Psychological Burden and Suicidal Vulnerability in Adolescents with Thalassemia Major: A Scoping Review.

Objective: To map the literature regarding suicidal ideation in adolescents with thalassemia, specifically examining its relationship with clinical, treatment-related, and psychosocial factors while identifying existing research gaps. This review is particularly timely as significant improvements in life expectancy for thalassemia patients have shifted the clinical priority toward long-term mental health management and suicide prevention. Methods: This scoping review follows the framework developed by Arksey and O'Malley and is reported in accordance with the PRISMA-ScR guidelines. A systematic literature search was conducted in the PubMed, Scopus, and CINAHL databases. Studies meeting the inclusion criteria were primary research articles with cross sectional, cohort study, or qualitative designs involving adolescents with thalassemia and explicitly assessing the suicidal ideation or related psychosocial factors. Data were extracted using a standardized data extraction form and analyzed descriptively and thematically. Results: Nine identified studies demonstrated a high prevalence of suicidal ideation in adolescents with thalassemia, which was closely related to disease severity, frequency of blood transfusions, and psychosocial stressors such as stigma and social isolation. This variance is explicitly driven by methodological differences, where self-report scales (Beck Scale) yielded significantly higher ideation rates compared to clinician-led diagnostic interviews (K-SADS), as well as demographic factors, with suicidal risk increasing alongside patient age and treatment intensity. Family and community-based support interventions demonstrated positive outcomes in reducing risk, although implementation was hampered by a lack of access to integrated mental health services. The review also revealed significant methodological gaps, including the absence of longitudinal study designs and randomized controlled trials. Conclusion: Adolescents with thalassemia face significant psychological vulnerability due to chronic medical burdens and psychosocial developmental challenges. Routine mental health screening using validated instruments and a multidisciplinary approach involving families are needed for early detection and effective prevention of suicide risk.