The rates of suicide and self-harm in Northern Ireland have increased markedly from 2004 to 2019, with a particularly striking increase from 143 registered suicides in 1996 to 305 in 2017. This review summarises the epidemiology of suicidal behaviour, as well as the evidence from a small number of studies that have identified risk factors associated with the high suicide rates here. These were mental illness, trauma, exposure to the conflict, deprivation, relationship problems, employment difficulties, financial difficulties, being LGBT, adversities and alcohol or drug use. It highlights key challenges and opportunities for suicide prevention, emphasising a lifespan approach. More needs to be done to address the relationship between substance misuse and suicide. Future research and prevention efforts should also focus on the transgenerational impact of the conflict, youth suicide, suicide prevention among minority groups and the criminal justice context. The delivery and access to suicide-specific psychosocial interventions need to be prioritised, more support for people in crisis is required, as well as interventions for mental illness. Protect Life 2, the national suicide prevention strategy, needs to be implemented in full. Given the legacy of conflict in Northern Ireland, all suicide prevention efforts should be trauma-informed.