Abstract / Summary
Background Risky sexual behavior (RSB) and suicidal behavior contribute substantially to adolescent morbidity and mortality but are typically addressed through siloed sexual-health and mental-health programs.Objective To synthesize evidence on the co-occurrence of RSB and suicidal behavior in adolescents (10–24 years), map shared determinants using the Social Ecological Model (SEM), and inform integrated prevention.Method PubMed, Scopus, and Web of Science were searched to 30 April 2026 (PRISMA 2020, PRISMA-S; protocol preregistered on OSF). Eligible studies were peer-reviewed empirical investigations of adolescents aged 10–24 years (cross-sectional, cohort, qualitative, or mixed-methods) assessing RSB and suicidal indicators in the same sample. Two reviewers independently screened and appraised studies (JBI checklists, MMAT). A convergent-integrated narrative synthesis (rather than meta-analysis, owing to heterogeneity) followed SWiM, with findings mapped to SEM levels.Results Eight studies (n ≈ 28,600 adolescents across nine countries) were eligible. Across these predominantly cross-sectional observational studies, adolescents reporting suicidal ideation, plans, or attempts were 1.7- to 4.5-fold more likely to report RSB; these estimates derive from individual studies, not a pooled effect. Shared determinants were reported across all SEM levels.Conclusions RSB and suicidal behavior frequently co-occur in adolescents with shared multilevel determinants, a pattern broadly consistent with, though not proof of, a syndemic. Given the small, observational evidence base, findings warrant cautious interpretation. Integrated sexual-and-reproductive-health, mental-health, and substance-use services delivered through school, primary-care, and youth-friendly platforms warrant evaluation as prevention strategies.