Systematic Review: A 25-Year Global Publication Analysis of the Role of Spirituality and Religiosity in Suicidal Risk Assessment in Adolescents.

Objective: Religiosity and spirituality have demonstrated protective associations against suicidal ideation and behavior in adults. Despite accumulating evidence of similar associations in adolescents, no systematic review to the authors' knowledge has examined associations between religiosity/spirituality and adolescent suicidality. The authors hypothesized that, in general, religiosity and spirituality would function as protective factors against suicidality in adolescent populations. This systematic review summarizes global findings on this topic, with particular focus on at-risk groups including racial, religious, and sexual minorities. Method: PubMed, Web of Science, Embase, and CINAHL were searched for relevant studies on December 18, 2023. Eligible articles were from peer-reviewed journals, included subjects ages 10 to 25, and employed measures of suicidality and religiosity/spirituality. Studies were evaluated using the Mixed Methods Appraisal Tool. Results: Inclusion criteria were met by 61 studies (340,170 participants); 49 were cross-sectional, 7 were longitudinal, and several were qualitative or used mixed methods. Of studies, 67.2% found protective associations between religiosity/spirituality and suicidality, 8.2% reported risk associations, 8.2% described complex associations, and 16.4% found no association. Mediators included general social support. Moderators included levels of parental monitoring. Studies of ethnoracially minoritized adolescents suggested a protective role for religiosity, whereas results in religiously minoritized and LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and others) adolescents were equivocal. Conclusion: A substantial majority of studies demonstrated that greater investment in religiosity/spirituality predicted reduced suicidality in adolescents. Findings suggest that religiosity and spirituality can provide adolescents with reasons for living and should be addressed in clinical practice and prevention efforts. Limitations include the cross-sectional design of most included studies, preventing causal inferences. Future research should evaluate spiritually inclusive therapeutic and preventive interventions for adolescents. Study registration information: Prevalence of Neurodevelopmental Disorders among Indigenous Children: A Systematic Review; https://www.crd.york.ac.uk/PROSPERO/view/CRD42021238669. Diversity & Inclusion Statement: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.