emphasize the importance of addressing anxiety symptoms as a crucial preventive measure against suicidal ideation in adolescents.
In addition, lacking family support and troubled parental relationships were found to be associated with an increased risk of suicidal ideation. These findings are in line with previous research highlighting the importance of family relationships and support as protective factors against suicidal ideation [45, 46], while family conflict exacerbates the severity of suicidal ideation [47]. These studies also underscore the crucial role of family dynamics and support systems in promoting adolescent mental health [48, 49].
Furthermore, excessive use of electronic devices was found to be associated with an increased risk of suicidal ideation, while limited use was linked to a lower severity of suicidal ideation. Based on empirical studies with a gender perspective, it has been demonstrated that adolescents who frequently engage in social software use or spend excessive time playing online games are significantly more likely to experience suicidal ideation [50, 51]. These findings are consistent with studies suggesting that excessive screen time and internet addiction can have detrimental effects on mental health and well-being among adolescents [52, 53].
Interestingly, our study identified certain protective factors associated with a lower severity of suicidal ideation. Older age, higher annual household income, and spending less than 5 hours per week using electronic devices were found to be associated with a reduced risk of severe suicidal ideation. These findings suggest that socioeconomic factors and healthy lifestyle choices may have a positive impact on adolescent mental health, which is consistence with previous findings [54, 55].
Although our study provides valuable insights into the prevalence and risk factors of suicidal ideation among Chinese adolescents, it is important to acknowledge some limitations. The data collected in this study relied on self-report measures, which may be subject to recall bias. Additionally, the study design was cross-sectional, limiting our ability to establish causal relationships. Future longitudinal studies are needed to explore further the complex interactions between various risk factors and suicidal ideation among adolescents. Thirdly, it is important to note that our study did not include adolescents from rural areas, highlighting the need for further research in the future to encompass this population.
Our research findings suggest the formulation and implementation of evidence-based policies and interventions. To address the higher risk and severity of suicidal ideation among female adolescents, it is crucial to enhance tailored mental health support. Moreover, improving accessibility to treatment for anxiety symptoms is essential to reduce the likelihood of developing suicidal ideation. Strengthening family support programs can play a vital role in mitigating the risk by providing guidance and support, particularly for those with troubled parental relationships. Finally, promoting responsible electronic device use through awareness campaigns, parental guidance, and school-based interventions can help minimize the association between excessive device use and suicidal ideation. By implementing these measures, we can work towards creating a safer and more supportive environment for adolescent mental health.
In conclusion, this study highlights the high prevalence of suicidal ideation among adolescents and identifies several risk factors associated with its occurrence. The findings underscore the importance of implementing gender-specific interventions, addressing anxiety symptoms, promoting family support, and addressing excessive electronic device use. By implementing the policy recommendations outlined above, healthcare professionals and policymakers can work towards reducing the burden of suicidal ideation and improving the mental well-being of Chinese adolescents.