Abstract

Aim: This systematic review investigates the complex relationship between stress and suicide ideation among adolescents in America. As a qualitative study, the research relies on data gathered from literature carefully chosen to provide an in-depth understanding of this intricate relationship.

Background: The review starts with identifying study basics that include authors’ names, years in which published these studies and the titles of publications. it later elaborates the definition of critical features necessary for understanding the study, provides information on research design and setting all in a geographical background within United States.

Methodology: As a structured review, this research is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines; it also uses Critical Appraisal Skills Programme CASP )for qualitative analysis. The structured data extraction table systematically presents and summarises results obtained from appropriate studies. This exposure section shows the minute details of stress and suicide ideation studied with a keen eye, which fits well within this review’s spotlight.

Results: Data extraction table is not only an organisational tool but also a part that plays a significant role in the continuation and completeness of the analysis from one study to another. Key Findings Related to the Effect of Stress on Adolescent Suicide and Ideation. It describes the identification of essential study details, group samples and studied exposure. The results emphasize the main stress factors that affect suicide ideation and potential approaches to managing them.

Conclusion: In conclusion, this qualitative systematic review is a very thoughtful and thorough deconstruction of the complicated interaction between stressors leading to eventual suicide ideation in youths.  

Chapter 1 – Introduction

1.1. Rationale 

In the United States, teen suicide and thoughts of suicide are becoming more common each year. Young people's mental illness is thus a public health issue that urgently requires appropriate investigations into its causes. Suicide and suicide ideation is the behavioral outcome, which as a general health indicator has become one of the leading causes of youth death in recent years (Curtin and Heron 2019). These types of problems are seen most clearly in the adolescent population, suggesting that research efforts should be focused there.

In terms of the result for population, adolescents in America show a very worrying tendency. Suicide ideation and planning among adolescent girls are a particular concern. According to Kann et al (2018), the figures for these two categories amounted respectively to 22.1 % and 17. The prevalence of mood disorders among this vulnerable group combined with biological, psychological and other factors make the problem all too pressing to ignore.

The main cause overall is exposure to stress, which almost everyone suggests. But whether the causes of stress come from environmental, social or individual sources, pressure is clearly an important factor in suicide ideation and attempts. Duprey et al. (2021) further emphasized the accumulative effect of past child maltreatment and recent, stressful life experiences on suicide ideation in socioeconomically disadvantaged adolescent girls as a distinct risk factor for such individuals to adopt this method of coping when faced with problems at home or school. The confluence of chronic and acute pressures means that stress, as an exposure variable must be examined more precisely.

Taking population into account, the special effects of stress on adolescents are numerous. Stresses Most prone to the ill effects of stress are adolescents, who face gigantic transformations in their lives. This stresses the importance of a study like that by Argabright et al. (2022), which shows how racial or ethnic discrimination stress influences suicidality in preadolescent youth, especially among Black Americans. These kinds of results shed light on the various pressures that adolescents have to deal with at home or in society, such as discrimination.

But exposure with regard to effect is another important focus of research. In fact, stress in one form or another is seen to have an impact on suicide and suicidal thoughts the world over. The work of Glenn et al. (2022) explains how interpersonal stress, via pathways such as thwarted belongingness, leads directly to increased suicidal ideation among high-risk adolescents. From this we can see stress is a universal but complex indicator of potential suicidal behaviour.

Lastly, the exposure related to outcome in the population specifically addresses the intersection of stress, suicide, and suicide ideation among American adolescents. Barzilay et al. (2021) provide a comprehensive analysis of how environmental factors, including individual-level adversities and neighbourhood environment, interact to influence youth suicidal ideation. This intersectionality highlights the nuanced ways in which various stressors, either compounded or isolated, significantly impact the mental health of adolescents, particularly in the context of their socio-environmental backgrounds.

1.2. Research Question

This research investigates: 
"How does stress contribute to suicide ideation among adolescents in the United States?"

This research is systematically analyzing the complex connection between stress and suicide ideation among adolescents in America. She hopes that it will help analyze the multiple forms of stressors-including child abuse, socioenvironmental pressures and discrimination--which affect adolescent mental health.

Looking at the different facets of stress-its early manifestation in socioeconomically disadvantaged and minority groups, for instance-this study can help to deconstruct some of the forces driving this public health crisis.

This question rests on the assumption that an accurate appreciation of these stresses is important to formulating effective measures for combating growing adolescent suicide ideation.

1.3. Relevance to Public Health

The growth in adolescent suicide and suicidal thinking in the United States is a public health crisis. There are so many different types of problems, and all caused by stress. Thus, more detailed systematic analysis may help in developing appropriate prevention and treatment policies.

Such studies as that of Duprey et al. (2021) reveal the effects on adolescent mental health when chronic stressors combined, such simultaneously through child maltreatment and socioenvironmental disadvantage. These kinds of findings are key to understanding the complex connections between stress and adolescent mental illness.

Additionally, other studies published this year by Argabright et al. (2022) and Madubata et al. (2022) indicate that minority adolescents and those in a low socioeconomic stratum of society are affected excessively through stresses such as racial or ethnic discrimination.

Enlightenments like these are important for public health, because they can aid in the identification of groups at greater risk so that control measures can be developed. Juvenile mental health This kind of knowledge can be used to foster environments conducive to juveniles 'mental wellbeing.

In addition, the findings of Chen and Kuo (2016) and Wasserman et al. (2017)'s conclusion about inhibitory factors in preventing suicidal tendencies offer some valuable insights into resilience.

These studies also make us realize that besides eradicating risk factors, it is equally important to build strong adolescent resilience and mental health. Only in this way will it be possible for governments to adopt a comprehensive public health policy capable of promoting mental happiness and solving the problems associated with youth suicide ideation.

1.4. Justification for Systematic Review Methodology

The use of the systematic review approach for this study is representative, mainly because it can most comprehensively synthesize existing information and consultatively appraise results.

An approach like this would also be helpful in putting together results of some other studies that are ongoing, one by Runkle et al. (2023) and another which explores whether there is a difference between people of different racial or ethnic groups as far as registered suicide attempts and success rates are concerned among adolescents who identify their sexual orientation with the same sex group to whom they

In other words, a systematic review brings together studies conducted in various contexts or among different populations and sum they up is one way (Linnenlueck et al., 2020). This can serve to explain the complex interactions between stress factors and adolescent suicide ideation. This sort of method is a key to providing people with greater vision (Linnenlueck et al., 2020).

Perhaps this too can reveal the shortcomings in present research and indicate directions for future enquiry. Moreover, the quality of a systematic review is also related to methodological rigor and transparency. This also guarantees that all conclusions reached are based on an entirely objective assessment of the evidence. This painstaking process of review, appraisal and collation builds up a strong body of evidence-based knowledge about the issue under consideration.

1.5. Aims and Objectives

Aim of the Research

The main aim of this qualitiative systematic review is to illustrate stress as a factor behind suicide ideation among American adolescents.

Objectives

•    To understand how types of stress ranging from maltreatment to socioeconomic environment and discrimination affect suicide in adolescents.
•    To identify stressors that hit socioeconomically disadvantaged and minority adolescents especially hard
•    To better understand the interaction of individual and environmental stresses in promoting suicide ideation.
•    To explore how resilience and protective factors reduce the likelihood of suicide ideation, helping specify appropriate public health interventions or policies. 

1.6. Signposting for the Systematic Review

Seeking to shed light on this complex interaction, in a collected, qualitative way these researchers have completed this systematic review of the US literature related to adolescent suicide ideation. The chapters which follow are carefully arranged to lead the general reader through a clear explanation of this public health issue.

The literature review chapter also undertakes a far-reaching survey of extant scholarly research into the many types of stress experienced by adolescents. Over here the discourse pays close attention to studies about the influences of maltreatment, socioenvironmental adversity and subtler forms of discrimination on adolescents 'state-of-mind shape. In particular, the burden of these stressors on low-income and minority groups is a focus of special attention for publication.

Thereafter, the methodology chapter discusses in detail their step-by-step process for evaluating and comparing qualitative studies. This section explains the methods used to select which literary works were included and those that excluded. It is only through this meticulous attention to detail that the outcome of the review can be sound, complete and representative.

The results chapter includes findings from the reviewed studies. It draws together the major themes brought out by this literature and at the same time points to omissions. The report offers a vivid description of how different types and levels of stress interact with adolescent suicide ideation, especially the ways in which differing forms influence one another on susceptible youth.

The discussion chapter further illuminates these results in the realm of adolescent mental health and public-health issues. It also critically explores the relationship between suicide ideas among adolescents and these stresses, considering possible interactions at various levels of human behavior (individual, environmental or social). This chapter also shows the importance of resilience and protective factors. In fact this balanced viewpoint looks at both risk-and protection-related elements to mental health among adolescents.

Lastly, the conclusion chapter sums up the review's most important findings and considers what these mean for public health policy, practice and future research. This emphasizes the importance of interventions and policies to deal with these sources of stress directly. In addition, it reinforces the importance of continual monitoring and research, so that scientific knowledge can be constantly improved on this truly vexing topic as social-environmental change occurs.

Chapter 2 – Literature Review

2.1 Introduction

The literature review introduction gives a brief description of the remarkable importance related to effects of stress on adolescent suicide, which is considered one of key issues in modern discussions about mental health. The mechanics of the prevailing debate on stress as well its correlation with adolescent suicide is meticulously identified, giving an insight into the complexities inherent in this multifaceted relationship.

A critical investigation into available primary and secondary sources is made with a discerning lens, contributing to the elevation of scholarly debate on this subject matter. This section outlines the paper’s outlined gaps within existing literature as a foundation point for further investigation.

2.2. Justification for Systematic Review

A systematic review is a necessary measure that should be put in place to address the problem of suicide from all possible angles due to its complexity and sensitivity (Linnenlueck et al., 2020). The global statistics presented point to the disturbingly high rates of suicide highlighting that it may thus be necessary for a comprehensive review on what has already been written in order to come up with evidence supporting appropriate interventions and policies.

The reasons that this systematic review is justified are many and range from the need to summarize different research findings, identify patterns in what matters when suicide occurs (Amir-Behghadami, 2021) The overwhelming scale and influence of suicide on a worldwide basis first demand that we take an all-encompassing panoramic view of the recent research.

When carrying out a literature review, one can adopt multiple perspectives and methods to explore systematically any given issue (Xiao and Watson, 2019). This approach implies that the results are not limited to a certain cultural or demographic situation but can be applied for generalization, allowing presenting suicides from a more wide and clear perspective.

Second, the utilized statistics show considerable gaps between suicide activities of different gender groups age group and economic class. Thus, a systematic review allows to take a closer look at these disparities and reveal the reasons that result in those differences (Boland et al., 2017). It is also necessary to consider peculiarities in suicide risk identification at different population groups discussed above for designing effective and culturally sound interventions. Plus, the post PRISMA and CASP guidelines review methodology taken signifies a systematic process of data extraction synthesis analysis (Kim et al., 2017).

Methodological accuracy makes these findings more reliable and valid, which provides a firm foundation of evidence on the basis of recommendations. By following these recognized criteria, the systematic review will reduce bias and enhance research quality across the board (Cumpston et al., 2019).

Suicide is, therefore a multi-dimensional problem that has been shaped by many factors such as mental state and social economic cultural issues among others. , through a systematic review, common threads trends and risk factors are identified in most studies that guide to much better understanding of how different elements relate with each other. The review therefore provides useful information that may be helpful in guiding prevention strategies, mental health interventions and policies on an international basis.

2.3. Theoretical Frameworks

The theoretical frameworks and conceptual models presented within the literature play an important role in helping to understand stress as well as its complex nature relating suicide behaviour among adolescents. The stress generation hypothesis by Liu and Spirito (2019) emphasizes a cyclical relationship between stress and suicidal behaviour in adolescents who have had history of suicide attempts suggesting that they are more susceptible to dependent inhibitory sources.

This theory is seen to be empirically supported as a study by Liu and Spirito (2019) notes that the number of times an individual has attempted suicide in his life correlates very positively with increased levels of dependent distress, thus emphasizing how psychological vulnerability interacts with external stressors (Liu and Spirito, 2019).

This model innovatively reinterprets suicidal behaviour from an entirely new perspective as a biological breakdown to acute stressors, especially in the uniquely vulnerable context of adolescence. Therefore, Miller and Prinstein (2019) meld neurobiological dimensions with psychosocial stressors to offer a comprehensive understanding of the intricate relationships between teens’ physiology reactions in response to short-term emergencies”. However, empirical validation of the model is also required to ensure its appropriateness for spreading among different adolescent populations (Kleiman et al., 2018).

Further, the stress sensitivity hypothesis by Duprey et al. (2021) sheds light on how child maltreatment connects to suicide ideation. This study serves as a supporting piece of evidence to the assertion that adults who have been abused when they were children are more sensitive towards recent interpersonal stressors, strengthening both such factors associations with suicidal ideations.

The stress sensitivity hypothesis focuses on the combined effect of a previous traumatic experience and current stressed circumstances which influences suicidal ideation, thereby indicating appropriate interventions that factor in all kinds of parcelled forms of tension at any one period in someone’s life (Duprey et al., 2021). However, such findings might not be generalizable as there are individual variations in resiliencies and coping strategies A more nuanced approach needs to be used when clinical application comes into play.

All these theoretical frameworks and conceptual models, taken together, provide a fuller picture of stress as related to teen suicide. However, the critical assessment of these models shows that there is still a demand for empirical verification and research to identify possible moderators in order to make them more robust and applicable across different populations.

2.4. Role of Social Support in Suicide Prevention

Another important theme found in the literature is how social support, specifically from parent- figurative shelter adolescents against stress’ effects on suicidal ideas (Mackin et al., 2017). This study highlights another form of protective influence, namely how high parental support can make a significant difference to adolescent girls’ susceptibility in facing suicide distance after stressful life events (Mackin et al., 2017).

Nevertheless, though the study elucidates on the importance of social support this requires additional inquiries into how different types of supportive networks such as peer and community aid really affect suicide prevention to have a full comprehension as to their role.

Oppenheimer et al. (2018) indicated that family factors and quality of the parent-child relationship are key determinants for connecting between time to suicidal ideation onsets in adolescence Their research results show that the quality of parent relationship is a predictor for early onset of suicidal ideation, especially among youth without history in parents regarding such thoughts.

This study highlights the complex interaction between family dynamics and individual vulnerability, stressing that targeted intervention approaches should be designed not only paying attention to a specific family context but also taking into account personal history for an effective prevention of suicidal ideation in adolescents (Oppenheimer et al., 2018).

However, the study encourages reflective thinking on possible mutual influences in parent-child communication and invites scholars to investigate such reciprocal processes shaping adolescents’ mental wellbeing.

Describing a longitudinal design, Glenn et al. (2022), delve into the process of thwarted belongingness with family and friends as its mediating role interpersonal stress to suicidal thoughts in high-risk adolescents. It reveals that family identification significantly moderates the relationship between interpersonal negative life events and next-day suicidal thoughts.

This highlights the pivotal role family relationships play in determining risk for suicidal thoughts, revealing why such interventions are necessary to boost familial support and reduce the adverse effects of individual strain (Glenn et al., 2022). However, the study also raises an need for a more detailed look at peer relationships and community belongingness when it comes to thwarted belongingness in suicide prevention efforts.

In other words, the analysis of social support in suicide prevention literature emphasizes its multi-dimensional aspect and calls for individualized approaches to interventions that take into account particular aspects of support as well as their relationships between each other (Kim et al., 2021).

Although existing studies help put forth valuable information, comprehensive analysis invites additional research to fill in gaps about the varied consequences of different support networks. Further, a balanced exploration of bidirectional influences within family dynamics and the broader social environment is equally important in enhancing effective suicide prevention approaches.

2.5. Suicide Ideation Correlates in Diverse Populations

Stark et al. (2022) add to the literature by exploring links between suicide ideation and resilience among native-borns. The study reveals negative relationships between suicide ideation and resilience, pointing at the vulnerability for adolescents born in the Middle East and North Africa regions.

This emphasizes the necessity of specific interventions and support structures for diverse populations recognizing that certain demographic groups present in particular challenges (Stark et al., 2022). Moreover, the study provides grounds for a critical assessment of resilience operationalization and its cultural relevance as researchers are encouraged to investigate culturally sensitive indicators that could help improve risk assessments.

Chu et al. (2020), empirically investigate cultural pathways to suicidal ideation and behaviours in ethnic minority LGBTQ adults, which provide useful findings into the intricate connections between general distress, cultural factors, and various idioms of Cultural Processes.

This research challenges popular paradigms that explain suicide primarily in terms of mental illness, underscoring the need for cultural considerations to be made during conducting research and programs related to prevention of suicides. However, the study raises an important question about possible heterogeneity within cultural groups and a need for ongoing subtle consideration of individual experiences that would require more research to outline different paths toward suicidal ideation in various culturally specific settings (Chu et al., 2020).

Im et al. (2017), conduct an extensive review of the literature as they analyse national data to identify risk factors for suicide ideation among adolescents. In their study, they identify different risk factors including, demographic characteristics behavioural and mental health related issues.

While the results reinforce that interventions are more effective if single out for those at risk, it invites a questioning of how diverse an adolescent population can be with urban neighbourhoods. Future studies should investigate subgroups that have distinct risk profiles so as to allow the design of specific and successful suicide prevention initiatives developed for diverse adolescent populations (Im et al., 2017). 

Overall, the multi-population literature on suicide ideation identifies unique challenges faced by different demographic groups.

Current studies provide some insights into the domain of risk and resilience mechanisms in specific populations; however, a critical evaluation encourages further work to improve conceptualizations novelty within cultural groups when estimating heterogeneity; devising challenge-specific profiles while considering diversity across adolescent youth population (Steele et al., 2018).

Addressing these considerations is essential for the progress of culturally sensitive, individualized and effective suicide prevention efforts within varied demographic contexts.

2.6. Longitudinal Studies on Stress and Suicidal Ideation

In their contribution to the study of stress and suicidal ideation, Hooper et al. (2017) conduct a 14-year longitudinal study gauging environmental stress before and after an attempted suicide in Black American adolescents. The study elucidates the complex characteristics of stress endured this particular group, identifying why there is a need for a multifaceted response as they can influence an individual in long haul.

On the other hand, a critical evaluation encourages an examination of possible confounding factors and helps determine how applicable findings are to different ethnic or racial groups prompting researchers to conduct comparative studies for better understanding stress and suicide in various populations (Hooper et al., 2017).

Rew et al. (2016) conducted a longitudinal study within rural adolescents’ suicide ideation rates, looking at the links between suicide ideation life events and maladaptive coping strategies. The research identifies that maladaptive coping may increase the risk of suicidal ideation in rural areas, and contextual factors should be considered.

However, critical analysis makes us think about the possible mutual link between life events and ideation which calls to investigating of temporal pattern of these factors for more in-depth comprehension as to how stress and suicidal tendencies interact with each other among rural teens (Rew et al., 2016).

Comparatively, this longitudinal study offers insights into adolescent girls’ unique vulnerability and the effects of depression and stress on increasing chances for suicidal ideation or behaviour. However, a close look reveals the need to reconsider such one-way connections among these variables and instead aim for bidirectional relationships between stress supplying suicidal outcomes as well as their time constants in relation to this impact Miller et al. (2017).

Despite each study having its unique contribution to the field, a critical assessment raises questions related to possible confounding variables or bi-directional relationships and how generalizable findings are. Further research is needed to perfect longitudinal methodologies, investigate different demographic groups and clarify the complicated mechanisms of relationship between stress and suicidal ideation for better prevention strategies as well interventions.

2.7. Perceived Stress and Resilience in Early Adolescents

Chen and Kuo (2020) further contribute to the knowledge base on how perceived stress, together with resilience impacts early adolescents’ behaviours associated with suicide.

The study at hand emphasizes that perceived stress is a major risk factor, and should be considered together with protective factors when developing suicide prevention programs among the targeted group of individuals. However, an in-depth analysis tends to reveal the necessity of discussing potential interrelatedness between stress perceptions, resilience and suicidal behaviours as certain temporal frameworks – with scholars being invited for researching such a dynamic interaction.

This study shows how chronic stress, cognitive factors and suicide ideation among adolescents are interrelated. A critical interpretation encourages researchers to think about specific differences in experiencing and contributing towards fatigue, with mediating factors that might cause variation not only between the relationship of stress perceived as such but also general understanding.

In this study, chronic stress is identified as a moderator that strengthens the relationship between cognitive inflexibility and severity of suicidal ideation. So, a critical analysis will also make one think about possible methodological limitations and the necessity to search further into specific cognitive processes that underlie stress-related suicidal ideation in teenagers (Cheek et al., 2023).

In summary, the researches on perceived stress and resilience of early adolescents are useful in terms of understanding that there is no simple relationship between stressors and suicidal behaviours. While each study provides its point of view, a careful review makes one consider interpretations about possible mutually reinforcing relationships between the variables in question, variations among individuals and logistical peculiarities (Cheek et al., 2020).

Future studies should emphasize the improvement of methods, study mediating variables and conceptualizing the dynamic relationship between cognitive, emotional , and environmental factors regarding stress and suicidal thoughts in early adolescents.

2.8. Youth Risk Behaviour Survey Data

Ivey-Stephenson et al. (2020) contributes to the discussion through their study utilizing data from Youth Risk Behaviour Survey providing important information regarding trends of suicidal ideation and behaviours among high school students in the U.S.” These findings show an alarming increasing trend of suicide attempts over the years from 2009.

A critical review would prompt considerations on the possible limitations that may be present in self reported survey data, thus compelling researchers to triangulate their findings with other objective measures and adopt a holistic approach when trying to understand adolescents’ suicidal behaviours (Ivey-Stephenson et al., 2020).

Exploration of demographic differences within Youth Risk Behaviour Survey data revealed that the rates for suicidal ideation and behaviours varied by gender, race, sexual identity, and other demographics (Ivey-Stephenson et al., 2020).

This accentuates a necessity for interventions that were designed to meet particular needs of separate adolescent groups. Nevertheless, a critical analysis prompts considering an intersectionality’s potential role in shaping these demographic changes and allows researchers to consider the perspectives of intersections between multiple identities for understanding better individuals’ lives at any crossroads or junctions identified by various connections (Ivey-Stephenson et al., 2020).

Overall, the data obtained from Youth Risk Behaviour Survey are very helpful for gaining insights into suicidal ideation and behaviours among high school students in the U.S . It is also useful to discuss limitations related to survey methodologies While such findings promote thoughtful directions towards suicide prevention strategies, this analysis looks at some of those considerations necessary when using any surveys.

2.9. Gaps in Future Directions

With the current literature being rather profound, there are certain gaps that stand out to be noticeable – they need attention of scholars and collective efforts in future research initiatives. Although the progress made in recent years has been substantial, there is an urgent need to take a more intimate look into how various aspects of multiple identities may affect suicidal ideation and behaviours among teenagers.

This calls for studies that are even more refined in its view of stressors to provide insight into the multidimensional workings and thus assist in developing interventions based on distinctions created by different demographic groups as hypothesized (Ivey-Stephenson et al., 2020; Stark et al., 2022).

Finally, it is observed that there appears to be a significant loophole in the literature regarding the long term effectiveness of current prevention programmes and interventions. Future research can be based on studies conducted over a long-term period, so researchers have the opportunity to establish whether special strategies are working

If yes, then which areas may need further enhancement. The need for a comprehensive, evidence-based approach to suicide prevention is prompted by the critical review of current body of literature and highlights that agencies must indeed proceed with their findings if only to better support adolescents susceptible or exposed to these deadly behaviours (Ivey et al., 2020; Stark et al., 2022).

2.10. Conclusion

In conclusion, the detailed literature review on adolescent suicide and stress has offered a serious overview of intricate connections determining suicidal ideation and behaviours. The incorporation of results from different studies including research into hypotheses on stress generation up to social support and longitudinal study outcomes has provided significant insight in this vital topic with multi-directional view.

In identifying gaps in the extant literature, along with suggested directions for future research, this reinforces that there still needs to make further scholarly endeavours towards improving the precise accuracy of efficacy suicide prevention strategies.

This comprehensive review paves the way for a deeper understanding of the intricacies associated with stress and adolescent suicide, calling upon both scholars and practitioners to cooperate in addressing identified gaps as well refining intervention strategies in order to ensure health among vulnerable youth. 

Chapter 3 – Methodology

3.1. Introduction

Within the context of this chapter of thorough discussion of the method, logical approach chosen for the process of the current systematic review is presented. The main focus of this research process is centred around the impact that stress has on adolescent suicide ideation within the context of the United States. so methodology is important within the context of systematic review in order to ensure that the research is valid, reliable and robust with regards to its findings.

This chapter exhaustively discusses the strategy adopted for the conduct of the search of literature which includes the selection of the data basis, the selection of the search terms as well as the keywords that have been used to conduct the research.

In addition to the same it also includes the selection of the search framework which is explained with respect to its importance towards the research question. In addition to the same this chapter also exhaustively discusses the inclusion and exclusion criteria, which found the inclusion or exclusion of studies within the context of this matter review. The conduct of the methodology of review cannot be overstated as it is relevant towards the credibility as well as integrity of the research outcomes.

3.2. Search Strategy

3.2.1. Database Used

The selection process for the databases adopted for the search process in this study has been methodical in approach with focus on the requirement of as well as medical research. Therefore, the databases that have been chosen for this research include PsychINFO, MEDLINE, Embase. Each of these databases offer a relevant as well as unique collection of studies and articles, which is significantly important to explore the research question with respect to the relationship between stress and adolescent suicide ideation (Gusenbauer and Haddaway, 2020).

PsychINFO - this is a notable database within the field of psychology which offers an expensive collection of literature that is relevant to mental and behavioural health sciences. This database offers a comprehensive body of knowledge that can offer several imported insights into the psychological, foundations and behavioural patterns that are related to adolescent stress and suicide. The inclusion of the database is brought towards finding and searching for studies that investigate the psychological dimensions pertinent to the research question post in the systematic review (AlRayat, 2019).

MEDLINE - this is a widely acclaimed database within the field of medicine and medical sciences which is highly resourceful with respect to collection of biomedical research literature (Heintz et al., 2023). This database includes a wide variety of studies within the context of health sciences which makes it a very useful source within the clinical and biological aspects of suicide and adolescent stress. The database is known to have a wide and robust collection of peer reviewed articles, which can ensure that the current systematic review will be founded within scientifically validated medical research which would go on to increase the credibility of the current systematic review.

Embase - this is another database which has a wide and vast coverage of pharmaceutical and medicine research which can complement the knowledge being clean by the systematic review by offering intervention and treatment perspectives to the management of stress induced issues that will be explored in the context of the current systematic review (Heintz et al., 2023). The inclusion of this database is significant to the study, as it may help the current systematic review to explore the intervention measures that are available for the subjects of the issues being developed in the context of the literature review.

Working in confluence, these databases provide a solid foundation of knowledge sources for the conduct of the current systematic review. the reason for selection of these databases is founded within the types of resources provided by these databases in order to ensure a rigorous, medical relevant and reliable body of knowledge within the context of the systematic review.

3.2.2. Search Terms and Keywords

In the process of executing a systematic review protocol, thoroughly developed collection of search terms and keywords is required. Accordingly, this systematic review incorporates carefully search terms and keys which are being used in confluence with Boolean operators. This approach is pertinent towards ensuring that the system can extract relevant data from the selected studies as well as showing that the search process is able to search and reach the required studies which conform the basis of the current systematic review. (Bramer et al., 2017)

Table 1: Search Terms and Keywords

The main search terms were "adolescent," "teen," "youth," and "minor," targeting an age-based demographic. These were paired with "stress," "psychological stress," "distress," and "trauma." Many terms were used to cover all aspects and nomenclatures of stress in a literature review.

To address suicidal thoughts and actions separately, "suicide," "suicidal ideation," "self-harm," and "suicide attempt" were used. Several languages were needed to capture the variety of suicide behaviours and thoughts.

Boolean operators were key to this search strategy. The operator "AND" connected many themes, such as "adolescent AND stress AND suicide." So, we could ensure that the retrieved material covered all important aspects of the topic. In contrast, "OR" was used to broaden the search within each domain. Keywords like "adolescent OR teen OR youth OR minor" were used to find relevant research.

This careful combination of the specific keywords in addition to the operators was important in the process of constructing a proper search strategy that could be both precise and exhaustive. This approach allowed for the collection of a comprehensive as well as credible body of knowledge which is essential for a strong analysis within the context of the systematic review.

3.2.3. Search Framework

The current systematic review chooses the search framework of SPIDER. This framework is specifically suited for qualitative nature of the research. SPIDER, is an acronym which denotes sample, phenomenon of interest, design, evaluation, and research type. In general usage, this search framework is focused and suited for qualitative and mixed methods research (Amir-Behghadami, 2021). Therefore, this divergence from the traditional PICO and PEO framework that are generally utilised within the context of quantitative studies.

The selected search framework effectiveness lies within its nuanced approach to the qualitative research methods. The sample component of the search framework allows for a focused investigation and identification of the population within the context of the systematic review. Furthermore, the element of phenomenon of interest enables a exploration of the subject that is being studied within the system review which in the current context is stress and its impact on adolescent suicide ideation (Zafar et al., 2023).

The next element of Design enables a search that is focused on the methodology adopted by the studies that would be reviewed. In the context of the current systematic review, studies of equality, nature will be selected under this element. Moreover, the element of evaluation is pertinent to the nature of the outcomes that are being studied within the context of the qualitative assessment of the study subject (Xiao and Watson, 2019). Finally, the element of research type allows the search strategy to be guided with respect to the type of qualitative studies that can be used in the context of the current systematic review (Boland et al., 2017).

Therefore, the selection the SPIDER framework is a necessary and important strategic choice within the Conduct of the current systematic review. In contrast to search frameworks like PCO and PEO that are often limited with respect to scope to quantitative studies, the current search framework has a broader application and hence allows for the evaluation of qualitative elements of a study. Therefore, this search framework alliance perfectly with the established research question and the objectives of the systematic review.

3.2. Inclusion and Exclusion Criteria

The discussion of the inclusion and exclusion criteria that forms the basis of the current systematic review is founded in the aims established by the objective as well as the direction of the research question. Collectively work in these criteria develop a framework that allows for the maintenance of contextual appropriateness, reliability and relevance of the literature being examined within the context of the current systematic review (Kim et al., 2017).

Table 2: Inclusion and Exclusion Criteria
 

Study Design: In this aspect of the inclusion and exclusion criteria, it has been identified that only qualitative studies will be included in the research process in the current systematic review as it is more suited towards answering the research question (Pati and Lorusso, 2018). The focus of the current systematic review is to understand the behaviour aspects towards stress and its interaction and impact on adolescent suicide ideation.

This research focus is aided by the inclusion of qualitative studies. A choice of quantitative studies can limit the research from gaining contextual perspective regarding the manner in which these elements interact with each other within the context of adolescent lives (Bleiker et al., 2019).

Language: For the context of the current research paper. The chosen language of studies to be analysed as English. This selection is practical, considering that the location and geographical setting of the studies to be examined will be the states. The usage of English as selected language of choice will also ensure that there will be High availability of studies for the content of the research.

Publication Year: The time bracket of 2013 and 2023 is idea for capturing the most contemporary research which can reflect the evolution of the dynamics of adolescent stress and suicide ideation. The selection of this time period is important to the study as it also includes a time period which has seen considerable changes and evolutions in the technological as well as socio cultural landscape which may have an effect on the phenomenon being studied (Chen, 2017).

Population: The current review focuses on adolescent who are aged within 13 and 19 years. The selection of this age group is founded on on the factor that this age group is associated with considerable social and psychological transitions and transformations. Therefore, this age group is also often subject to vulnerability towards a large number of different mental health issues (Thomas et al., 2020).

Country: The current study has been limited with respect to the geographical focus within the United States of America. this choice is aimed at showing that the research is more focused and allows for a more in-depth and intricate investigation of the subject of the study in a specific setting. Therefore, the output generated by the study can offer more accurate representation of the contextual factors that exist in the certain geographical setting (Bleiker et al., 2019).

Topic: Ensuring that inclusion of studies is made only with respect to the topics of adolescent suicide. Education and stress will ensure that the research remains focused on the aims established through the aid of the research objectives as well as the research question (Chen, 2017). This will ensure that the study is not guided by bodies of literature that do not contribute to this study of the current phenomenon.

All of the criteria that has been specified above is aimed towards acting as a strategic filter through which the focus of the study may be amplified and expounded.

3.3. Quality Assessment

In the regular process of executing the current systematic review, the choice of the critical appraisal skills program (CASP) as the quality assessment tool is both justified and pertinent. This quality assessment tool is a widely revered framework that is highly suited for qualitative research.

The fundamental advantages offered by the quality assessment framework are founded in its approach towards the evaluation of the relevance and integrity of qualitative research. It enables a thorough investigation of the key elements of a study, which include aims, methodology, research, design, data collection, and analysis (Buchheri and Sharifi, 2017).

This high degree of attention to the details of the structural elements of a study is extremely important towards the conduct of a research that is based on the quality and depth of qualitative perspective and insights.

The tools structured questions assist the reviewer by guiding them through a process of systematic evaluation of the validity of each study. In addition, it also enables the researcher to engage in an investigation of the significance of the findings made by the research with respect to its relevance to the main research question (Ma et al., 2020).

The tool also enables the research to gather further clarity with respect to the studies aims and also ensures that the researcher evaluate the appropriateness of the method logical approach that had been chosen for the data collection and analysis of the study (Purssell, 2020). All of these elements ensure that the studies that are selected through the quality assessment are of high methodological quality which ensures that the insights generated by the studies are reliable and relevant and the context of the current systematic review (Hannes and Bennet, 2017).

The tool places high emphasis on ethical and transparency of the research process, and this especially alliance well with the ethical consideration that is required to be a priority within the context of a study or systematic review, such as the current one which discusses the condition of a vulnerable population such as the adolescent. This tool ensures that the studies that are included in the systematic review are held up to highest ethical standards which goes on to ensure that the systematic review has higher ethical integrity and credibility (Quigley et al., 2019).

Therefore, the adoption of this quality appraisal tool is a statement towards the current systematic review’s adherence with methodological quality and integrity. This tool ensures that the included studies are not only pertinent to the research question but are also of high methodological quality.

This choice ensures that the findings that are generated by the current systematic review will be both reliable as well as robust, and therefore they will generate meaningful insights in understanding the phenomenon of interest within the context of the current research paper (Pursell, 2020).

Within the context of the current systematic review, the application of the quality assessment tool was required to be conducted with absolute precision in order to ensure the accurate quality appraisal of the studies that were included within this systematic review (Buccheri and Sharifi, 2017). Each of the studies that were included in the systematic review went through a exhaustive assessment process which was guided by the framework of the quality assessment tool.

The criteria of the quality assessment tool were applied systematically to each of the studies. This enabled the identification of potential inaccuracies, biases (Long et al., 2020). This process also ensured a thorough evaluation of the findings and the validity and also allowed the research to explore the cumulative contribution of each of the gathered studies towards the primary research question.

The application of this approach with respect to quality assessment ensured that the studies which stood up to the quality quality requirements as ascribed by the researcher were included within the context of the current systematic review (Ma et al., 2020).

In addition to the same in order to ensure high degree of transparency towards the readers of systematic review, the quality assessment process engaged into by the researcher is included within the context of the systematic review in the form of a checklist table (Hannes and Bennet, 2017).

This inclusion will showcase the process adopted by the researcher with respect to assessing the quality of the studies included in the research process. Furthermore, the inclusion of the quality assessment checklist also allows the reader to gain an insight into the process undertaken by the reviewer to assess the quality and reliability of the included studies.

3.4. Data Extraction Table

The current systematic review that is focused on the qualitative investigation of the relationship between stress and suicide. Ideation among adolescent in the United States requires the development of a strategic data extraction table. This data would be developed with the aim of organising and synthesising the data that is extracted from the selective studies with the objective of ensuring detailed and methodical analysis (Kim et al., 2017).

Table 3: Data Extraction Table Layout
 

Within the conduct of the current systematic review, the data extraction table is not just an instrument for the organisation and presentation of the collected data but also acts as an important contribution in ensuring that the analysis carried out across the collected studies is consistent and comprehensive in nature.

3.5. Results presentation

Both narrative descriptions and tables will need to be used. In this context, the table is used to organise the important parts of the research, which include things like the study itself, its features, its measurable outcomes, and its important results. In order to make it easy to compare and analyse the studies that were chosen for the study, the presenting approach will use tabular format (Boland et al., 2017).

When presenting the findings of the systematic review, a narrative synthesis is just as important as the tables. Finding the overarching themes that come out of bringing all the research papers together is what this approach is all about (Xiao and Watson, 2019).

This allows the research synthesis to explore the findings' complexities and nuances. However, this would enable a more accurate and comprehensive research data study. Using this strategy, a narrative synthesis process could be developed to investigate many perspectives on the studies considered (Cumpston et al., 2019).

CASP findings will also be included in the systematic review's results chapter. These data will be in a summary table that includes all CASP tool factors used to evaluate each research study. The systematic review may include tabular representations of methodological strengths and weaknesses in each study (Munn et al., 2018).

Results must be presented clearly and consistently. Simplifying complex information for easy comprehension is crucial (Kim et al., 2017). The findings are coherent and clear, ensuring that they are understood in relation to the research question and objectives. Consistency and clarity are crucial due to the sensitive and complex topic (Boland et al., 2017).

Consistency and accuracy are crucial when presenting systematic review results. This aspect is based on the research's need to present the systematic review results clearly. Readers' perception of the findings in relation to the research questions and systematic review objectives depends on how clearly the results are presented (Xiao and Watson, 2019).

Chapter 4 – Results

4.1. Introduction

The complex phenomena of suicidal ideation and suicide in adolescents are examined in this chapter, which focuses on stress in the US. The text examines the complex relationship between societal, familial, and personal factors that cause adolescent mental health issues. A meticulous method allows the systematic review to filter through mountains of research and find the most important publications on this important topic.

This chapter synthesises qualitative research papers to better understand the patterns, causes, and experiences associated with suicidal ideation and suicide among adolescents. This comprehensive approach is influential on academic discussion and provides healthcare professionals, educators, and lawmakers with valuable insights. These insights will help them find more informed, empathetic, and targeted solutions.

4.2. Results of Search Strategy and Study Selection

This section uses the PRISMA flow diagram as adapted from Page et al. (2021) to describe this systematic review's research selection and rigorous search strategy. The PsychINFO, Medline, and Embase search yielded 556 records. Scopus, PubMed, and Medline provided tonnes of content with 190, 183, and 184 entries, respectively. After eliminating duplicates—essential for exclusivity and relevance—100 records were eliminated, leaving 456 suitable articles for preliminary screening.

Due to rigorous screening, 400 recordings were discarded. The most common explanation is that the results did not meet qualitative research criteria or were unrelated to the study's themes. To determine eligibility, the 56 remaining full-text articles were thoroughly reviewed. Many factors led to exclusion, including: Twelve studies were outside the U.S., fifteen diverged from the research's main topic, and twenty were mixed or non-qualitative.

Nine research sources met the strict qualitative synthesis criteria. The selection of these studies was made because they provided a deep qualitative understanding as to the complicated nature of this subject as well as its relevance towards adolescents’ ideation and suicide in demanding situations.

A rigorous selection procedure guarantees that all of the synthesis should be substantive and relevant, providing support for the study’s scholarly basis. This section will also be organised using a PRISMA flow diagram to keep it simple. It leads readers through a process of selecting appropriate research methods. This methodical practice lays grounds for theme analysis while promoting the authenticity of results.

4.3. Study Characteristics 

This systematic review is a critical analysis of research to examine what causes stress and suicidal tendencies in American adolescents. In spite of using different methodologies and topics, these researches complement this complicated field.

Gulbas et al. (2015) used exploratory qualitative approaches on NSSI and suicidal behaviours among latinas adolescent females. The group’s dynamics were outlined by them in terms of how members deal with their emotional issues relating family affiliation and cultural identity. This required an understanding of their culture, and emotion-focused research.”

Examining hospitalized adolescents’ journey from suicidal ideation to suicide attempt: An overview of O’Brien et al., 2021. Their qualitative data focused on histories, societies, relationships, and selves through semi structured interviews. Thus, the complexity of this change became apparent.

Ballard et al. (2013) examined the paediatric emergency department's suicide risk screening and its effects on youth 10–21. As most participants support suicide screening, their research shows that early diagnosis and intervention are crucial.

A detailed interview with Native American adolescents by Tingey et al. (2014) identified individual, family, community, and societal risk factors for suicide. New information on this group's unusual impacts and challenges makes this research important. Grief and emotional dysregulation are two.

Gulbas and Zayas (2015) examined how Latina adolescents' families and cultures affected suicide thoughts and actions. Their comparative research revealed cultural and family factors that affect adolescents' mental health and emotional distress coping mechanisms. These findings supported cultural tensions and family relationships as causes of emotional distress.

Kelada et al. (2016) examined parents' NSSI management of adolescents. Their research examines parents' emotions, parent-child interactions, and professional support.
Holliday and Vandermause's 2015 research focused on adolescents' experiences following suicide attempts. They stressed communication, the transformative journey, and isolation and reintegration in healing. This was done using hermeneutic phenomenology.

In conclusion, Richards et al. (2019) examined why healthcare workers may not report suicidal ideation before attempting suicide. Text analysis and semi-structured interviews reveal healthcare facility challenges. Fear of stigma, overreaction, and health system interactions prevent disclosure.

Besides being methodologically sound and following strict standards, all the research made significant contributions. This research synthesis comprehensively explains the many factors that affect adolescent suicide and suicidal thoughts. Social, familial, and cultural support systems are important.

Table 4: Data Extraction Table
 

4.4. Results of Study Quality Evaluation

CASP Quality Assessment of the selected studies shows research quality to be generally high, with a certain amount of variation in various aspects. Most of these studies, including those conducted by Ballard et al. (2013), O'Brien et al. (2021) and Gulbases et el. (2014), do not depart much from the CASP criteria; their research aims are clear; they use appropriate methodology in a rigorous fashion.

But there are cases where the suitability of the research design and relationship between researchers and subjects is pointed out. For instance, these are some of the uncertain areas shown by Gulbas & Zayas (2015), Holliday and Vandermause (2015), Richards et al. They can be related to whether the research design appropriately matches stated aims, or how participant-researcher relationships were handled. Such factors affect what conclusions and applications are drawn from findings.

The wiggling that we see for this 'value of the research' criterion in studies such as O’Brien et al. (2021), Gulbas & Zayas (2015) or Richards et al. points to a need on our part, I believe, for more finely attuned understanding about how these particular and individual contributions It may be a question of the direct relevance to practice or use in future research.

As a summary, although most of the studies present high methodological quality and ethical care, the assessment notes some areas to be further scrutinized or may still need to improve upon such as linking design with objectives; supervising researcher-participant dynamics. This subtle appreciation helps understand the overall quality and contribution of these studies to adolescent mental health.

Table 5: CASP Quality Assessment Table
 

4.5. Results of Synthesis

This synthesis brings together significant findings across studies on adolescent suicide and ideation, providing a more comprehensive appreciation of the subject. Key and core themes have been discussed in addition illustrative of tree map as part of the thematic analysis.
 
Figure 2: Theme Treemap

The importance of “Emotional regulation and Coping” among Latina adolescents is emphasized by Gulbas, et al., (2015) and Gulbas & Zayas (2015). Such studies unveil the vital significance of “emotional response” and “coping mechanisms” as they concern NSSI and suicidal behavior while exploring “family dynamics” and “cultural pressure”.

O’Brien et al.(2021) adds onto the theme section “Family and cultural dynamics” pointing out “the interplay of historical, sociocultural, interpersonal, and intrapersonal factors that precede the transition from suicide ideation to attempt”.

The study casts a wider net by introducing other factors such as sex and sexual orientations. In suicide prevention “the Importance of Social Support”, (Ballard et al., 2013). On the matter of Pediatric Emergency settings, Ballard et al. emphasize on “patient-nurse connection” and value of screening.

The “stigma and communication barriers” theme in Tingey et al.’s (2014) study investigates Native American teens about emotional dysregulation and stigma around treatment. It highlights society burden and grief pain contributing towards the high-risk causes of suicide on this community.

Kelada et al. (2016), and Holliday & Vandermause (2015) highlight “family relationship” and post suicide attempt “communicative aspects”. Kelada et al. give an original perspective for “parental emotional responses” as well as “impact on parent – child relationship”, while Holliday & Vandermause emphasise on the “transformation after the try” along with the “part disconnection and reconnection in recovery”.

Finally, Richards et al. (2019) discuss “Healthcare system challenges”, the reason for which patients do not reveal suicidal thoughts. The research they did on “fear of stigma”, “overreaction” and “loss of autonomy” underscore the communication challenges in health care settings.

The theme-oriented analysis blends various fragments of researches about teenage suicides and ideations, offering comprehensive insights. The “TreeMap” of ‘core’ and ‘key themes’ is used here to provide you with a snapshot of these relationships, emphasising how much emotions, family-related issues, culture, and society shape teenagers’ experiences involving suicides and feelings.

4.6. Thematic Analysis

4.6.1. Emotional Regulation and Coping

Exploring “Emotional Responses” and “Coping Mechanism” – is a central theme for analysis in adolescent suicide and ideation. Study by Gulbas et al. (2015) and Gulbas and Zayas (2015), to mention some; makes notable contribution with deep understandings of emotional landscaped explored by Latina adolescent.

Gulbas et al, (2015) explain complex nature of “Emotional regulation” within NSSI and suicide behaviors, showing how emotional reactions may either result in or precede these acts. The emotion spectrum is composed by a myriad of feelings that include despair and frustration in a combination, which influences these types of behaviors observed on them. The research reveals that this emotional regulation is not just an individual struggle but is deeply entrenched into the fabric of family and culture.

Additionally, Gulbas and Zayas (2015) expand on this investigation onto coping mechanisms. This thorough study identifies how the cultural conflicts and family dynamics that cause of Latina adolescent’s stressors inform their coping techniques. In that regard, this study highlights the need for appreciating how these coping mechanisms are understood based on culture and family relations as they may just be perceived as individualistic reactions rather than being based on broader socio-cultural backgrounds.

The two have demonstrated complex interconnectedness of “Emotional Responses” and “Coping mechanisms”. If a teenager faces an emotional stress, it becomes very dependent on both cultural and family expectations in order for him or her to cope with it. These studies highlight the importance of taking a culturally sensitive view in addressing these various psychological issues associated with different adolescent children.

Also, these assessments widen the scope of adolescent psychology since they make it apparent that cultural aspects should be considered while planning the prevention of mental disorders. Such efforts become valuable in the prevention as well as interventions geared towards such suicide cases and teens engaged with NSSI.

Summarily, “Emotional Regulation and Coping” which formed the main part in most of the studies provides insight into the world inside the mind of an adolescent who has suicidal thoughts or feelings. Such approach brings into the limelight that adolescent’s issues pertaining to emotions and psychology should be understood within their given setting and family. Such a holistic approach, is crucial for designing better and more empathic strategies in addressing teenage suicide and self-harm.

In general, the topic of emotional regulation and coping which appears in these studies looks into the inner world that suicidal adolescents face. It emphasizes the necessity to recognize and respond to the psychological or emotional needs of adolescents within diverse cultural families. It is this holistic concept that makes taking a more effective and humane approach to the prevention of adolescent suicide all important.

4.6.2. Family and Cultural Dynamics

Adolescent suicide and ideation is central to comprehending the theme of “Family and Cultural Dynamics” theme including “family relationships” and “cultural contexts”. In detail, this theme is investigated in the studies of Tingey et al. (2014), Gulbas et al. (2015) and Gulbas & Zayas (2015).e}.
Gulbas et al. (2015) explore the intricate relationship between family relationships and emotional regulation within Latina adolescents.

It is revealed in their study that some family relations like those that are based on cultural expectation and pressure greatly affect the mental health of these teens. The finding highlights the significance of family as a source of support and pressure in order to understand the ways in which interaction among family members may attenuate or aggravate risk-factors associated with NSSI and suicide.

Likewise, Gulbas & Zayas (2015) explored how culture and family influenced suicidality among Latina adolescents. They show how cultural conflict combines with family dynamics leading to mental problems among adolescents. It emphasizes the importance of understanding how cultural values and family expectations lead to internal conflicts that amplify suicide risks when people start experiencing extreme emotions and adopt abnormal coping mechanisms.

Tingey et al. (2014) further elaborate this theme on native american adolescents concerning the sociocultural and familial determinants of suicide rates among this ethnic group. The focus of their research is on the family bereavement and peer pressure that leads to emotional dysregulation.

It is also the case that there prevails a strong stigma regarding the treatment of mental illness in these communities which, in turn, adds up to cultural issues within families. This study identifies a culturally specific situation where adolescent Native Americans are affected by unique social circumstances with regard to their health care.

Taken together, these studies demonstrate the importance of “Family Relationships” in respect of suicidal ideation among the children of adolescents. Family bonds, with their cultural obligations, are often protective against or causative for mental illness depending on which is at play. Hence support, understanding, and acceptance of parents, brothers and extended family, they can help greatly with their positive impacts on adolescent’s mental health.

In addition, “Cultural Contexts” in which these teenagers are situated become of great importance. Distress expression, seeking help, and coping all depend upon cultural norms, values, and beliefs. This understanding is key for successful prevention and intervention plans which take into consideration adolescents diversity backgrounds.

Therefore, it is critical to incorporate “Family and Cultural Dynamics” into the discussion on adolescent suicides and ideation. Emphasizing the comprehensive nature of holistic approach necessitates consideration of cultural contexts as well as family relations which are the major determinants of adolescents’ mental health status. This requires culture-sensitive and home-based solutions to build protective family environment and strengthen adolescents’ resiliency in the context of their culture.

Thus, the incorporation of "Family and Cultural Dynamics" in adolescent suicide and ideational discourses is indispensable. This thematic emphasis also points to the need for an integrated perspective in dealing with adolescent mental health, one absorbing both family relations and cultural backgrounds as a whole. Approaches of this kind require interventions which are culturally sensitive and family-based, promoting positive familial environments where adolescents can develop within their own cultural environment.

4.6.3. Importance of Social Support

Family support, school support, healthcare professional support — is found as a fundamental theme in adolescent suicide and ideation. Ballard et al., (2013) and Kelada et al., (2016) all demonstrate that support systems are critical for teenage mental well-being. Among others, Ballard et al. (2013) address “Healthcare Professional Support” in pediatric emergency departments into the discussion.

The research by them shows that most of the young patients are for suicide risk screening revealing an important role played by health care providers in identification and intervention towards the problem. Mental health assessements should be integrated in the emergency care setting allowing health care professional to act as a crucial buffer against adolescent suicides.

Adding more dimension to the issue, Kelada et al. (2016) examine the views of those parents who have to cope with their adolescent children’s NSSI. The impact that these challenges have on parents is shown with reference to the need for professionals who will assist them. Health care providers should not only provide for the adolescents, but they should also help in guiding and counseling their families.

Taken together, these studies highlight the multiplexity of “Social Support” in relation to adolescent mental health. However, they emphasize the need for multifaceted support systems which involve family, school, and health care personnel respectively. The suite of the support systems offers unique roles as pillars, assisting adolescents dealing with suicidal thoughts and attempts.

Finally, “Family Support”, “School Support”, and “Healthcare Professional Support” must be integrated to develop an overall support structure for teenagers. This reflects a holistic approach to looking at adolescent’s mental health. To that effect, it entails a team effort for ensuring a conducive environment where adolescents enjoy themselves and have support when in distress.

To summarize, the combination of "Family Support", "School Support" and "Healthcare Professional Support" is necessary if we are to establish a comprehensive support system for adolescents. This all-encompassing perspective brings into relief the necessity of cooperation among sections, so that adolescents can be nourished and feel secure. When times are hard, they will have help to turn to if something in their minds goes wrong during these vulnerable years.

4.6.4. Stigma and Communication Barriers

It is vital in tackling adolescent suicide and ideation under Theme 4 comprising of “Fear of stigma”, “communication challenges” & “healthcare system challenges” which are found in the studies discussed ahead. The study of Richards et al. (2019), Tingey et al. (2014) and Ballard et al. (2013) explores the challenges on handling mental illnesses in adolescents.

Richards et al. (2019), provide a piercing insight as to why Adolescence might fail reporting suicide related ideations in health care settings, focusing primarily on the Fear of Stigma”. The study reveals that most of the adolescents assume unfavorable reactions towards the disclosure of their mental distress, thereby inhibiting them from reporting issues bothering them. This stigmatic silence as a consequence of this fear of being stigmatised leads people to ignore serious problems.

Additionally, “the Communication Challenges” involved in talking about mental health matters, as indicated by Richards et al. (2019). By this point, it has already been noted that communication about suicide is extremely sensitive, dependent on the wording utilized and what someone understands their brain to be. Another problem stems from the apprehension and hesitancy of sharing experiences revolving around the teen’s inner life. As a case in point, teens tend not to disclose what is going on mentally or ask for professional assistance.

In this paper Tingey et al. (2014), discuss about “Healthcare System Challenges” to Native American adolescents and how culture and shame impact on the access for the mental health care. Through their study, it shows up the different situations in health system that could fail an interventional plan for suicidal teenagers, including insensitivity culture and the embarrassment of seeing a psychiatrist. These systemic issues could fail to provide adequate support to at risk teens and thus deprive these individuals of essential means of assistance.

Additionally, Ballard et al. (2013) emphasize the importance of healthcare professionals in spotting and dealing with adolescents’ mental health problems. Nonetheless, the success of such support is hindered by the mentioned communication problems and systemic challenges. Their study encourages healthcare systems to embrace more holistic and interconnected approaches in order to effectively deal with the problems.

To conclude this section, “Stigma and Communication Barriers” are considerable impediments for adolescent suicide and ideation management and prevention. The barriers are not only at the personal and interpersonal levels such as the fear of stigma and communication problems but even at the system level whereby there may not be adequate health facilities that cater for mental health disorders in adolescents. These obstacles should be surpassed by encouraging open, sympathetic conversations, decreasing prejudice, and more convenient, appropriate medical settings for children.

In a nutshell, stigma and communication barriers reflect major obstacles to suicide management and prevention among adolescents. These obstacles are by no means limited to the personal or interpersonal realm, as for example there is fear of stigma and difficulties in communication.

Even at a structural level, the healthcare system might not be equipped with systems appropriate for treating adolescents who have mental health problems. Rising to this challenge requires concerted work towards opening dialogue, removing the stigma and making health care a place that is reachable for adolescents 'mental-health needs.

Chapter 5 – Discussion

A growing problem in public health circles For this systematic review, the rising incidence of suicide and suicidal ideations among adolescents in the United States is critically reviewed. The main concern of this dialogue is to examine closely the preliminary conclusions from this systematic review in light of current academic landscape.

The goal of this investigation is to expose the intertwined kernel levels within adolescent mental health crises, while acknowledging at the same time that most previous studies are ascribed limitations. Furthermore, the discourse ventures hopeful suggestions and specifies channels for future work to do in these practices. It therefore participates in the wider conversation about adolescent mental health and suicide prevention.

5.2. Critical Appraisal of Included Studies

While the methodology used in these studies is mostly qualitative, which indicates that a thorough investigation of all factors concerning adolescent suicide and suicidal ideation has been undertaken. Particularly, Gulbas et al. (2015) and Tingey et al. (2014) use an exploratory or Apache model interview respectively regarding specific ethnic groups--Latina and Native American adolescents.

These culturally specific cohorts emphasise the stereotyped nature of social and family influences on emotional regulation, as well. In a similar vein, O’Brien et al. (2021) choose in-depth interviews given over to an adolescent cohort admitted to hospital. This choice of methodology offers a private view into the personal and sociocultural factors affecting suicide attempts.

Pediatric patients are included by Ballard et al. (2013) In an extension, the significance of suicide risk screening through interviews is emphasized as means to prevent disaster and maintain patient-nurse relationship. Comparative analysis and a combination of interviews and questionnaires diversifies the qualitative spectrum even further, as applied by Gulbas and Zayas (2015) or Kelada et al. (2016). Family and cultural influences, parental experiences These studies look at the family environment when an adolescent is faced with a mental health problem.

In order to examine the experience of post-suicide attempt, Holliday and Vandermause (2015) use a hermeneutic approach with limited numbers or individuals. This approach makes it easier for us to understand the communicative aspects, transformation and recovery.

Just as Richards et al. (2019) use content analysis interviews to look at why people don't report ideation, they extracted very important information on fear of stigma and the role alcohol plays, while also looking at how health systems are involved in those processes that suppress ‘ideators’.

The populations studied here vary from individual ethnic groups to larger adolescent subsets. Sample sizes also differ, ranging between just six individuals and over a hundred participants. To add to the richness of our data this diversity in sample size and characteristics presents challenges when it comes generalisability, representativeness. In short, the methodologies used in these studies are laudably designed to delineate adolescent suicide and ideation.

By doing this they get the complexity of emotional, family and social relations--the salient weaknesses being those imposed upon qualitative research by subjectivity, arbitrariness in selection procedures for case studies combined with small sample sizes. These methodologies allow us to see the actual conditions of life for adolescents, providing a foundation from which we can develop targeted interventions or policies.

Validity and reliability of the findings are crucial in research conclusions drawn from those studies reviewed. Because the nature of these studies is qualitative, internal validity must be established--usually by rigorous methodology and self-reflexivity among researchers.

For instance, in studies by Gulbas et al. (2015) and Tingey et al., using richly textured interviews that are culturally attuned strengthens validity because the experiences of an ethnic group are recorded accurately. These results, especially in qualitative research, are very much dependent on the consistency and openness of methodology or interpretive framework. This is shown by Ballard et al. (2013)’s and O'Brien et al.'s studies with their systematic collecting of data followed by analysis thereof.

But the different sample sizes and specific situations of these studies make external reliability and generalisability difficult to achieve. Moreover, the diversity of qualitative methodologies adopted across studies—Holliday and Vandermause (2015) employ hermeneutics analysis while Richards et al. adopt contentanalysis --emphasizes how important contextual interpretation is in this area.

Such approaches excel at eliciting detailed insights, but there are valid concerns over whether the findings can be replicated in different settings or with other populations. The soundness of the studies is enhanced by open expression and description of results, accompanied with admission that they have their limitations. The studies are always reflexive, showing the influence of the researcher's standpoint on interpretation and strengthening confidence in the conclusions.

Overall, the conclusion reached by these studies is rooted in their meticulousness of methodology and how faithfully they interpret data. Nevertheless, due to the intrinsic qualities of qualitative research--the specificity of samples and subjectivity in interpretation-extrapolation from these findings needs careful consideration.

5.3. Discussion 

5.3.1. Despair Leads to Self-Harm Tendencies

The findings point out that the regulation of emotion in NSSI and suicide behaviors is a complex process, where despair can lead to self-injury or be its result; frustration may either preface it or follow along with other emotions on this spectrum. Among these active parts we focus on emotional regulation. This is certainly not something all done by the individual, but has its own deep roots in family life and culture, a factor which needs to be understood when people are undergoing mental health interventions.

Also, Gulbas and Zayas (2015) take a deep look at coping strategies. Cultural conflictions and family dynamics create stresses for Latina adolescents which then determine their styles of adjustment. This study emphasizes the need to see coping mechanisms not as pure forms of individualism, but rather very much expressions of socio-cultural backgrounds.

These results fit in with literature existing already, such as Brausch et al., (2017), Miller at el. (2018) and Hatkevich at el. (2019), all of whom find that specific emotion regulation deficits and strategies are especially important when predicting NSSI or suicide ideation among adolescents. These studies indicate that deficits such as lack of emotional awareness, poor cognitive reappraisal and inadequate access to emotion regulation strategies were extremely closely associated with the presence or severity of suicide ideation.

Moreover, according to the studies of Gómez-Tabares et al. (2021), and Wastler and Núñez (2022), these results are consistent with their findings that coping strategies as well emotion regulation play an important part in suicide ideation or suicidal efforts. In addition, Midkiff et al. (2018) point out that during attempts to prevent or stop NSSI an emphasis should be placed on development of emotion regulation skills rather than just increasing coping self-efficacy alone.

Taken as a whole, these studies suggest that emotion in teenagers who commit or ideate about suicide is very complex. Taking these developmental factors, such aains as those stemming from adolescence; problems associated with the family background (mostly social in origin); and attitudes of many Chinese towards suicidal thoughts--all this has to be factored into play.

5.3.2. Families Shape the Mental Outlook of Adolescents

The findings show that family and cultural factors have a significant impact in terms of impacting the mental state of adolescents and teenagers who might undergo suicide ideation. Family and cultural factors in adolescent suicide and ideation are complex, to say the least. The results show that adolescent mental health can indeed be influenced by families not only through family relationships but also cultural factors.

It has been described that the tangled relationship between family dynamic and emotional regulation among Hispanic adolescents, how cultural norms and parental pressures impact their psychiatric status is particularly noteworthy. This finding illustrates that family can serve as both a support and a source of stress. It is important to note, however,that it help affect risk factors for NSSI or suicide.

In addition to the same, Gulbas and Zayas (2015) also look at how culture, along with family influence suicidality among Latina adolescents. According to their research, when these two factors overlap and combine with cultural conflict, they find that indeed adolescents experience mental health problems. This research emphasizes that with such strong emotions and maladaptive coping mechanisms, the interaction between cultural value systems and family expectations coupled with internal conflicts can exacerbate suicide risk.

Further, Tingey et al. (2014) focus on adolescent Native Americans and consider how these factors influence suicide rates among this population. Family bereavement, peer pressure and the stigma often attached to mental illness treatment are some of the issues brought out in this study that affect residents in these communities. With regard to that, this research contains some initial points about the culture-specific obstacles hindering Native American youth mental health care.

Independently, Boyd et al. (2021) and Hausmann-Stabile & Gulbas (2023), both highlight the role of parental engagement and that cultural understandings about family functions exhibit a great degree of complexity themselves within particular cultures. The work of Augsberger et al. (2018) and Marraccini et al., in particular, considers cultural factors such as pressure to succeed or the dynamics of intimate relationships that lead Asian American women towards suicidal ideation which require culturally sensitive approaches for suicide prevention. Aytur et al. (2022) and Ortin et al. (2018), round out this discussion with treatments of social-ecological theory which they apply to suicidal ideation, as well as looking at a parent--adolescent acculturation gap arising from differences between countries' national Together, these studies focus attention on the central role of family and cultural factors in adolescent suicide and ideation. They point to a need for more culturally sensitive interventions that adequately capture this ever-changing landscape.

5.3.3. Adolescents need Social Support for better Management of Suicide Ideation

The findings highlight the importance of social support systems in adolescent mental health, including suicide and ideation. The findings highlight the key role of healthcare professionals in pediatric emergency departments, especially screening for suicide risk. Kaleda et al. (2016) points out that we need to bring mental health assessments into emergency care settings. In this way, medicine should be at the forefront as gatekeepers in doing early recognition of suicide risks among adolescents from an early age.

Kelada et al. (2016) add another dimension by considering how parents feel about their adolescents 'nonsuicidal self-injury (NSSI). The two-way strategy of helping adolescents at the same time as guiding their families is essential to comprehensive mental health care. These results are further reinforced by Mackin et al. (2017) who find that parental support seems to be particularly effective in protecting youth from the influence of interpersonal life stress over suicidal ideation and self-harm during adolescence.

At the same time, Hollingsworth et al. (2018) tie inadequate social support to beliefs about being a burden, which can then lead to suicidal thinking. Ibrahim et al. (2019) indicate that the roles of family support and spiritual wellbeing combined strongly predict suicidal ideation amongthose marginalized adolescents under their study.

Mitchell et al. (2021) examine the various elements of social support trodden by sexual- and gender-minority youth, shedding light on how experiencing suicidal behavior can affect a depressed mood as well as exploring just what kind of role is played in these situations by the notion of social support itself. Tabaac et al. (2016) and Kim (2021) further explore the role of social support, including family support in addition to peer-based assistance, on suicide risk among sexual minority women as well as Asian immigrants.

It is also clear that the nature and quality of these social support systems are as important a factor in adolescent mental health. The relationship between social support and adolescent mental health is not as straightforward. In research conducted by Mackin et al. (2017) and Hollingsworth et al. (2018), parental/peer support quality was found to make a big difference in teenagers 'mental wellbeing, amid myriad sources of stress including suicidal thinking.

Social support is not limited to the family, peer group. Mitchell et al. (2021) and Tabaac et al. (2016), among others, stress the importance of community support--which is perhaps even more important for sexual-gender minority youth, who are particularly vulnerableto unique hardships in our culture soaked with concepts attributing social worth to based upheaval and saturated with ideas about normalityand Kim (2021) expresses this complexity in support systems, given the reality of cultural diversity and acculturation among immigrant populations.

All the researches together show that social support systems should be comprehensive and culturally acceptable, but adaptable enough to cover all adolescents 'differing needs. And support systems offer not only a safety net against mental health crises, but also help kids develop strength that allows them to deal with all kinds of obstacles.

If the multi-tiered support systems mentioned above can be incorporated into mental health intervention and policy, this will help promote young people's overall welfare.

Together, these studies suggest that a strong network involving family members, peers and medical professionals is crucial in reducing the influence of risks caused by suicidal ideation or behavior. Adolescent mental problems are multifactorial. Therefore, preventive strategies and interventions integrating social support must be placed in the first line of attack.

5.3.4. Seeking Help for Suicide Ideation is Often Limited by Stigma

The findings show the crucial problems of mental illness in youths, e.g., stigma and communication. According to Richards et al. (2019), the main reason for not admitting suicidal ideation among adolescents is fear of stigma in a medical setting. The result is that adolescent often maintain a stigmatic silence, hiding their mental suffering.

This shows the negative effect stigma has on adolescents 'willingness to seek help. And talking about mental health, as noted by Richards et al. (2019) communication problems indicate the sensitivity and complexity of conversations surrounding suicide. It is further exacerbated by the hesitation and uncertainty of adolescents in revealing their psychological woes to someone, or even seeking professional advice.

Cultural difficulties Tingey et al. (2014) examine the reasons why Native American adolescents have such trouble getting health care services, noting that cultural barriers and shame make it hard for these people to get mental health treatment in particular. Further, the study points out that there are systemic problems, such as cultural insensitivity and social stigma attached to seeking psychiatric care. These obstacles can reduce or even prevent effective intervention.

It is an important task for the health sector professionals to identify and treat problems with adolescents ' mental well-being, as Ballard et al. (2013) point out. However, such support is often frustrated by communication problems and systemic malfunctions. Their studies argue that such issues need to be integrated in more comprehensive and joined-up ways into healthcare systems. For example, this may take from the literature in Keller et al. (2019), McGillivray et al. (2023) and Pharr at el.. Silva and Van Orden (2018), Aguirre Velasco et al. (2020) among others, highlight the barriers in many of these areas for both Hispanics and other racial minority groups (Tosco et al., 2019).

Fighting the stigma and communication barriers against adolescent suicide prevention work is a difficult task. Stigma is a complex construct, according to studies of Keller et al. (2019) and McGillivrayetal.,( 202). It differs from culture to culture and person by person, but effects help-seeking behaviors. Though these obstacles are not limited to outside factors, often many of them suffer self-stigmatization and hesitate even more.

There is considerable emphasis in both Pharr et al. (2018) and Silva & Van Orden (2018), for example, on the role of community or individual resilience counterbalancing structural stigma's negative impact upon sexual minorities. Combating the negative psychological effects of stigma One way is to develop resilience, particularly in marginalized groups.

Inclusive policies and a good community network can help develop such resilience. One possible way to overcome communication barriers, suggests Toscos et al. (2019), is integrating telemental health resources. Anonymous, stigma-free online platforms give adolescents a place to turn for help. Yet the digital divide and issues of privacy must be resolved if we are to ensure equal distribution. Also, Aguirre Velasco et al. (2020) highlight the importance of mental health literacy and education in combating stigma.

Only by raising the level of mental health awareness among adolescents and their families can a more open, tolerant atmosphere for discussing these issues be achieved. These studies taken together help to underline the urgent need for interventions, which can overcome stigma and information exchange difficulties, are culturally sensitive and create an environment where young people dare not raise a question about their mental health problems even in some communication.

5.4. Opportunities for future research

An analysis of the results of a systematic review shows that health care providers, educators and policy makers concerned about adolescent suicide and ideation should adopt a comprehensive approach. Therefore, as Richards et al. (2019) point out in the first case that reducing the fear of stigma requires open communication, and McGillivray et al. (202) argue that this should be based on fostering a developmental paradigm by establishing an alliance with health workers to ensure patients 'welfare is included in their considerations about how Moreover, Silva and Van Orden (2018) believe that cultural sensitivity training is indispensable when doing work with diverse groups of adolescents.

Mackin et al. (2017) state that social support has been shown to reduce suicide risk, and educators need to provide supportive school environments, the authors point out. Teaching mental health education in the curricula will make them better understand and less stigmatized, so they are more willing to go for help.

As suggested in a conversation by Pharr et al. (2022), policy makers must establish policies and enforce them to eliminate structural stigma, at the same time as fostering community strength. Suicide prevention is effective only through investment in early accessible mental health services and interventions, especially for vulnerable groups. This is because we require an integrated, culturally sensitive strategy that takes into account both individual factors and systemic causes related to adolescent mental health.

5.5. Limitations

Some of the studies, particularly Gulbas et al. (2015), O’Brien et al.(2021), and others, had adopted a predominantly qualitative methodology which gives greater depth but restricts its application more broadly to an adolescent population as a whole. Further, the focus of studies by Gulbas et al. (2015) and Tingey et al. (2014), respectively, on Latina adolescents or Native American youths demonstrates that this is a culture-specific finding--one which may not hold true for all groups of adolescents from different racial backgrounds.

Moreover, Holliday & Vandermause (2015), who included only six adolescents in their studies, cannot generalize their conclusions. The use of self-report measures, as in Richards et al. (2019), involves inherent bias due to personal perceptions and stigma; thus, it is unclear whether the reported experiences are accurately portrayed or not.

Therefore, although there are some runs on the board from this review that could help us better understand adolescent suicide and ideation, these limitations remind one of the need for careful interpretation when reading about research. Another major limitation that has to be acknowledged in the current systematic review, is its dependence on a single reviewer.

Generally, systematic reviews with more than one reviewer are able to mitigate any issues that may be faced as a result of bias caused by the dependence on only one reviewer.

5.6. Strengths of the Systematic Review

In doing this qualitative systematic review, using a wide search method to find all kinds of studies was very important. This helped make sure the researcher looked at many articles on the subject in the current field of research.

The details of the things causing thoughts about suicide among teenagers were carefully caught. This showed a complicated and different range of factors that affect it. This careful search plan, guided by a strict inclusion criteria, acted as a close filter. It made the picked studies more important and higher in how they were carried out. Using strict testing methods doesn't only show careful work but also ensures the trustworthiness of combined evidence.

Chapter 6 – Conclusion

6.1. Conclusion

Looking at many literatures, the review found that stress and thoughts about suicide are connected in teenagers. The study showed that there are many kinds of stress, like bad treatment and social issues. It told how these pressures can influence people's thoughts about suicide in many different ways.

The main goal is to know what teenagers are upset about. The study suggests that bad treatment and money troubles hurt them strongly. It is especially hard on minorities or people from not-so-rich backgrounds compared to others. Mackin et al. (2017) along with Ibrahim et al. (2019) demonstrate how strong connections help to reduce the effects of stress on thoughts about suicide, noting that there is a tricky link between personal problems and issues from outside sources. Mitchell et al. (2021) found that young people who are LGBTQ+ face extra challenges, so it is important to remember different types of people when trying to stop suicide attempts.

The results closely examine strength and safety points with the aim of discovering ways to reduce thoughts about suicide in teens. Ballard et al. (2013) and Kelada et al. (2016) show how important support networks are, stressing the need for actions to help not just teenagers but also their families as well. The main idea shows how important it is to think about stress in a way that looks at both what might cause problems inside and outside of your personal life. It gives the whole picture, which helps make good health policies for everyone's well-being.

Even though the qualitative systematic review is strong, it is important to look at its weaknesses. This will help give a clearer meaning of what was found in these reviews. One big problem is that the researcher only checked studies in English. This could make it unfair and might accidentally miss important information found outside of English. This picky rule might limit how complete the review is by missing important views and studies done in other languages.

Another important limitation is the focus on research done in the United States. This detail makes the information more useful to the people it is aimed at, but at the same time it limits how well these findings can be applied in different cultural situations. Since stress and suicide ideation is very nuanced, many countries should be thought of when looking at this kind of thing. Just focusing on one culture may not make the results or findings helpful for other places too.

Another big challenge comes from the different ways and tools used in all kinds of studies included. This diversity makes it hard to directly compare and combine results, possibly impacting the overall understanding. Also, not including unpublished literature and grey literature could make a possible slant towards what gets published. This may miss out helpful details from places that have not been checked by others.

This bad opinion can mistakenly make the proof unfair; it affects how thorough a detailed study is. It is crucial to know these limits for maintaining fairness and high standards when examining the results of a qualitative system review. This helps give an un-biased view about how far or where they can be used, making their use fairer overall. 

Furthermore, this review is planned and strong. It helps combine evidence in an orderly way to form a clear story. The organized method helped bring together different studies. It gave a big-picture look at what is known now about stress and how it affects suicide ideation in teenagers. The putting together of information was not just a simple joining but careful thinking, which helped get deep understandings from the various qualitative studies that were used.

Important studies like Ballard et al. (2013), Kelada et al. (2016) and the extensive study details in the data extraction table helped make sure the overview was systematic, giving the discourse deep insight into stressors affecting teen mental health problems and how they do this. These strong points together show that this in-depth study is believable and covers all the areas. It gives a big base to look deeply into stress effects on thoughts of suicide for teenagers.

6.1.1. Alignment with Objectives

The systematic review matches its planned goals, giving a careful study of problems and their complicated ties with thinking about suicide among teens in the United States. The first goal, which tries to see how different kinds of pressure affect teen suicide rates, is carefully looked at.

The review looks at different studies like Mackin et al. (2017), Mitchell et al. (2021) and others to show how stress can come from many things such as bad treatment, unfair income differences or fighting against what's right/good behaviour in social life thinking about suicide ideation by teens is affected differently due to these reasons listed earlier.

The review helps find out what causes stress more for poor and minority teenagers. This supports the second goal. Ibrahim and Kim's studies in 2019 and 2021 give helpful information about the unique problems faced by people who are marginalized. This shows that there is a need for special efforts to help these groups deal with their specific stresses.

The third goal, which tries to understand how person and environment stresses make suicide thoughts happen is met well. The research by Mitchell et al. (2021) shows that social support affects different young people in complicated ways, making it essential to think about various backgrounds when trying to stop suicide among youths.

The last goal, looking at how strength and safe things make suicidal thoughts less likely is firmly connected throughout the study. Ballard et al. (2013) and Kelada et al. (2016) show the important need for help systems and actions that do not just matter to teenagers but also their families, helping understand what reduces thoughts of suicide better.

In the end, a thorough review matches its goals perfectly by fully looking at stressors and how they are different. This includes the complex mix of things affecting thoughts about suicide in teenagers.

6.2. Recommendations for Practice

Based on the study's results, the researcher suggests focusing on culturally friendly and specific treatments in their practices. There is a requirement to start mental health programs in schools. These focus on various worries and make teenagers stronger against them. Studies like Mackin et al. (2017) and Kim (2021) show how important it is to take into account cultural differences when planning ways to lessen the effect of stress on people who are already struggling.

Doctors should include checking for suicide risk in normal care, especially focusing on groups that might be prone to it. Studies such as the one done by Ballard et al. (2013), show how important healthcare workers are in recognizing and helping prevent teens from committing suicide. These studies also point out that frequent checks should be done to spot early signs of this problem and allow us assist sooner.

Also, group efforts in the community are supported to build social care and lessen negative feelings about mental health problems. Ibrahim and Tabaac studies from 2019, 2016 stress how important it is for support groups in neighbourhoods to stop teenagers from thinking about suicide. They push people to come up with all-encompassing plans that also include the community when talking about keeping mental health good.

6.3. Recommendations for Research

For future studies, it is suggested to look at if certain ways help with stressors found in this systematic review. Studies that go on for a long time, like the ones done by Mitchell et al. (2021) or Hollingsworth et al. (2018) can show important things about how stress changes over time. This helps to understand its effect on thoughts of suicide among teenagers. It is important to look at how stress and thoughts of suicide might be different for men and women. This helps fully understand the situation.

Studies like Kim (2021) show that special help designed for boys and girls might be needed to handle the different ways teens feel stress. In the future, research should do studies that compare different cultures. This will help learn more about many things. Understanding how stressors show up and affect thoughts about suicide differently in different cultures, as pointed out by Ibrahim et al. (2019), would help use finding for more people and tell what sort of culturally keen activities that could be done to assist those definite needs.

6.4. Self-reflection

Through self-reflection, this systematic review has been a smart journey with troubles and discoveries. I learned during the research process that questions about teen mental health are constantly changing and new discoveries keep coming. Systematic reviews need to change and check them carefully for each step. This shows how important strict methods are in the process. This journey shows how important it is to keep learning, work together in many fields and always look for new information.

This helps us deal with difficult public health problems better. It is a reminder that mental health studies always change, so there is a need to keep up with new things and use both mind and physical methods. The problems faced during this careful study have helped me learn and grow personally and in my task. They also showed how complex it can be to research mental health issues.

 

Top Healthcare Samples

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