Prevalence of suicidal ideation and risk factors among school-going adolescents in Ethiopia: a systematic review and meta-analysis

Suicidal ideation among school-going adolescents is an important public health concern in Ethiopia. Existing evidence suggests that many adolescents experience thoughts of self-harm, but findings are fragmented and no comprehensive synthesis is available. This systematic review and meta-analysis aimed to consolidate available evidence on the prevalence of suicidal ideation and risk factors in school-based settings in Ethiopia. A thorough literature search was carried out across multiple databases, including Google Scholar, EMBASE, Scopus, PubMed, ScienceDirect, African Journals Online, Medline, and CINAHL, covering studies published up to June 22, 2025. The review included cross -sectional studies that examined suicidal ideation and risk factors among school- going adolescents in Ethiopia. Data extraction was performed using a standardized data extraction form developed based on the study objectives. The methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist for cross-sectional studies. The pooled prevalence of suicidal ideation and risk factors was analyzed using a random-effects model. Study heterogeneity was quantified using the I² statistic, and the possibility of publication bias was examined using funnel plot symmetry and Egger’s regression test. The present systematic review and meta-analysis included ten (10) published studies involving a total of 7,146 participants. The pooled prevalence of suicidal ideation and risk factors among school-going adolescents in Ethiopia was estimated to be 25.58% (95% CI: 9.42–41.73; I² = 59.0%, p < 0.009). The following factors were found to be significantly associated with suicidal ideation: Being female was significantly associated with suicidal ideation, with a pooled odds ratio (POR = 1.71, 95% CI: 1.22–2.39; I² = 66.8%, p = 0.017), Having depression (POR = 5.80, 95% CI: 2.17–12.40; I² = 94.5%, p < 0.001), Anxiety (POR = 4.83, 95% CI: 2.77–8.43; I² = 90.4%, p < 0.001), Lifetime alcohol use (POR = 2.98, 95% CI: 1.42–6.27; I² = 93.3%, p = 0.001), Family history of suicide attempt (POR = 3.77, 95% CI: 1.73–8.23; I² = 92.3%, p < 0.001), Poor social support (POR = 2.85, 95% CI: 1.71–4.74; I² = 85.1%, p = 0.001), Disappointment in school results (POR = 2.96, 95% CI: 2.29–3.83; I² = 0.0%, p = 0.63), Feelings of hopelessness (POR = 6.38, 95% CI: 1.72–23.68; I² = 94.0%, p < 0.001) and Khat chewing (POR = 3.24, 95% CI: 2.07–5.10; I² = 0.0%, p = 0.920). The study revealed that suicidal ideation is prevalent among school-going adolescents in Ethiopia. Key risk factors include being female, having depression, anxiety, lifetime alcohol use, a family history of suicide attempts, poor social support, disappointment with school result, feelings of hopelessness, and khat chewing. These findings carry important implications for policymaking, clinical practice, and future research aimed at addressing suicidal ideation and risk factors in this population.