“Suicidal Behavior In Juvenile…” Study By Serra Et Al.


Certain demographics are more susceptible to experiencing mental health problems based on various circumstances. Gender, age, sociocultural elements, and family situations are several of the multiple factors that may have a direct or indirect effect on one’s psychological well-being. However, another perspective that is to be considered is the outcomes following such a diagnosis. Researchers have studied one particular association between mental health and suicidal behavior. Namely, the study highlights the correlation between juvenile bipolar and major depressive disorder and suicidal behavior. The problem statement applied within the research was the high number of adolescent patients and the need to explore potential causes and mediators of suicide in this particular demographic. Thus, the research question is “is bipolar and major depressive disorder facilitate suicidal ideation among the juvenile population?”. In this critical appraisal, the study will be summarized, reviewed, and examined in regard to its validity, potential limitations, and reliability. Based on the analysis, the research provides unbiased information supported by evidence that can later be applied in prevention measures and policy implementation concerning mental health programs for young people.


The selected study exemplifies the link between mental health conditions (bipolar and major depressive disorder) and suicidal behavior among the juvenile demographic. Namely, the hypothesis demonstrated by the researchers is the existence of a positive relationship between the two factors. Thus, the authors have proceeded to review the topic with the initial argument that juveniles who have been diagnosed with the two conditions mentioned prior are more likely to consider, idealize, attempt, or commit suicide (Serra et al., 2022). The correlation between the two elements has been reviewed through a meta-analysis. Thus, the researchers have analyzed more than 40 reports from various countries to obtain a comprehensive view of the matter. The subjects examined during the research were children and adolescents not older than 18 years old with suicidal behavior measured as self-harming behavior exemplified with the intention of passing.

The applied reports differed based on the median age and sex disparities. Nonetheless, the researchers of the current study have identified the overall median age and the approximate equality in sexes when it comes to the analysis of suicidal behavior. As a result, the sample size included more than 100,000 juveniles. The variables that were considered were the mental health condition and suicidal behavior among individuals with a median age of approximately 14 years (Serra et al., 2022). As a result, the researchers aimed to assess the risk correlating with the aforementioned mental conditions, exposure, and lethality. By implementing the use of relevant literature and reliable reports containing information on subjects with bipolar and major depressive disorder, the authors have examined external data.

The findings have revealed a link between bipolar and major depressive disorder among juveniles and suicidal behavior. Researchers have determined that more than 13,000 individuals examined through the meta-analysis have had at least one suicide attempt during their lifetimes (Serra et al., 2022). Moreover, it has been determined that the presence of the aforementioned illnesses generated higher risks. Namely, individuals diagnosed with either of the two conditions are more likely to attempt or commit suicide compared to the same demographic, yet with no diagnosed mental illnesses. Among the group with bipolar disorder, suicide behavior was reported to be present in more than 7% of all cases, with a slightly lower number among individuals with major depressive disorder (6,25%) (Serra et al., 2022). However, both identified variables are higher than the rate of suicidal behavior among healthy populations within the same group. The difference is particularly highlighted in individuals diagnosed with bipolar disorder as this particular demographic correlates with higher risks of suicide attempts. The researchers attributed the phenomenon to the manic-depressive mixed states experienced by the individuals in which depression is accompanied by impulsion. As a result, the risks correlating with one’s proclivity to take their life increase.

The acquired information has been formulated based on international research. This is exemplified by the author’s aim to select reports from 15 different countries (Serra et al., 2022). Thus, a specific demographic has been analyzed in relation to the global appliance of the statistics and information examined through the study. Moreover, the researchers highlight that both females and males participated in all the reports, with slight statistical differences between the groups. As a result, the results can also be applied to both sexes when considering the study as background for potential interventions of further analysis.

In regards to exposure time, the researchers came to a conclusion considering both the longevity and the frequency of the suicide attempts. Exposure time in this particular study highlights the number of years an individual is experiencing the symptoms of one of the two mental conditions. The findings have revealed that while a more extended time period facilitates more suicide attempts, their frequency decreases (Serra et al., 2022). As a result, the findings reveal that juveniles recently diagnosed with one of the two conditions are to be monitored and assisted as such interventions minimize the dangerous risks of short-exposure time in relation to suicidal behavior.

The researchers also mention the limitations that have not been considered during the research. Namely, inconsistencies when it comes to fatalities, medication, and treatment that some of the participants may have experienced have not been examined (Serra et al., 2022). Furthermore, the study was funded, yet the authors of the publication mention data being objectively selected and analyzed, implying the lack of bias within the findings. This allowed researchers to highlight the reliability of the information within the paper that can be applied in future research, intervention proposal, and policy implementation concerning suicide prevention.

Critical Analysis

The peer-reviewed article has been structured based on existing guidelines widely applied by researchers. Namely, the authors have summarized the objectives, methods, results, and conclusion within the abstract in a comprehensive and succinct manner. The introduction illustrates the broader subject and introduces the main objective, which is to find a correlation between juvenile bipolar and major depressive disorder and suicidal behavior (Serra et al., 2022). Moreover, the selected methodology, meta-analysis, is associated with the identification of high-level evidence for the chosen research question and hypothesis (Khan et al., 2019). The discussion and conclusion highlight the results of the link determination, and the limitation provides an overview of factors that may have impacted the findings.

Literature Support

A factor that supports the reliability of the study is the coverage of a similar subject by fellow researchers who draw similar conclusions. Indeed, current literature contains information on the existing link between the two factors. Namely, Siu (2019) highlights that psychopathology is one of the principal identifiers of suicide risks among children and adolescents. A similar finding has been reported by Serra et al. (2022). The researchers mention bipolar disorder as linked to impulsiveness, which ultimately generates circumstances in which juveniles with this condition are more likely to injure themselves. Mental illness has been linked to suicide by additional researchers. Specifically, Bilsen (2018) mentions the variable as one of the deciding factors regarding one’s experienced risks. While the specific mental disorders have not been specified in this particular paper, the category encompasses the conditions highlighted in the research currently reviewed.

Chosen Demographic

Another strength of the current study is the efficiently-selected demographic. The researchers have decided to examine suicide behavior as a correlation between mental health conditions in young people. Namely, the examined individuals’ median age was approximately 14 years (Serra et al., 2022). It is important to mention that according to researchers, the median age for suicide is higher even among young individuals. For example, according to Lee et al. (2019), more than 60% of older adolescents committing suicide are between 17 and 19 years old. However, as the variable that is being examined is the presence of a mental health condition, it is vital to consider it concerning this particular demographic. Thus, current literature highlights that more than half of psychological disorders occur before the age of 18, and the median age is 14 (Solmi et al., 2021). Thus, it is inevitable that the demographic selected by the researchers of the current study has been considered from this particular perspective.


Needless to say, despite the study’s reliability and validity, limitations persist and are to be addressed. One of the main disadvantages is the lack of consideration of potential treatment received by the sample group. Thus, juveniles with bipolar and major depressive disorders have been assessed. Yet, the researchers do not include information on whether individuals who are medicated or attend psychotherapy are more or less likely to engage in suicidal behavior. Existing studies highlight that suicide prevention measures, such as medication and psychological support offered by healthcare providers, have a mitigating effect on self-harming actions (Horowitz et al., 2020). Thus, including such variables within the research would have a positive effect on the validity of the findings and highlight disparities among different groups within the overall sample size.


The selected study provides reliable and valid information on the relationship between mental health and suicidal ideations. Namely, the study highlights that juvenile individuals diagnosed with a bipolar or major depressive disorder are more likely to engage in suicidal behavior. Relevant statistics support the argument as the authors have applied secondary data gathered from multiple valid reports. The article is well-structured and correlates with various strengths. Namely, conducting a meta-analysis focusing on younger individuals with a median age of 14 and having an evidence-based subject supported by fellow researchers exemplify the strong points of the study. However, the lack of consideration of such variables as a potential treatment and the fatalities of suicide attempts are the limitations that, if addressed, would have facilitated more extended findings. Nonetheless, the article provides an important overview of mental health in association with self-harming behavior among young people and can generate further trigger identification. Moreover, the findings can facilitate the establishment of evidence-based interventions and programs for suicide prevention through psychological health.


AIHW. (2021). Suicide among young people. Australian Institute of Health and Welfare. Web.

Bilsen, J. (2018). Suicide and youth: Risk factors. Frontiers in Psychiatry, 9.

Horowitz, L., Tipton, M. V., & Pao, M. (2020). Primary and secondary prevention of youth suicide. Pediatrics, 145(Supplement_2).

Khan, S., Memon, B., & Memon, M. A. (2019). Meta-Analysis: A critical appraisal of the methodology, benefits and drawbacks. British Journal of Hospital Medicine, 80(11), 636–641.

Lee, S., Dwyer, J., Paul, E., Clarke, D., Treleaven, S., & Roseby, R. (2019). Differences by age and sex in adolescent suicide. Australian and New Zealand Journal of Public Health, 43(3), 248–253.

Serra, G., De Crescenzo, F., Maisto, F., Galante, J. R., Iannoni, M. E., Trasolini, M., Maglio, G., Tondo, L., Baldessarini, R. J., & Vicari, S. (2022). Suicidal behavior in juvenile bipolar disorder and major depressive disorder patients: Systematic review and meta-analysis. Journal of Affective Disorders, 311, 572–581.

Siu, A. M. H. (2019). Self-harm and suicide among children and adolescents in Hong Kong: A review of prevalence, risk factors, and prevention strategies. Journal of Adolescent Health, 64(6).

Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2021). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295.