Risk factors for suicide in individuals with depression: a systematic review.

BACKGROUND

Depression is the most common psychiatric disorder in people who die by suicide. Awareness of risk factors for suicide in depression is important for clinicians.

METHODS

In a systematic review of the international literature we identified cohort and case-control studies of people with depression in which suicide was an outcome, and conducted meta-analyses of potential risk factors.

RESULTS

Nineteen studies (28 publications) were included. Factors significantly associated with suicide were: male gender (OR=1.76, 95% CI=1.08-2.86), family history of psychiatric disorder (OR=1.41, 95% CI=1.00-1.97), previous attempted suicide (OR=4.84, 95% CI=3.26-7.20), more severe depression (OR=2.20, 95% CI=1.05-4.60), hopelessness (OR=2.20, 95% CI=1.49-3.23) and comorbid disorders, including anxiety (OR=1.59, 95% CI=1.03-2.45) and misuse of alcohol and drugs (OR=2.17, 95% CI=1.77-2.66).

LIMITATIONS

There were fewer studies than suspected. Interdependence between risk factors could not be examined.

CONCLUSIONS

The factors identified should be included in clinical assessment of risk in depressed patients. Further large-scale studies are required to identify other relevant factors.