Assessing the Relationship Between School Failure and Suicidal Behavior in Adolescents and Young Adults: A Systematic Review and Meta-analysis of Longitudinal Studies


There is an increasing acknowledgment that suicidal behaviors are negatively affected by school failure in adolescents and young adults. However, no systematic reviews with meta-analysis have been performed to evaluate the strength of this association. We assessed the magnitude of association of school failure as risk factor for suicide behavior in adolescents and young adults. Six international databases were searched up until January 2017. Inclusion criteria were: (1) assessment of suicide attempt or suicide; (2) case–control or cohort studies; (3) subjects aged 12–26 years; (4) school failure evaluated, which includes low academic performance, school dropout, school expulsion, and grade repetition. Random effect models were used; population attributable risks (PARs) were estimated. From 26,883 potentially eligible articles, 14 (62,298 individuals) were included. Meta-analyses could only be performed for suicide attempt. A history of school dropout (OR 6.44, 95% CI 3.03–13.65), low academic performance (OR 1.48, 95% CI 1.22–1.81), and school failure (OR 1.98, 95% CI 1.49–2.64) were significant risks of suicide attempts. Highest PAR estimates were 9.9% for school dropout, 5.1% for low academic performance, and 6.7% for any school failure. Only one study has been found for suicide, but results suggest an association with school dropout. Results show that the students who had school failure are at higher risk of suicide attempt and probably for suicide. The development of effective programs to prevent suicidal behaviors in educational settings may be an effective strategy to reduce these behaviors. However, reliable conclusions from this review are limited by the small amount of included studies for analysis.

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Thanks to Dave MacFarlane and Victoria Mailen Arfuch for help in management of the data extraction form and data abstraction.


This work was supported by the ISCIII-FEDER (PI13/00343); Ministry of Health, Social Services and Equality, PNSD (2015I015); Instituto de Salud Carlos III (ISCIII) (Sara Borrell, CD12/00440 and CD18/00049); ISCIII (Río Hortega, CM14/00125); Ministry of Education, Culture and Sport (FPU15/05728); UJA-FEDER (R08/06/2018), Generalitat de Catalunya (2014 SGR 748 and 2017 SGR 452), and by the Spanish Ministry of Science, Innovation and Universities, the State Research Agency (AEI), and ERDF funding thanks to PSI2017-90650-REDT grant. The corresponding author (JA) confirms that he had full access to all the data in the study and had final responsibility for the decision to submit for publication.

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JA and PC developed the original protocol. Three investigators (PC; AM; and OP) did the literature search in October 2013 and updated it in January 2017. Twelve investigators (JA; IA; MJB; AC; RCS; AG; MG; CL; JAP; MR; JRM; TRJ; and VSS) double-screened titles, and abstracts of all studies to establish eligibility for full-text screening, and they extracted the data independently onto a data extraction form. PC identified all the articles included from the broad review, reviewed all data extracted from previous reviewers, and conducted all analyses. PC developed the article, figures, and tables. PC, AM, and OP resolved any disagreement about eligibility for inclusion in the review and discrepancies arising during data extraction. All authors read and approved the final draft of the manuscript.

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Correspondence to J. Alonso.

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Castellví, P., Miranda-Mendizábal, A., Alayo, I. et al. Assessing the Relationship Between School Failure and Suicidal Behavior in Adolescents and Young Adults: A Systematic Review and Meta-analysis of Longitudinal Studies. School Mental Health 12, 429–441 (2020).

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  • Suicidal behavior
  • Adolescents and youths
  • School failure
  • Systematic review
  • Meta-analysis