Suicidal risk factors and completed suicide: meta-analyses based on psychological autopsy studies

Kouichi Yoshimasu,Chikako Kiyohara,Kazuhisa Miyashita

doi:10.1007/s12199-008-0037-x

Abstract

The purpose of the present review is to evaluate the effects of common risk factors for suicide by meta-analyses using data extracted from studies based on the psychological autopsy method. We focused on five common risk factors of suicide: substance-related disorders, mood disorders, adverse marital status, adverse employment status, and self-harm behaviors. A total of 24 articles were identified from MEDLINE in which the crude odds ratio (OR) could be calculated for the above five risk factors through 30 April 2007, using such search keywords as "suicide," "psychological autopsy," and "case-control study." Overall, both substance-related disorders [OR = 5.24; 95% confidence interval (CI) = 3.30-8.31] and mood disorders [OR = 13.42; 95% CI = 8.05-22.37] were strongly associated with suicidal risk. Suicidal attempt and deliberate self-harm, which can directly lead to completed suicide, have been shown to be very strongly associated with suicidal risk [OR = 16.33; 95% CI = 7.51-35.52]. Effects of social factors such as adverse marital and employment status were relatively small. As substance-related disorders and mood disorders were strongly associated with an increased risk of completed suicide, the comorbidity of these two disorders should be paid a maximum attention. The effective prevention of suicide depends on whether we can successfully incorporate these personal factors as well as social factors into an adequate multi-factorial model.

Highlights

Suicide is a serious problem all over the world
Substance-related disorders are the category of mental disorders most prevalent among completed suicides as well as mood disorders documented by more than 20 major psychological autopsy projects [15]
These studies reported that the range of current prevalence of alcohol dependence/ abuse preceding suicide was from 15 to 56% [15]

Summary

Introduction

Suicide is a serious problem all over the world. Approximately 1 million people are estimated to commit suicide per year [1]. Several epidemiologic studies [2,3,4,5,6,7,8] have indicated risk factors for suicide, such as depression, severe anxiety, substance abuse, poor interpersonal relationships including social isolation, inability to maintain a job, anhedonia, somatic diseases, financial problems, and personal or familial history of suicide. These suicidal risk factors can be divided broadly into two categories, personal and social factors. The other factors except age and race, such as irritation, loss of physical health, or unwilling to accept help, are conceptually obscure; that is, they are likely to be defined differently by each epidemiologic study design and to be affected by the value system in each country with different cultural backgrounds

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