REE 20(3) Riobamba sep. - dic. 2026

BY NC ND

128

ISSN-impreso 1390-7581

ISSN-digital 2661-6742

Psychological autopsy as a tool for identifying suicide risk factors in adolescents: A systematic review

Autopsia Psicológica como herramienta para identificación de factores de riesgo del suicidio en

adolescentes: Revisión sistemática

https://doi.org/10.37135/ee.04.27.09

Authors:

Leonor Jacqueline Moreano Jara1 – https://orcid.org/0009-0008-5768-6433

Erika Gabriela Márquez Flores2 – https://orcid.org/0009-0003-3239-9386

Affiliation:

1Higher Technological Institute Republic of Germany (ISTRA), Riobamba, Chimborazo.

2Private Institution, Quito, Pichincha.

Corresponding author: Leonor Jacqueline Moreano Jara. Higher Technological Institute Republic of

Germany (ISTRA). Address: Veloz and Vargas Torres, Riobamba, Ecuador. Email: lmoreanoj@istra.edu.ec.

Telephone: 0995239576.

Received: Juny, 6 2026 Accepted: September, 18 2026

ABSTRACT

Suicide among adolescents is a public health problem due to the interplay of multiple factors involved in its

occurrence. The objective of this study was to analyze the scientific evidence regarding the usefulness of

psychological autopsy in identifying risk factors for suicide among adolescents. A systematic review was

conducted following the PRISMA 2020 guidelines and selected and evaluated 14 original articles using the

CRF-QS instrument. The related findings showed that psychological autopsy makes it possible to access

retrospective information from various sources and to identify risk factors for mental health problems, a

history of suicidal behavior, violence, family conflicts, social isolation, academic difficulties, substance use,

and issues related to the digital environment. Thus, the psychological autopsy allows us to look beyond the

completed act to reconstruct the circumstances that preceded it and highlight factors that might otherwise go

unnoticed.

Keywords: Adolescent; Suicide Risk Factors.

RESUMEN

El suicidio en adolescentes constituye un problema de salud pública debido a la interacción de múltiples

factores que intervienen en su aparición. El objetivo de la investigación fue analizar la evidencia científica

sobre la utilidad de la autopsia psicológica para la identificación de los factores de riesgo del suicidio en

adolescentes. Se realizó una revisión sistemática siguiendo las directrices PRISMA 2020, seleccionándose

14 artículos originales evaluados mediante el instrumento CRF-QS. Los hallazgos mostraron que la autopsia

psicológica posibilita acceder a información retrospectiva de diversas fuentes y reconocer factores de riesgo

relacionados con problemas de salud mental, antecedentes de conducta suicida, violencia, conflictos familiares,

aislamiento social, dificultades escolares, consumo de sustancias y problemáticas vinculadas al entorno digital.

Así, la autopsia psicológica permite ir más allá del hecho consumado para reconstruir las circunstancias que

lo precedieron y hacer visibles factores que de otro modo, podrían permanecer inadvertidos.

Palabras clave: adolescente; suicidio; factores de riesgo.

INTRODUCTION

Adolescence is the developmental interval between childhood and adulthood, occurring between ages 10 and

19; a fundamental stage for the individual's comprehensive development.

(1)

Changes are evident at the physical,

sexual, and cognitive levels. In the latter, the development of cognitive functions such as reasoning and

decision-making is notable and crucial to adolescent development. However, in this stage of emotional

vulnerability, the construction of identity and autonomy can generate confusion and stress.

(2)

Therefore, emotional problems that are not managed correctly can be associated with fatal consequences

such as suicide, considered the deliberate act of taking one's own life. It is the third leading cause of death

among young people aged 15 to 29 worldwide, with more than 720 000 deaths annually; moreover, for every

completed suicide, there are many more attempts.

(3)

In Ecuador, 1 106 suicides were recorded in 2023, the

majority of which were committed by young men, placing the country among the ten with the highest rates

of adolescent suicide.

(4)

Factors for suicide in adolescents are complex and encompass biological, psychological, familial, and social

dimensions. These include genetic and neurobiological determinants

(5)

as well as mental health conditions,

hopelessness, and low self-esteem.

(6,7)

Furthermore, suicide attempts are recognized as warning signs of

serious risk,

(8)

while substance abuse is associated with a significant increase in the likelihood of suicidal

behavior.

(9)

Similarly, self-harm is a relevant factor that should be considered in the comprehensive assessment

of suicide risk in this age group.

(10)

The family and social environment also plays a crucial role; it has been noted that neglect or lack of affection

creates a hostile environment that negatively impacts mental health.

(11)

In the school setting, factors such as

bullying and academic stress increase emotional vulnerability.

(12,13)

Likewise, discrimination and isolation

raise the risk of self-destructive behaviors,

(14)

especially in adolescents who face stigmatization due to their

sexual orientation or gender identity.

(11)

Given the complexity and interaction of these factors in suicidal behavior, the psychological autopsy is defined

as a retrospective technique that allows the reconstruction of the mental, social, familial, occupational, and

academic state of a deceased person.

(15)

This tool provides complementary information in the analysis of

death in doubtful cases,

(16)

and in the context of suicide, it facilitates the identification of risk signs that may

have gone unnoticed and that contributed to this outcome.

(15)

Studies that have used psychological autopsy agree that mental health conditions,

(17)

the influence of family

and school factors,

(18)

lack of access to psychiatric and psychological treatment, along with family problems,

can influence suicidal behavior.

(19,20)

Therefore, psychological autopsy has been used to understand the

circumstances surrounding suicide and to identify risk factors associated with this fatal outcome.

This research stems from a specific need: the importance of identifying factors that can increase the risk of

suicide in adolescents. While scientific literature exists that focuses specifically on suicide cases, the available

information on its usefulness in identifying risk factors in adolescents has not yet been integrated and

analyzed together. This justifies conducting a systematic review to synthesize the available findings.

For this reason, the study in question aimed to analyze the scientific evidence on the usefulness of psychological

autopsy for the identification of suicide risk factors in adolescents.

METHOD

This research is a systematic review of scientific literature, prepared following the guidelines of the 2020

PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses),

(21)

to analyze

the available scientific evidence on the usefulness of psychological autopsy for identifying suicide risk

factors in adolescents. The study used the PICO format, which is most appropriate for structuring the

research question and organizing the review components by population, intervention of interest, and expected

outcomes, without establishing a comparison group.

(22)

(Table 1)

The research question posed was: What is the usefulness of psychological autopsy as a tool for identifying

suicide risk factors in adolescents?

Table 1.

PICO format

Search strategy

For data collection, a literature search was conducted in the PubMed, SciELO, Redalyc, and ScienceDirect

databases to identify studies related to the usefulness of psychological autopsies in identifying suicide risk

factors in adolescents. The search was carried out between May and July 2026 and included documents

published between 2012 and 2026 in Spanish and English.

DeCS descriptors were used in SciELO and MeSH in PubMed, including "suicide," "adolescent," and "risk

factors." The free-text term "psychological autopsy" was also included, as it was not found in the DeCS or

MeSH thesauri. The terms were combined using the Boolean operator AND, adapting the search syntax to

each database consulted.

Search strategy used according to the database

In PubMed, the search used the MeSH descriptors "Suicide," "Adolescent," and "Risk factors," along with

the free term "Psychological autopsy," using the Boolean operator AND.

In SciELO, the following DeCS descriptors were used: ''Suicide'', ''Adolescent'', ''Risk factors'', along with

the free term ''Psychological autopsy'', also using the Boolean operator AND.

In ScienceDirect, the search was performed using English keywords: psychological autopsy, suicide, adolescent,

and risk factors with the Boolean operator AND.

In Redalyc, the following Spanish terms were used: psychological autopsy, suicide, adolescent, and risk

factors, combined with the Boolean operator AND.

These strategies retrieved 76 records, distributed as follows: PubMed (n=45), SciELO (n=12), ScienceDirect

(n=9), and Redalyc (n=10).

Inclusion criteria

• Original articles of an observational, experimental, or field nature.

• Published between 2012 and July 2026.

• Open access and full PDF.

• Written in Spanish or English.

• Studies that included adolescent populations. In studies that included different age groups, only

information on adolescents was included.

• Documents where psychological autopsy was the primary method of gathering information.

• Studies that explicitly mention risk factors associated with suicide.

Exclusion criteria

• Publication outside the required age range.

Selection process

After searching the databases described, we removed duplicate documents. We then examined the titles and

abstracts of the identified articles to determine their relevance to the objective. We fully reviewed relevant

articles and verified them against the pre-established inclusion criteria and keywords. Articles that were not

related to the study objective or that met exclusion criteria were discarded. The PRISMA 2020 flowchart

(Figure 1) summarizes the procedure for identifying, selecting, assessing eligibility, and including studies.

Data extraction

After selecting articles that met the established criteria and thoroughly reviewing each one, we organized the

information into a matrix to facilitate understanding of the results. This matrix recorded the article title,

authors, year of publication, the usefulness of the psychological autopsy, and the suicide risk factors identi-

fied in each study. We determined the usefulness of the psychological autopsy based on each study's objecti-

ves, procedures, and main findings. We extracted the risk factors directly from the authors' reported results.

This organization enabled orderly, detailed information collection for subsequent analysis (Table 2).

Methodological quality assessment

The evaluation of the methodological quality of the selected studies was carried out using the Critical

Review Form- Quantitative Studies (CRF-QS) instrument, developed by Law et al.

(23)

It consists of eight

general criteria and nineteen items that allow the assessment of aspects related to the purpose of the study,

literature, methodological design, sample, measurement, intervention, results, and conclusion with clinical

implications.

(24)

Two reviewers independently selected, extracted, and evaluated the studies, recording the information in a

data matrix. The reviewers resolved discrepancies through joint review until they reached consensus. Finally,

articles scoring above 16 points were included in the analysis.

Figure 1.

PRISMA 2020 methodology used for the detection, selection, and categorization of studies performed.

RESULTS

Table 1. The following table presents the results of the analysis of the selected articles, organized by study objectives and defined themes.

DISCUSSION

The reviewed evidence suggests that psychological autopsy is a useful tool for identifying risk factors and

understanding the circumstances surrounding suicide in adolescents. One of its main contributions is integrating

information from family members, peers, teachers, and healthcare professionals, along with clinical, medical,

police, and forensic records.

(26,30-33,36)

This diversity of sources expands the information available about

adolescent’s life, since no single person necessarily knows all their experiences. Peers provided complementary

information about interpersonal relationships, school experiences, and social media use.

(33)

Furthermore, the

technique allowed for the exploration of warning signs that had not been recognized before death

(28)

and for

comparing the circumstances of suicide cases with those of deaths classified as accidents.

(36)

In this sense, the

usefulness of psychological autopsy is related to its ability to gather information from different sources and

approach aspects of adolescent’s life that may not have been previously identified.

Among the factors identified, those related to mental health and suicidal behavior were the most recurrent.

Depression and other mental disorders were present in several studies, as were histories of suicide attempts,

self-harm, and suicidal ideation.

(25,26,28,30,31,33-38)

The repeated presence of these factors shows that in different

cases there were manifestations of psychological distress before death. However, their identification should

not be interpreted in isolation, since they were accompanied by other circumstances present in the adolescents'

lives. Thus, the psychological autopsy allows us to place mental health difficulties and suicidal behavior

within the prior history of each case, avoiding reducing its understanding solely to the presence of a disorder

or a history of suicidal behavior.

(25-38)

The family environment was another recurring dimension in the reviewed studies. Family conflicts and

difficulties were identified

(25,26,30,33,34,37)

as well as domestic violence, physical and verbal abuse, dysfunctional

families, parental separation, and difficulties communicating problems to parents.

(25,26,28,29,35)

The coexistence

of these circumstances with a history of mental health issues and suicidal behavior suggests that, in some

cases, the adolescent's experiences were also linked to their family environment. Difficulties in communicating

problems are particularly relevant because certain experiences may not have been known to close adults. In

this sense, information obtained through post-death interviews can complement what the family had not

previously identified.

Reconstructed histories also included school, social, and emotional circumstances. Several studies described

academic pressure, study-related expectations, and school difficulties,

(26, 28, 33, 34, 37)

while others reported

bullying and cyberbullying.

(26, 27, 33, 35)

Added to this were social isolation, conflicts with friends, difficulties

in emotional relationships, and the loss of significant people.

(32-35, 37)

These findings broaden the understanding

of the factors identified through psychological autopsy, showing that the circumstances preceding suicide

were also related to everyday spaces of adolescent life, such as school, friendships, and emotional

relationships.

Other factors were identified in fewer studies. Alcohol and other substance use were described in several

studies,

(25, 26, 29-31, 33)

while impulsivity appeared in several of them.

(27, 29, 32, 35-37)

Irritability, aggression, and

anger were noted more frequently.

(30, 37)

The lower frequency of these elements requires cautious interpretation

in relation to each case's other circumstances. Specific conditions related to the digital environment were also

identified, such as excessive use of social media, social comparison, exposure to suicidal or self-harming

content, cyberbullying, suicidal contagion, and sextortion.

(27)

. Another study examined the availability of

firearms in the home, their normalization within the family, and their unsafe storage.

(38)

These findings show

that psychological autopsy can address specific dimensions according to the characteristics and circumstances

of each case.

The diversity of identified factors is also evident in those elements described only in specific studies. These

include forced labor during adolescence

(25)

sexual abuse,

(31)

grief, relationship breakups, and unplanned

pregnancy,

(34)

as well as exposure to suicides in the family or community.

(36)

Difficulties coping with

problems, unfulfilled aspirations, value conflicts, economic or social deprivation, low educational attainment,

and physical illnesses were also identified,

(32)

in addition to alcohol consumption by parents or caregivers.

(29)

Because these elements were reported on a case-by-case basis, it would not be appropriate to consider them

general characteristics of adolescents who died by suicide. Rather, their presence demonstrates that the

circumstances identified through psychological autopsy can vary among cases and encompass different

dimensions of the adolescent's life.

The participation of different informants is therefore key to assessing the technique's usefulness. Peers provided

information that complemented what parents provided, especially regarding psychological, academic, and

social aspects.

(33)

Similarly, the combination of interviews with clinical, police, and forensic records allowed

for the collection of information from different sources.

(26, 34, 36)

Since this is a reconstruction after death, the

information obtained depends on the memories, perceptions, and knowledge of those involved. Therefore, its

interpretation must consider the scope of the information available in each case.

Taken together, the reviewed studies show that the usefulness of the psychological autopsy relates to its ability

to integrate different sources of information and recognize factors across various dimensions of adolescents'

lives. Although some antecedents recurred, the diversity of circumstances identified does not allow for

establishing a universal hierarchy among the factors or causal relationships between them. Rather, the

studies show different combinations of individual, family, school, and social circumstances in the histories

analyzed.

(25-38)

This heterogeneity should be considered when interpreting the evidence and when assessing

the possibility of extrapolating its results to other populations.

In the Ecuadorian context, these findings are particularly relevant considering that 1,106 suicides were recorded

in the country in 2023.

(4)

The reviewed evidence shows that psychological autopsy can provide information on

mental health history and suicidal behavior, family relationships, school and social experiences, as well as

other circumstances present before death.

(25-38)

However, the included studies were conducted in different

contexts, so their results cannot be directly extrapolated to the Ecuadorian adolescent population. This difference

should be considered when assessing the technique's usefulness in the country, particularly because the

situations identified may vary depending on the context in which adolescents live.

A limitation of this review was the limited availability of studies focused exclusively on adolescent populations.

Therefore, it was necessary to consider research that included different age groups and analyze only the

information corresponding to adolescents. Furthermore, the heterogeneity of the studies, both in terms of the

context in which they were conducted and the circumstances analyzed, limits the generalizability of the

findings to other populations. Finally, reliance on informant-provided information and available records may

be subject to recall and information biases.

(26,33-36)

CONCLUSIONS

The psychological autopsy proved useful in identifying risk factors and reconstructing the events preceding

the adolescent suicide by integrating information provided by family members, close acquaintances, and

clinical or forensic records. Its application allowed for a deeper understanding of the experiences and

circumstances present before death, fostering a broader comprehension of the case.

The reviewed studies identified mental health problems, a history of self-harm and suicide attempts, adverse

experiences, and substance use, along with difficulties in family, school, and social environments, as the

main risk factors. Taking together, these findings show that adolescent suicide cannot be understood as a

single factor, but rather as a product of the various conditions present in an adolescent's life. From this

perspective, the identified factors highlight the need to consider the different dimensions involved in the

adolescent context holistically.

Funding: The authors fully covered the expenses generated by the research.

Conflict of interest: The authors declare that there is no conflict of interest for the publication of this scientific

article.

Contribution statement:

Leonor Jacqueline Moreano Jara and Erika Gabriela Márquez Flores prepared the article and participated

jointly in all stages of the manuscript.

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