Table 5. Summary of included studies (n = 27).

Author/s, year & country	Aims	Sample & study population	Methods	Findings
Bergmans, et al. [47], 2009, Canada	To understand the transition to safer behaviours and to provide clinical suggestions to those who provide care to this population.	Sixteen people aged 18–25 years with a history of two or more suicide attempts.	Qualitative, grounded theory study	A pathway from high to lower risk was established. Young people at the highest risk of attempting suicide spoke about “Living to Die” and progressed through “Ambivalence and Turning Points” to “Pockets of Recovery” as they move aware away from suicidality.
Bostik and Everall [24], 2007, Canada	To develop an understanding of adolescent’s perceptions of the role of attachment relationships in the process of overcoming suicidality.	Fifty adolescents who were previously suicidal between the ages of 13 and 19 years old.	Qualitative interviews, grounded theory study	Parents, peers and extra-familiar adults each had important attachment relationships with young people recovering from suicidal ideation as did a spiritual connection. Finding acceptance, having a permanent relationship, receiving encouragement and experiencing intimacy and closeness were all common experiences of attachment. These attachment relationships and experiences helped young people change their self-perceptions.
Coggan, et al. [42], 1997, New Zealand	To enhance knowledge of ways to address youth suicide.	School age students	Focus groups and analysis	Students spoke about what they believed the warning signs of a suicidal friend, their perceptions of available services and resources for young people at risk and potential prevention strategies.
Everall, et al. [21], 2005, Canada	To illustrate the role developmental processes, cognitive development, identity formation and autonomy seeking played in one teenager’s experience of becoming and overcoming being suicidal.	One 20-year-old female	Case study	The participant spoke about factors which contributed to her becoming suicidal and those that were important in overcoming suicidality.
Everall, et al. [25], 2006 Canada	To explore how adolescents and emerging adults conceive their emotional experiences associated with being suicidal.	Forty-one females, nine males previously suicidal between the ages of 14–24	Qualitative interviews, grounded theory approach	Participants spoke of the overwhelming despair, shame and self-loathing, and alienation and isolation they experienced. They also spoke of how they responded to these emotions and how they moved beyond suicidality.
Fullagar, et al. [26], 2007, Australia	To explore how everyday understandings of the issues surrounding suicide risk and prevention were constructed within community contexts and were mediate by a range of social institutions.	Eighty-one young people (aged 15–24 years), service providers (teachers, school counselors, sports coaches and youth and health workers) and adults (parents and community leaders)	Structured interviews including 10 open ended questions	Constructions of suicide through statistics and stories were common, as was discussion about stigma and distancing of suicide. Young people and adults also differed on their perspectives of youth suicide.
Gulbas, et al. [31], 2015, USA	To describe and compare the conditions and experiences that precede the decisions to self-harm in order to contribute to an understanding of the contexts surrounding self-harmful behaviours within in Latina adolescent behaviour.	Thirty-seven Latinas between the ages 11–19 who attempted suicide through self-harm.	Qualitative interviews and analysis	Attempters spoke about feeling powerless, as well as unloved and unsupported in their interpersonal relationships. A history of self-harm was also common.
Gulbas and Zayas [32], 2015, USA	To link the attempters experience to the broader socio-cultural forces that the attempters both encounters and surrenders to.	Ten Latina teen suicide attempters and their parents	Qualitative interviews and comparative analysis	Participants reported subjective distress, interpersonal discord and emotional isolation.
Herrera, et al. [34], 2006, Nicaragua	To explore perceived causes and discover triggers and processes leading to suicidal behaviour among adolescent girls in Leon, Nicaragua.	Eight Nicaraguan girls aged between 12–19 admitted to hospital after attempting suicide	In-depth interviews, grounded theory and content analysis	Perceived causes were material conditions, family structure and norms and values. When combined with triggering events and emotions these conditions elicit action from the participants. These actions were explained as problem solving, escape or suicide attempt.
Holliday and Vandermause [38], 2015, USA	To describe and interpret the phenomenon of attempted suicide in a sample of teens who visit an emergency department for a suicide attempt	Six young people aged 15–19 who visited an emergency department for a suicide attempt	Heideggerian hermeneutic methodological approach	Common patterns and themes were identified. The pattern of attempting as a way of communication was evident through themes of Ambiguity and cries of pain. The second pattern, attempting as transforming is described through being unconnected, spiraling down and being alone with suffering. Conversely, connecting was seen as a way to climb upwards.
Jegannathan, et al. [37], 2016, Cambodia	To explore the views of the focus group on the societal attitudes towards suicide, contemporary media norms, Buddhism and their influence on suicidal behaviour	Forty-eight students from 2 schools in Cambodia	Focus groups and thematic analysis	The social stigma of suicide was a common theme throughout, as was the double-edged nature of the media as both educative and suicide-provocative. Suicide-ambiguity in Buddhism was also prevalent.
Jo, et al. [22], 2011, Korea	To understand the suicidal ideation of the qualitative content analysis in South Korean college students	One hundred and thirty-four South Korean college students	Non-structured open questions, qualitative content analysis	Physical, physiological and social concerns were discussed as being facilitators of suicidal ideation, while religious, individual and relational beliefs were seen as inhibitors.
Keyvanara and Haghshenas [35], 2011, Iran	To illuminate the socio-cultural context of attempted suicide among Iranian youth.	Twenty-five young people aged 14–17 who attempted suicide and were admitted to hospital in Isfahan	Qualitative interviews, thematic analysis	Participants frequently reported despair, failure in love, family issues involving conflicts between children and their parents and/or siblings, the pressure of high expectations from family and peers, and poverty as important factors in their suicide attempt.
Matel-Anderson and Bekhet [43], 2016, USA	To explore components of resilience in adolescents who survived a suicide attempt from the perspective of nine psychiatric nurses.	Nine psychiatric nurses.	Focus group and analysis	Risk factors were split into six categories: Unstable households and traumatized childhood history, having a means to drugs and firearms, bullying, cognitive distortions and lack of vision for the future, absence of parental bonding and lack of positive role model, and poor self-esteem and issues with identity.
Montreuil, et al. [40], 2015, Canada	To find what the perceptions of children with suicide associated risk factors and their parents are regarding helpful nursing care in pediatric mental health settings?	Children with at least one suicide risk factor and their psychiatric problem, and their parents	Semi-structured interviews, participant observation and inductive analysis	Caring for the child as a special person was considered important in recovery. Ways of doing this included getting to know the child, personalizing care, being available, and communicating calmly. Caring for parents was achieved through being available to parents and reassuring parents through talking. Managing the child’s illness involved including parents in the care team, linking the body to the thinking and teaching coping behaviours. It was also important to create a therapeutic environment by managing the physical and social environments.
Orri, et al. [36], 2014, Italy	To explore the perspective of adolescents directly involved in suicidal acts	Sixteen adolescents with either single or multiple suicidal acts in their past or with a history of.	Qualitative interviews and interpretive phenomenological analysis	Common themes were divided into individual and relational dimensions of the suicide attempt. Individual dimensions included negative emotions toward the self and the need to have control over their lives. Relational dimensions involved a perceived impasse in interpersonal relationships, communication issues, and suicide as revenge.
Roen, et al. [39], 2008, UK	To consider how some young people become positioned as suicidal subjects while others do not and how some young people find suicidal behaviour imaginable while others do not	Sixty-nine people aged 16–24 years	Interviews and focus groups, discourse analysis	Common themes for discussion involved the ‘othering’ of suicide, suicidal subjecthood as being readily accessible and attempts to rationalize why people attempt suicide.
Schwartz, et al. [23], 2010, USA	To understand the attitudes, beliefs and perceptions of adolescents and parents of adolescents from a variety of backgrounds regarding adolescent suicide	Ninety-six children of 13–18 years of age and parents/guardians of children aged 13–18 years	Semi-structured focus groups, analysis	Participants spoke about the risk factors, predictability, preventability and environmental factors of suicide in young people,
Shilubane, et al. [46], 2012, South Africa	To identify psycho-social target points for future educational interventions	Fourteen adolescents who recently attempted suicide	One-on-one in-depth interviews, analysis	Psychosocial factors identified in this study were disturbed family relationships and perceived accusations of negative behaviour. Problems with social support systems, such as family and peer problems, and experiences of negative emotions and depression were also prevalent. Participants discussed negative life events, often a family history of suicide, peer suicide or the individual’s previous suicide attempts, as well as the impact of living circumstances and a lack of knowledge of available counsellors.
Shilubane, et al. [44], 2012, South Africa	To describe the impact on high school students of a suicide or suicide attempt by a peer to assess students’ knowledge about suicide, perceived risk factors, signs of poor mental health, and to assess their awareness of available mental health care and resources and opinions on prevention	Fifty-six high school student who had a peer commit or attempt suicide	Focus groups, inductive analysis	Peer reactions were discussed, as were the signs of poor mental health, the perceived cause of the peer’s suicide attempt/suicide, perceived availability of resources and opinions on prevention.
Strickland and Cooper [27], 2011, USA	To gain an understanding of the moving processes and stories from the view of youth by focusing on the experiences of ‘at-risk’ Indian youth residing in a Pacific Northwest tribe.	Thirty ‘At-risk’ American Indian youth aged between 14 and 19 years old residing in a Pacific Northwest tribe.	Focus groups and observation, content analysis	Participants spoke of the effects that getting into trouble could have and ways of dealing with the trouble and coping with the stress. Staying on track was also considered an important focus for at-risk youth.
Strickland, et al. [28], 2006, USA	To gain parents and elders perspectives on community needs and to identify strengths on which the community might build to reduce suicide	Forty-nine American Indian parents and elders	Focus groups, content analysis	Discussions centred around a loss of culture and tradition, and a breakdown of family values. Participants also considered that a connection to culture and community can protect against suicidality.
Sukhawaha, et al. [41], 2016, Thailand	To understand and describe the triggering factors associated with suicidal attempts in adolescence from the perspective of adolescents who had direct experience with suicidal attempt by exploratory descriptive study.	Eighteen adolescents who had attempted suicide and some of their parents.	In-depth interviews, content analysis	Triggering factors included severe verbal criticism, unwanted pregnancies and mental illness causing intense emotions and irresistible impulses.
Tingey, et al. [29], 2014, USA	To develop the Apache conceptual model of youth suicide with qualitative data from a community-based sample of Apache adolescents who have attempted suicide.	Twenty-two native adolescents who had attempted suicide	Longitudinal interviews, qualitative descriptive approach	Individual factors contributing to suicide involved emotion recognitions and dysregulation, and impulsivity and reactivity. Family factors included family dynamics, household composition, substance use and family support. Community factors involved grief burden, and stigma, while societal factors were imitation and minimizing the significance of youth suicide after the fact.
Walls, et al. [30], 2014, Canada	To share the voices of adult community members from a single cultural group across 3 separate central Canadian first nations reserves who participated in focus group discussions about the devastating loss of their young people to suicide.	Elders and service providers	Qualitative interviews, thematic analysis	Participants spoke of interpersonal factors such as the presence of suicide clusters/normalization of suicidality, barriers to communication and relationships/early dating. Meso-level factors included family and community factors. Family factors involved the parental abuse of alcohol and drugs, gambling and poor parenting skills. Macro-level factors such as historical trauma, the effects of European contact and residential school systems, loss of identity and the need to return to the traditional way of life were all discussed in these focus groups.
White and Morris [45], 2010, Canada	To document the planning and implantation of a four-part, classroom-based suicide prevention education program within one secondary school as a way to better understand how it is conceptualized and experienced.	Two grade 11 English classrooms scheduled to receive a suicide prevention curriculum	In-depth case study discursive critical constructionist methodology	Depression and mental illness, stress, uncertainty, multiplicity and unpredictability were all common perceptions of youth suicide. It was also observed that children often learned things which were not actively taught and the role this may play in planning education programs.
Zayas, et al. [33], 2010, USA	To explore what the conditions in which suicide attempts occur among young Latinas, how Latinas experience the circumstances that led to the attempt and what young women say precipitated their suicide attempts and what triggers the act.	Twenty-seven teenage Latinas aged 11–19 living in New York City who had attempted suicide	Qualitative interviews, thematic analysis	Participants varied in why they attempted suicide and patterns of distress involving escalating tensions and a trigger were prevalent. These teenagers also spoke about their reactions, regrets and insights following their attempts.