A Silent Gap: Underrepresentation of Latin American Patients in Pivotal Genitourinary and Skin Cancer Trials.

Adolescent suicide remains a major public health concern in the United States, with serious consequences for youth, families, schools, and communities. In 2023, suicide was the second leading cause of death among people ages 10–34. From 2013 to 2023, the Youth Risk Behavior Survey documented rising suicide risk, measured as suicidal thoughts and behavior (STB), among high school students: suicidal ideation increased from 17% to 20%, suicide planning from 14% to 16%, and attempts from 8% to 9%. Although ideation and attempts share overlapping pathways, they are commonly examined separately given distinct clinical implications. Contemporary suicide theory, including the Ideation-to-action frameworks, Three-Step Theory, and Interpersonal Theory of Suicide, proposes that psychological pain and social disconnection contribute to suicidal ideation, while distinguishing suicidal desire from the capability to attempt suicide. These theories suggest that relational contexts may be vital for understanding adolescent STB by shaping adolescents’ sense of belonging, connection, recognition, and social value. Adolescent suicide risk emerges from a complex interplay of individual vulnerabilities, interpersonal experiences, and broader social and community environments, making prevention and early intervention challenging. Individual-level risk factors such as depressive symptoms and substance use are consistently linked to increased suicide risk. Interpersonal stressors—particularly bullying victimization—also play a central role, both as direct correlates of suicide risk and as contributors to worsening mental health and behavioral outcomes. A growing body of research highlights that suicide risk among adolescents is shaped not only by mental health symptoms and behavioral risk factors, but also by relational contexts that can either increase vulnerability or provide protection. Consistent with a social determinants of health perspective, these relational contexts are part of the broader social conditions in which adolescents live, learn, and develop, and they may influence suicide risk by shaping exposure to stressors, access to supportive relationships, and opportunities to experience belonging and recognition. A socioecological framework is needed to comprehensively understand the role of relational context in adolescent suicide risk and guided multilevel prevention. Moving beyond the understanding of suicide risk as an individual outcome, socioecological theories emphasize that adolescent suicide risk is embedded within multiple levels of influence, including interpersonal, relational, and community levels. Relational protective factors operate across interpersonal and individual levels through interconnected pathways, mediating youth exposure to psychological pain and hopelessness and preventing its escalation into suicidal thoughts or behaviors. However, empirical studies primarily focus on individual or interpersonal risk factors, or measure these processes narrowly or within a single relational context. This focus reflects a broader risk-oriented, individual-level bias in literature, with limited attention to social contexts and support systems, leading to an underrepresentation of protective factors. This is an important gap since suicide theories emphasize connectedness, belonging, and social value.