Background Suicide is a major public health problem and for decades, it has remained one of the leading causes of injury and death worldwide. The objectives of this study were to investigate the prevalence of suicidal behavior, suicidal ideation, and patterns among youth in the Anywaa zone of the Gambella regional state, Southwest Ethiopia. Methods and materials A mixed-method study design was used in which a quantitative survey was conducted along with qualitative interviews and FGDs in the Anywaa zone. A total of 136 respondents were included in the survey study from the two woredas. The survey was conducted to assess the prevalence of suicidal behavior and ideations in a sample of preparatory school youth students. A pre-tested and structured questionnaire was used for the descriptive analysis. Qualitative information was also obtained through interviews and focus group discussions to identify the patterns of suicide and to gain more nuanced participants/ survivors’ experiences. Data were analyzed using SPSS version 20, for which descriptive statistics were used. Qualitative data were analyzed using thematic analysis. Results Suicidal behaviors and ideation were high among youths in the study area. In this study 62.3% of respondents reported they had heard others talk about their wish to die by suicide, 68 (64.2%) of youth said they had heard many youths claim that “I feel like there is no way out”, 48 (43.3%) reported having seen someone with the signs of planning a suicide such as obtaining a weapon or writing a suicide note. About 68 (64.2%) of participants said, “My family would be better off without me.” The majority of respondents were in the age groups ranging from 26 to 30 years. The results on the patterns of suicide attempts showed that hanging and drug overdose or poisoning were the most common patterns used by both men and women. Conclusion The findings indicate that the prevalence of suicide-related behaviors and ideations was high among youths in the Anywaa zone. The results on the patterns of suicide attempts showed that hanging and drug overdose or poisoning were the most common patterns used by both men and women. As a result, we would like to recommend that Government, Non-Governmental Organizations NGOs, and Faith-Based Organizations (FBOs), along with health care providers and counselors should work together by creating awareness, and by establishing Programs that target youths. Meanwhile, early identification and management of suicide risk in youth should be strengthened.