Suicide is a global public health concern, impacting millions of lives (Zortea et al., 2020). The US CDC defines suicide as death caused by self-directed injurious behavior, undertaken with the intent to die (Klonsky et al., 2016). This definition encompasses a continuum of suicidal behaviors, including suicidal ideation, planning, and attempts (Noh, 2019; Wang et al., 2018). A survey reported that the lifetime prevalence rates for suicidal ideation, planning, and attempts were 9.2 %, 3.1 %, and 2.7 %, respectively (Kim et al., 2023). According to the World Health Organization, over 800,000 people die by suicide every year (Park et al., 2018). Suicide mostly affects the 15–29-year age group (many of whom are likely to be students) and is the second-highest cause of death after unintentional injury-related death from accidents (Rasheduzzaman et al., 2022). The repercussions extend beyond individual loss, contributing to healthcare costs, diminished productivity, and premature death, posing a substantial burden on the country and society (Ertl et al., 2020).

Several factors contribute to an elevated risk of suicidal behavior, with anxiety being a significant contributor. The interpersonal theory of suicide identifies perceived burdensomeness, thwarted belongingness, and acquired capability for suicide as components that predispose a person to suicidal behavior (Schreiner et al., 2019). According to this theory, disorders associated with social conflict or isolation are most predictive of thwarted belongingness or perceived burdensomeness, and thus, are strongly associated with suicidal behavior. Anxiety is linked to increased thwarted belongingness, potentially increasing an individual's risk of suicidal behavior (Silva et al., 2015). Additionally, anxiety constitutes the stress component in the stress-diathesis model of suicide and is often the proximal stressor leading to suicidal behavior, which is associated with an increased risk of suicidal behavior (Ryan and Oquendo, 2020; Hawton and van Heeringen, 2009).

Anxiety represents a significant public health concern and is among the most prevalent psychiatric disorders. Anxiety is a natural response and necessary warning adaptation that includes both anxiety disorders and symptoms (Hill et al., 2011). Anxiety disorders, with an estimated prevalence in the general population ranging from 4 % to 8 %, are common in the developmental stage of adolescence, with a median onset age of 11 years (Bertelsen et al., 2022; Essau et al., 2018). Anxiety during adolescence can lead to various adverse consequences. It can negatively affect psychosocial functioning, including social interactions and school dropout. Furthermore, adolescents with anxiety face an increased risk of subsequent suicidal behavior, illicit drug dependence, depression, anxiety, and alcohol dependence as young adults (Baker et al., 2021; Woodward and Fergusson, 2001). Moreover, several studies indicate a significant comorbidity between anxiety and other psychiatric disorders, such as depressive disorders and attention-deficit/hyperactivity disorder (ADHD), resulting in disability and reduced quality of life (Koyuncu et al., 2022; Mohammadi et al., 2020).

Notably, there is a significant gender difference in anxiety prevalence and suicidal behavior. Anxiety is more prevalent among women than men (Bekker and van Mens-Verhulst, 2007; Faravelli et al., 2013). This difference may be attributed to the greater range of cyclical fluctuations in hormone levels in women than in men. These hormones affect regions of the brain involved in the modulation of mood and behavior, rendering women more susceptible to stress. Additionally, anxiety is more prevalent in female adolescents than in male adolescents (Wu et al., 2022). Conversely, an epidemiological study revealed an overall suicide rate of 10.7 per 100,000 people, with a male-to-female ratio of 1.7, indicating that men are almost twice as likely to commit suicide as women (Bachmann, 2018). Evidence suggests that suicidal behavior is more strongly associated with the prevalence of internalizing disorders (such as depression and anxiety) in females than in males, whereas males are more likely to exhibit externalizing disorders (such as substance abuse disorders and conduct disorders) (Miranda-Mendizabal et al., 2019).

Numerous studies have shown that anxiety is a significant risk factor for suicidal behavior (Gradus et al., 2010; Thibodeau et al., 2013; De La Vega et al., 2018; Nepon et al., 2010). However, these studies are cross-sectional and thus limited when trying to make causal inferences. Additionally, studies have shown a positive relationship between anxiety and suicidal behavior in adults; however, relatively little is known about this association in adolescents (Rodriguez and Kendall, 2014). Given the high prevalence of anxiety in adolescents, which may be associated with an increased risk of subsequent suicidal behavior, it is necessary to recognize adolescents with anxiety as a high-risk group for potential suicide behavior and formulate proactive policies and implement appropriate intervention measures (Russell et al., 2013). To the best of our knowledge, no meta-analysis or systematic review has summarized the longitudinal association between anxiety during adolescence and subsequent suicide behavior. This systematic review and meta-analysis exclusively included longitudinal studies focused on adolescents. Employing an observational research approach, aiming to elucidate the relationship between anxiety in adolescents and subsequent suicide behavior, providing valuable insights for future interventions and prevention measures to reduce the prevalence of suicide in this population.