Adolescent self-harm and suicidality in the post-pandemic digital era: a mini review of social determinants and implications for precision public health

Adolescent self-harm and suicidality across pandemic and post-pandemic periods are frequently described as a single escalating crisis. That account obscures differences among non-suicidal self-injury, broad self-harm, suicidal ideation, suicide attempts, and suicide mortality, and it treats surveys, emergency presentations, notifications, hospitalizations, and vital registration as interchangeable. We conducted a focused narrative review. The evidence does not support one population-wide trajectory. Pediatric emergency data indicate increases in attempted-suicide presentations in some periods and groups, particularly girls, while pooled changes in ideation and self-harm are less consistent. Brazilian notifications fell abruptly when service access and reporting were disrupted, whereas several mortality trajectories in Brazil and the United States were already rising before 2020. Social disadvantage, violence, bullying, and Indigenous and ethnoracial inequities are associated with risk and with differential visibility in surveillance systems. Digital evidence is similarly differentiated: cybervictimization, problematic or addictive use, exposure to self-harm content, nocturnal use, and sleep-related pathways show more consistent associations than time-only measures, but most studies remain observational. Online peer support and help-seeking may offer benefits, though preventive effects remain uncertain. Precision public health may help translate this heterogeneity into population action by identifying groups, places, exposures, and intervention intensity. It should not be equated with individual suicide prediction, whose accuracy remains limited. Equitable application requires universal prevention with proportionately greater support where need is higher, together with representative data, transparent governance, and stronger evidence from underrepresented regions, including Latin America.