Global Perspectives on Adolescent Suicide and Self-Harm: Findings and Insights From the ASCAPAP Grand Forum

Abstract

Adolescent suicide and self-harm have become pressing global public health crises. At the 2026 Asian Society of Child and Adolescent Psychiatry and Allied Professions Grand Forum on Suicide and Self-Harming Behavior in Adolescents Worldwide, researchers, clinicians, and policymakers from multiple countries presented current evidence and field experiences. This study synthesizes the forum’s major presentations and discussions in the thematic areas. The forum emphasizes that South Korea continues to report one of the highest adolescent suicide rates among Organisation for Economic Co-operation and Development (OECD) countries and that suicide-related behaviors and non-suicidal self-injury have reached concerning levels across Asia. The cross-national evidence presented at the forum indicated a marked post-pandemic increase in adolescent suicide attempts and self-harm, with a disproportionate burden on adolescents and young women. The speakers further emphasized that aggregate national statistics could obscure the heightened risk faced by the most vulnerable subgroups. Major risk factors included psychiatric comorbidities, diminished sense of belonging, social media use, algorithm-driven content exposure, and socioeconomic disparities in healthcare access. The forum emphasized that for many adolescents, self-harm reflected not a wish to die but an attempt to escape overwhelming psychological pain. Proposed solutions centered on a paradigm shift toward primary prevention, integrated school–government–professional systems incorporating AI-based early warning, the “Safety by Design” principle for social media, community-based safe spaces, and strengthening families and communities. Adolescent suicide prevention is not solely a medical issue but a collective societal responsibility that requires international collaboration.

INTRODUCTION

Suicide and self-harm in adolescents are critical global public health issues. According to the World Health Organization, suicide is the third leading cause of death among individuals aged 15–29 years globally in 2021 (the second leading cause among young women and the third among young men), with approximately 727000 deaths reported worldwide [1]. A significant proportion of these deaths occurred in adolescence and young adulthood. Furthermore, the widespread prevalence of self-harm and suicide attempts, precursors to completed suicide, suggests a substantial burden of suffering that exceeds what is captured by mortality statistics alone [2,3].

The coronavirus disease 2019 (COVID-19) pandemic has severely affected adolescents’ vulnerable mental health. Numerous international studies have confirmed a post-pandemic surge in suicide attempts and self-harming behaviors [4,5]. This increase was driven by a complex interplay of factors, including the suspension of in-person education, intensified social isolation, increased domestic violence, and economic stress. The acceleration was particularly evident in Asian countries in which academic competition, familial conflict, and rapid changes in the digital environment intersect [6,7]. In particular, South Korea has consistently reported one of the highest adolescent suicide rates among Organization for Economic Co-operation and Development (OECD) countries [8]. Although the overall national suicide rate has shown a modest downward trend, the steep rise among adolescents and women in their 20s reveals a critical gap in the current prevention policy [9]. Of particular concern, the trends presented at the forum indicated an alarming downward shift in age, with self-harm increasingly being observed even among elementary school-aged children.

Against this backdrop, the Asian Society of Child and Adolescent Psychiatry and Allied Professions (ASCAPAP) convened the Grand Forum, “Suicide and Self-Harm Behavior in Adolescents Worldwide,” and brought together experts in epidemiology, clinical practice, policy, and media. The forum served not only as an academic gathering but also as a platform for cross-cultural and cross-national cooperation. This study synthesizes the key research findings and clinical and policy recommendations from the forum and provides practical reference material for researchers, clinicians, and policymakers in South Korea. As a narrative summary of the major presentations and discussions from the 2026 ASCAPAP Grand Forum, this study provides an overview of selected themes, perspectives, and recommendations presented by the invited speakers and panelists; thus, it should not be regarded as a formal expert consensus statement, systematic review, or comprehensive conference proceeding.

The major themes, key messages, and practical implications discussed throughout the forum are summarized in Table 1.

Table 1.

Major themes, key messages, and practical implications from the 2026 ASCAPAP Grand Forum

Theme	Key messages from the forum	Practical implications
Epidemiology and emerging trends	Adolescent suicide and self-harm continue to increase globally, with substantial variation across countries, racial groups, and sociocultural contexts.	Prevention strategies should be tailored to local epidemiological patterns and vulnerable populations.
Social media and digital environment	Algorithm-driven content exposure may increase vulnerability to self-harm and suicide contagion, while online communities may also provide emotional support for marginalized youth.	Promote media literacy, safer digital environments, and balanced approaches that maximize benefits while reducing harm.
School, family, and psychosocial factors	Academic pressure, family relationships, peer interactions, and school experiences remain major determinants of adolescent mental health and suicidal behavior.	Strengthen school-based prevention programs and integrate family-centered approaches into routine assessment and intervention.
Fragmentation of mental health services	Delays in identification, referral, and follow-up frequently occur because schools, healthcare systems, and community services operate separately.	Improve continuity of care and strengthen coordination among schools, emergency departments, community services, and mental health professionals.
Early identification and integrated prevention systems	Earlier detection of risk and timely intervention are essential for preventing escalation to suicidal crises. Digital phenotyping and AI-based approaches may support this process when implemented with appropriate safeguards.	Develop integrated school–community– healthcare networks while ensuring privacy protection, transparency, and human oversight.
Policy, regulation, and youth empowerment	Sustainable suicide prevention requires not only technological and legal regulation but also the development of adolescents’ capacity to navigate digital environments safely.	Combine Safety by Design principles, regulatory frameworks, and media literacy education to promote long-term resilience and prevention.
Future directions	Effective suicide prevention requires a shift from post-crisis response toward proactive prevention, while preserving the central role of human connection and community support.	Foster cross-sector collaboration and maintain human-centered approaches alongside technological innovation.

GLOBAL STATUS: HOW SERIOUS IS IT?

Prevalence in Asia and worldwide

Comprehensive epidemiological reviews that cover multiple geographic regions have indicated that suicidal ideation and non-suicidal self-injury (NSSI) are public health issues worldwide [2,3]. Cross-cultural data presented at the 2026 ASCAPAP Grand Forum further underscored this crisis; surveys in multiple Asian countries reported that a substantial proportion of adolescents engaged in suicidal behavior, with a particularly high prevalence among female students [2,3].

A critical finding of the forum was the high frequency of recurrent self-harm. Systematic reviews have indicated that approximately 16%–22% of patients, including adolescents, present to hospitals with self-harm and repeat self-harm in one year, with substantially higher cumulative rates for the next five years [10]. This underscored that the period after the initial crisis was a vital window for intervention.

Comparative studies conducted before and after the pandemic yielded relevant results. A comparison of data from the same schools in India between 2016 (pre-pandemic) and 2023 (post-pandemic) revealed a threefold increase in suicide attempts and suicidal ideation and a twofold increase in self-harming behaviors [11]. These findings suggest that the increase is not merely a temporary phenomenon caused by the COVID-19 pandemic but that the pandemic has structurally altered the psychosocial environment of adolescents [4].

Specific context of South Korea

Korean adolescent suicide epidemiology draws on three core data sources: the National Emergency Department Information System, National Health Insurance Service, and Korea Youth Risk Behavior Web-based Survey (KYRBS). National Emergency Department Information System-based analyses have documented a sharp and sustained increase in suicide attempt-related emergency department (ED) visits, particularly among young women. Between 2016 and 2021, the average annual percentage change (APC) was 10.8% among women and girls, nearly seven times that of men and boys (1.6%), with the steepest increase in adolescents aged 12–19 years (APC 22.3%) and young adults aged 20–29 years (APC 17.2%). Even among pediatric patients (0–17 years) who presented to EDs for self-harm in 2018–2022, girls accounted for 77.0% of all visits [12].

The 19th KYRBS (2023) found that 25.3% of 46987 middle and high school students reported having depressive symptoms [13]. Longitudinal National Health Insurance Service data further confirmed that previous self-harm was among the strongest independent predictors of eventual suicide death [14]. Together, these findings reveal a persistent gap in protecting the most vulnerable subgroups, despite growing prevention investments [12].

Psychiatric comorbidities increase the risk of suicide substantially. A meta-analysis of longitudinal studies among young individuals reported that any psychiatric disorder was associated with an approximately 3.6-fold increase in the odds of suicide attempts [15]. Beyond individual clinical factors, the structural communication gap between schools and healthcare providers remains a core obstacle in the early identification of at-risk youths [16]. Adolescents from lower-income households face disproportionately elevated risks of suicide and yet are significantly less likely to access timely psychiatric care, indicating that economic disparities translate directly into disparities in the protection of life [17-19].

Disparities among vulnerable subgroups

A large-scale analysis in the United States demonstrated stark disparities among vulnerable populations. Integrating data from three independent cohorts—the Adolescent Brain Cognitive Development Study, 2021 Centers for Disease Control and Prevention Youth Risk Behavior Survey, and Children’s Hospital of Philadelphia Emergency Department cohort—a study analyzing 38380 non-Hispanic Black and White youths identified Black girls as the highest risk group for suicidal ideation and attempts [20]. The prevalence of suicidal ideation and suicide attempts in the past year was approximately 22.5% and 8.6%, respectively. Overall, girls had 1.75 times the odds of ideation and 1.8 times the odds of attempts compared with boys, whereas Black youth had 1.6 times the odds of attempts compared with White youth. These risks remained obscured in the national aggregate statistics from the Centers for Disease Control and Prevention (CDC) [20].

This finding illustrates a fundamental limitation of population-level data: aggregate figures can render the groups most in need of intervention statistically invisible. Heightened vulnerability among Black girls reflects the compounding effects of racism, sexism, interpersonal violence, and structural inequality [20]. Therefore, the universal “one-size-fits-all” prevention is no longer adequate, and targeted strategies that account for sex, race, and socioeconomic status are urgently needed [20]. This challenge is not confined to the United States. In South Korea, the overall decline in national suicide rates has similarly obscured the worsening trajectory among adolescent and young adult women [9].

RISK FACTOR ANALYSIS: UNDERLYING MECHANISMS

Psychiatric factors and the comorbidity effect

As previously noted, the risk of suicidal behavior increases substantially with the cumulative burden of comorbid mental disorders [15]. Rather than facing a single clinical challenge, adolescents must often contend with multiple co-occurring pathologies that can eventually exceed their coping capacity. Furthermore, although NSSI is conceptually distinct from suicide; its high prevalence among adolescents, reaching approximately 17.2% globally [21], has been emphasized as a powerful “gateway” to suicidal behavior. This finding underscores the urgent need for early NSSI screening as a primary step toward suicide prevention.

Another concerning development is the phenomenon of “digital contagion.” Exposure to or sharing self-harming behaviors through social media serve as a catalyst for peer-led imitation. A Korean community-based study of adolescents with self-harm explicitly identified social media as a route through which contagion and connections co-occurred, associating online self-harm exposure with increased suicidality [22]. In South Korea, a marked stepwise increase in ED visits for self-harm was documented among adolescents and young adults during the same period in which adolescent social media engagement expanded. ED visits per 100000 individuals for self-harm among those aged 10–19 years increased from 6.25 in 2015 to 15.71 in 2019, with late-teenage women showing the steepest and most sustained increase [9]. These data suggest that social media platforms function as environments that contribute to or amplify the risk of self-harm among vulnerable youth.

Psychological context of adolescent self-harm and suicide

Unlike in adults, adolescents’ self-harm and suicidal behaviors often have deeper psychological meanings that go beyond a mere desire to die. As noted by frontline school counselors during the forum, many adolescents experiencing suicidal crises may be understood as “not wanting to die but being unable to tolerate living.” This expression captures a profound emotional distress that often underlies suicidal thoughts and behaviors. Self-harm and suicide attempts are often used to regulate or temporarily evade overwhelming and persistent emotional pain. They are less characterized as a rejection of life and more as a desperate attempt to escape from current suffering.

In this framework, the specific Korean sentiment of “i-saeng-mang” (이생망, meaning “this life is ruined”) has gained significant attention. Beyond being a self-deprecating vocabulary term, this expression reflects a profound sense of hopelessness, the belief that no meaningful change can be expected in one’s current life. A qualitative study of emerging South Korean adults’ perspectives on death and suicide identified an attitude characterized by what the authors termed “naturalistic fatalism,” in which death and the ending of one’s present existence were framed as natural rather than catastrophic [23]. This suggests that traditional concepts, such as “suicidal impulses,” fail to fully capture the psychological essence of adolescent suicidality in this cultural context, highlighting the need for preventive strategies that reflect age- and culture-specific nuances.

Recent studies have demonstrated that negative proximal social media experiences are associated with an increased short-term risk of suicidal ideation among adolescents [24]. This finding highlights the need to reevaluate current suicide risk screening tools for adolescents. Given significant sex disparities in internalizing distress and digital engagement [12], screening using depression scales alone is insufficient. A more comprehensive assessment that includes social media usage patterns and digital experiences, which play an increasingly critical role in the mental health landscape of the 21st-century youth, is required.

Lack of belongingness and social isolation

Suicide among adults is often triggered by specific identifiable life events such as workplace harassment, financial bankruptcy, or marital discord. By contrast, for adolescents, a pervasive “sense of not belonging anywhere” can act as the most powerful motivator for suicide, even in the absence of a single distinct event. This aligns with the concept of “thwarted belongingness” articulated in the interpersonal theory of suicide, which posits that suicide risk escalates substantially when an individual feels they are not fully accepted by any group [25].

This lack of belongingness is intensified by the complex interplay of factors, including disconnection from peers owing to academic pressure, social exclusion through school violence, comparison, ridicule on social media regarding gender identity or physical appearance, and isolation in the family caused by conflict or neglect [26]. Thus, the participants in the forum discussed the potential value of non-traditional approaches, such as animal-assisted therapy and arts-based activities, which might help adolescents reconnect with others, engage in the present moment, and strengthen their sense of belonging.

Furthermore, structural changes in the Korean society have been identified as critical background factors that weaken social safety net [27]. These include the rise of one-person households, which have exceeded 35% of all households in recent national statistics, and the gradual collapse of extended family networks. In a society in which communal solidarity has eroded, individuals in crisis are left in a state of absolute isolation. This creates a structural vulnerability that may culminate in suicidal behaviors.

Effect of social media and algorithms

South Korea has one of the highest smartphone penetration rates and highest levels of mobile data consumptions worldwide. National surveys have reported that approximately 95% of Korean adolescents own smartphones, and a substantial proportion use them for several hours daily [28]. Today’s adolescents are “digital natives” who are fully immersed in a digital environment in which online relationships and communication form the core of their lives. For this generation, social media is not merely a leisure tool but a primary space for self-identity formation and peer connection.

In this environment, the dysfunctional aspects of social media escalate suicide and self-harm risks through several pathways. First, the algorithms of short-form content platforms such as TikTok and Instagram Reels are designed to continuously expose users to similar content, as they react to emotionally intense or provocative material. This may increase the likelihood of emotionally vulnerable adolescents being exposed to negative content or materials that portray self-harm [26].

In South Korea, the phenomenon of “media-induced suicide,” in which individuals share suicide methods or intentions and broadcast suicidal acts in real time, has emerged as an important social concern in the digital era. This may represent an evolving form of suicidal contagion that extends beyond the traditional Werther effect. The real-time nature of social media and algorithm-driven content exposure may contribute to the dissemination of suicide-related content and increase the vulnerability among at-risk individuals. Domestic studies have also reported that increasing social media engagement among adolescents has paralleled increases in self-harm-related ED visits [9,13].

Furthermore, constant social comparison mediated by social media persistently erodes adolescent self-esteem [24]. By comparing their unedited reality with the meticulously curated lives of others, adolescents experience a reinforced sense of “not being enough,” leading to chronic inferiority and shame. This, in turn, may increase susceptibility to self-harm and suicidal ideation.

Social media can influence adolescents’ cognitive and emotional experiences. This phenomenon, sometimes referred to in popular media as “popcorn brain,” has been hypothesized to reflect changes in attention patterns associated with repeated exposure to highly stimulating digital content. Although “popcorn brain” is not a formal medical diagnosis, neuroimaging studies of problematic internet and smartphone use have reported alterations in neural systems involved in cognitive control and reward processing [29]. Such changes may contribute to difficulties in sustaining attention and regulating responses to highly stimulating digital environments.

Simultaneously, social media may provide important supportive functions for some adolescents. For marginalized groups, such as LGBTQ+ or neurodivergent youth, who may struggle to find support systems offline, social media often serves as a vital emotional anchor and source of information [24]. Therefore, rather than a simplistic approach that labels social media as an “enemy,” there is a need for a more nuanced perspective that focuses on the “quality” of online experience and empowers youth in the digital landscape [24].

Economic disparity and healthcare access

Adolescents from lower-income families face a markedly high risk of suicide; however, they are less likely to have access to psychiatric treatment or counseling. This pattern confirms that economic disparity translates directly into a disparity in life protection [17-19]. Using two decades of nationally representative data from the KYRBS, a 2024 analysis demonstrated a steep household income gradient in adolescent mental health. In 2022, the weighted prevalence of stress was 62.77% in the lowest-income group compared with 40.07% in the highest-income group, with similarly large disparities in sadness, suicidal ideation, and suicide attempts [17]. Simultaneously, only a small proportion of Korean adolescents who perceive a need for mental health care actually access services. In a study of middle school students, only 3.3% of those with self-perceived needs sought mental health services, and only 2.1% of the overall sample had used such services in the past year [18].

This treatment gap is not merely a matter of cost but also reflects a compound disadvantage. The contributing factors include limited information about mental health services, transportation barriers, parental availability, and the culturally entrenched stigma surrounding mental illnesses. In South Korea, intense college entrance competition and an achievement-oriented culture place exceptional academic pressure on adolescents. Consequently, lower-income youth face a dual burden in which the psychological crisis arising from academic underperformance is compounded by material vulnerability. Multilevel analyses of Korean adolescents have shown that lower scores on the Family Affluence Scale and self-rated academic achievement are independently and synergistically associated with depressive symptoms, with the highest probability of depression observed among students with low socioeconomic status and perceived academic achievement [19].

LIMITATIONS OF CURRENT RESPONSES

Post-attempt intervention-oriented paradigm

South Korea’s suicide prevention budget increased substantially from approximately KRW 13.7 billion (USD 10 million) in 2018 to approximately KRW 48.9 billion (USD 36 million) in 2023 [30]. However, a considerable proportion of this expanded budget remains concentrated on crisis intervention and post-attempt management after suicidal behavior has already occurred. Consequently, a paradoxical situation persists in which suicide rates among adolescents and young adults continue to rise despite increasing financial investments [30-32]. The current system resembles dispatching a fire truck only after a fire begins. The referral from the ED to psychiatric services following a suicide attempt and subsequent linkage to community-based services after discharge remain fragmented and discontinuous, frequently leading to missed opportunities during the critical “golden time” of crisis intervention [27].

These limitations underscore the need to shift from an approach focused predominantly on intervention after a suicide attempt toward earlier identification and prevention of suicide risk before an attempt occurs.

Paradox of screening systems

The limitations of existing school-based mental health screening systems, including the Emotional and Behavioral Characteristics Test, have been increasingly discussed in relation to their ability to accurately identify students at risk of suicide [33]. Several studies have reported that suicide is not only confined to students classified as high-risk but is also observed among those who are not identified as at-risk through screening [31,33]. These findings suggest that the current screening indicators may not fully capture the complex and multifaceted nature of suicide risk.

Several explanations have been proposed for this phenomenon. First, some adolescents may underreport or conceal emotional distress because of concerns that disclosure may negatively affect their academic records or school lives. In addition, many existing screening instruments primarily focus on depressive and anxiety symptoms, which may limit their ability to reflect recently emerging social and environmental risk factors such as a diminished sense of belonging, patterns of social media use, domestic violence, and interpersonal stress [33]. Accordingly, there is a growing need to refine the predictive validity of the current screening systems and develop complementary assessment approaches that incorporate a broader range of evolving risk indicators.

Fragmented support systems

The forum strongly emphasized that interventions by schools, hospitals, families, and government agencies remain insufficiently connected and continue to operate in a fragmented manner [27,32]. Because the Ministry of Education, Ministry of Health and Welfare, and Ministry of Gender Equality and Family manage suicide prevention programs according to separate administrative logic and budgetary structures, inefficiencies frequently arise in the form of duplicate services or, conversely, serious service gaps. Adolescents referred by school counselors often have to wait several weeks before obtaining psychiatric appointments, and the link between ED treatment and subsequent community-based services is frequently disrupted after discharge [27]. The consequences of fragmentation extend beyond administrative inefficiencies. When adolescents repeatedly experience “falling through the cracks” after seeking help during crises, they may ultimately lose the motivation to seek assistance altogether. This process fosters a sense of learned helplessness, which is characterized by the belief that “nothing changes even when I ask for help.” Consequently, adolescents facing subsequent crises may become increasingly isolated and attempt to manage their distress alone. Therefore, fragmentation in support systems should not be viewed simply as an administrative problem but rather as a structural issue directly associated with adolescent survival.

Structural blind spots in statistics

The forum also highlighted the structural limitations of large-scale aggregate statistics, which obscured the heightened risks faced by vulnerable subgroups such as Black girls, sexual minority youths, adolescents from low-income households, and youths from multicultural families [34,35]. Even when national suicide rates appear to be declining, dramatic increases in specific subgroups often remain hidden in aggregate averages. A similar pattern was observed in South Korea, wherein, although the overall national suicide rate showed a modest decline, this trend might conceal the worsening risk observed among particular groups, including adolescents and women in their 20s [9]. Accordingly, the evaluation of suicide prevention policies should move beyond reliance on overall suicide rates and instead incorporate stratified analyses that account for sex, age, socioeconomic status, and geographic region. As universal “one-size-fits-all” prevention strategies are increasingly recognized as insufficient [35], more precise intervention models tailored to the unique characteristics and contextual vulnerabilities of specific groups are urgently required.

SOLUTIONS AND RECOMMENDATIONS

Paradigm shift toward primary prevention

A strong consensus emerged that current crisis-management-centered systems must fundamentally shift toward preventive systems capable of intervening before problems escalate into acute crises [4,27]. This shift entails redistribution of resources. Budgets and personnel currently focusing on post-crisis intervention and treatment should be redirected toward universal mental health promotion and proactive support at earlier stages of vulnerability. The starting point for such a transformation is to create a culture in which families, schools, neighborhoods, and religious communities collectively recognize adolescents’ emotional distress not as a sign of weakness or abnormality but as part of ordinary human suffering [32]. A member of the National Assembly described this approach as “finding sparks before the fire begins,” which emphasized that fostering a social atmosphere that encouraged help-seeking behaviors must precede even the most sophisticated clinical interventions [32]. Concrete proposals include integrating mental health literacy education into mandatory school curricula, substantially expanding suicide prevention gatekeeper training programs for teachers and parents, and strengthening peer support programs that enable adolescents to recognize and respond to one another’s emotional suffering [32,36].

Establishing an integrated school–government– professional mental health system

The forum emphasized that one of the highest priorities was to establish a seamless integrated system linking schools (frontline detection), government agencies (supervision and coordination), and specialized clinical services (professional treatment) in real time [27,32]. The integrated model consisted of three major components. First, AI-based early warning systems may help analyze diverse data streams, including online behavioral patterns, school attendance changes, and sudden academic decline, to detect early signs of a crisis. Second, trained professionals can function as bridges capable of rapidly intervening once warning signals are identified. Importantly, AI is intended not to replace human care but to facilitate timely human connection. Third, comprehensive case management should continue without interruption after treatment and ensure continuous support from ED discharge to school reintegration, community service linkage, and family counseling.

Thus, an ongoing large-scale prospective cohort study of adolescents at high risk of self-harm and suicide is of particular significance. This study aimed to identify early warning signs of suicidal behavior through the longitudinal monitoring of psychological and behavioral changes in daily life using digital phenotyping approaches, including smartphone-based assessments and physiological indicators. Such efforts may contribute to the development of more proactive and personalized suicide prevention strategies. In addition, this study seeks to develop and validate an integrated case management model that connects hospitals, schools, and community resources, thereby providing an empirical foundation for future nationwide integrated systems.

Although AI-based early warning systems and digital monitoring approaches may offer opportunities for earlier identification of at-risk adolescents, their implementation should be accompanied by appropriate safeguards associated with privacy protection, transparency, and human oversight. Future efforts to develop integrated suicide prevention systems should ensure that technological innovation is balanced with ethical considerations, equity, and protection of adolescents’ rights.

Expanding community-based safe zones

The forum strongly emphasized the need to deliver services directly to spaces in which adolescents spend most of their time. Conventional mental health services have traditionally remained confined to hospitals or counseling centers, and adolescents are expected to seek help independently; however, the proposed model advocates proactive outreach-based services that meet adolescents where they already are [28]. A representative example introduced at the forum was the “Sai-Shim” shelter located in the middle of Seoul’s Gangnam private academy district. The name combines the Korean words sai (“between”) and shim (“rest”), reflecting its role as a brief resting space for adolescents between academy classes and commuting periods. This facility functions as an anonymous drop-in space in which hundreds of adolescents can briefly rest, receive counseling, or decompress between academic classes and commuting periods each day. Participants proposed expanding this model to more than 100 locations nationwide, particularly around densely concentrated private academic districts and school areas where academic stress is most severe [28].

Furthermore, clinical experiences from Japan presented at the forum offered important insights: the restoration of regular daily rhythms might significantly reduce self-harm urges among high-risk adolescents [28]. Many adolescents in crisis exhibit profoundly disrupted biological rhythms, including irregular eating habits and sleep patterns. Clinical evidence suggests that simply reestablishing structured meals and sleep schedules may meaningfully reduce self-harm impulses even before formal psychotherapy or pharmacological intervention begins [28]. This perspective implies that Safe Zones should function not merely as crisis counseling spaces but also as environments that support the restoration of healthy daily routines.

Multilayered strategies for social media regulation and education

In 2024, the Australian government became the first in the world to pass legislation prohibiting social media access for individuals younger than 16 years. Under this law, social media companies may face fines of up to AUD 50 million (approximately USD 36 million) if they fail to implement appropriate age-verification measures [7,26]. Although approximately 4.7 million underage accounts were reportedly deactivated following the implementation of the policy, concerns remained regarding adolescents’ ability to circumvent age restrictions, highlighting the practical limitations of legal enforcement [26,37]. These experiences indicate that simple access bans are insufficient in protecting adolescents from the risks associated with social media.

Therefore, the forum proposed three sustainable and comprehensive approaches. The first is the mandatory implementation of the Safety by Design principle [7,37]. Similar to how automobiles are required to include seatbelts at the design stage, social media platforms are legally required to incorporate adolescent protection mechanisms at the earliest stages of development. Such measures could include automatic filtering of self-harm and suicide-related content, restrictions preventing repeated algorithmic recommendations of harmful materials, and limitations on default nighttime usage. Second, the forum called for strong legal regulations of major technology companies at a level comparable to that of the European Union’s Digital Services Act (DSA) [37,38]. Global platform companies generating enormous profits should bear enforceable legal and social responsibilities to ensure adolescent safety. This approach seeks to overcome the limitations of voluntary self-regulation by mandating algorithmic transparency, permitting independent third-party audits, and prohibiting commercial exploitation of adolescents’ personal data. Third, there has been a systematic expansion of media literacy education [26,39]. Adolescents do not automatically acquire digital resilience when they reach a particular age. From early childhood, students receive structured education on how algorithms function, how online content should be critically interpreted, and how individuals can actively shape their own digital experiences. Unlike purely technological regulations, this approach strengthens adolescents’ internal capacities, enabling them to protect themselves, even in environments where formal regulations are insufficient.

Strengthening the role of families and communities

Clinical experiences have repeatedly emphasized that family dynamics are deeply intertwined with adolescent self-harm and suicidal behavior [36]. Excessive parental control, emotional neglect, domestic conflict, and abuse experience substantially increase suicide risk among adolescents. Despite this, current treatment approaches often focus almost exclusively on individual adolescents rather than on the broader family system. Consequently, the active integration of family-based interventions with adolescent treatment is necessary to help parents recognize and respond appropriately to their children’s distress signals. The forum particularly emphasized that genuine treatment involves “not simply treating the child but transforming the interaction patterns of the entire family system.” At a broader societal level, the reconstruction of “social capital” was identified as another major challenge [28,30]. Modern societies must find ways to revive traditional communal cultures of care in contemporary forms and encourage neighbors, schools, religious organizations, and civic groups to collectively support vulnerable youths. Building dense and interconnected community safety networks that ensure that no adolescents remain isolated may be one of the most fundamental long-term strategies for suicide prevention. The perspective of “simplifying life,” which was discussed in relation to Singaporean experiences, also provided important implications. Reducing excessive academic competition and digital overload, while fostering environments closer to nature and cultures that value existence rather than achievement alone, may strengthen adolescents’ psychological and emotional resilience.

Social communication strategies using media

The forum emphasized that even the most rigorous scientific findings cannot generate meaningful social change unless they effectively reach the public and adolescents [39]. Accessible communication strategies and high-impact media engagement are essential for suicide prevention. A successful example presented at the forum was the “Resuscitation Campaign,” which transformed public perceptions of medical helicopter noise complaints into recognition of the sound as “the sound of saving lives.” Similarly, a nationwide public awareness campaign is needed to help society recognize adolescents’ suicide warning signs not as “problematic behaviors” but as signals calling for help [28]. In addition, it is important to educate adults to recognize and respond to adolescents’ online SOS signals such as depressive social media posts, sharing emotionally suggestive lyrics, and messages resembling farewells.

In response to concerns regarding problematic smartphone use, participants also proposed participatory campaigns such as the “11 pm Sleep Challenge” in which families placed their smartphones in a box and seal them at 11:00 pm, subsequently sharing their participation on social media [28]. Unlike coercive regulatory approaches, such participatory platforms may encourage adolescents and families to voluntarily modify their behaviors while simultaneously creating natural opportunities for family communication. Furthermore, the participants called for stronger policy-level monitoring to ensure that existing guidelines regarding the portrayal of suicide and self-harm in dramas, webtoons, and social media content were appropriately implemented [30,40].

FUTURE RESEARCH DIRECTIONS

There is an urgent need to expand research infrastructure to narrow the gap between statistical data and real-world clinical practice. Future research should focus on the longitudinal monitoring of adolescents at high risk of self-harm and suicide using real-world behavioral and digital phenotyping data. Such efforts may help identify early warning signs preceding the transition from suicidal ideation to suicidal behavior and provide an empirical foundation for the development of AI-based early warning systems.

The need for international data integration has also been emphasized. The ASCAPAP could serve as a central platform for collecting and integrating standardized data across countries in the Asia–Pacific region [11], thereby enabling a clearer identification of culture-specific risks and protective factors and facilitating the development of multifaceted intervention strategies addressing the underlying causes. Large-scale international comparative studies that extend beyond the limitations of single-country research are essential to strengthen evidence for adolescent suicide prevention.

Several important methodological challenges were identified. First, greater emphasis should be placed on intersectionality-based research examining the interactive effects of sex, race, socioeconomic status, and sexual orientation [34,35,41]. Second, longitudinal studies that track the temporal trajectories of suicidal behaviors should expand beyond simple cross-sectional investigations. In addition, efforts should be made to strengthen the big data research infrastructure capable of safely integrating social media usage data, electronic health records, and school-based information. Finally, the implementation of scientific approaches should be reinforced to ensure that research findings can be translated more rapidly into real-world policies and clinical practice.

CONCLUSIONS

Once again, this forum clearly demonstrates that adolescent suicide and self-harm are not issues that can be addressed by any single country, government sector, or professional discipline. Korean epidemiological data, analyses of racial disparities in the United States, Australia’s experience with social media regulations, comparative studies examining pre- and post-pandemic trends in India, and clinical experiences from multiple Asian countries have collectively revealed that adolescent suicide is a highly complex and multidimensional phenomenon, both in terms of its causes and potential solutions. Two overarching messages emerged from this forum. First, a paradigm shift from post-crisis management toward proactive prevention is no longer optional but essential. In the Korean context, translating this paradigm shift into practice requires closer collaboration among schools, Wee Centers, Mental Health Welfare Centers, EDs, and child and adolescent psychiatrists. Strengthening the continuity of care from school-based identification and emergency services to community-based follow-up may help address the fragmentation highlighted throughout the forum discussions. Family-based approaches should be integrated more systematically into routine assessments and interventions, and broader efforts are required to address the effects of excessive academic pressure and competitive educational environments on adolescent mental health. Second, even the most advanced technologies and sophisticated systems cannot replace the warmth of communities in which individuals remain connected and care for one another. Even if AI can detect warning signs and create systems that aim to bridge structural gaps, the essence of suicide prevention ultimately lies in one human remaining next to another.

Funding Statement

Funding Statement None

Availability of Data and Material

Data sharing not applicable to this article as no datasets were generated or analyzed during the study.