Wafy Gamal, Ajayi Lin, Siddiqi Sara, Saravanamuttoo Taylor, Shorr Risa, Solmi Marco, Colman Ian, Fiedorowicz Jess G
Arch Suicide Res. 2024 Aug 26:1-22. doi: 10.1080/13811118.2024.2394671.
Suicide is a major global public health concern. While some progress has been made in understanding risk factors for suicidal behavior, other relevant questions have received less attention. One such question relates to the longitudinal course of suicidal behavior amongst individuals with multiple suicide attempts. This systematic review investigated whether there is an increase in the lethality across multiple suicide attempts.
This systematic review followed PRISMA 2020 reporting guidelines. A literature search was conducted in MEDLINE, Embase and PsycINFO electronic databases from inception to August 2023 to identify studies with key terms related to multiple suicide attempts and lethality. The review included longitudinal studies with data on multiple suicide attempts, and any rating of their lethality. Covidence was used to guide the screening and extraction process. A narrative synthesis approach was used to descriptively summarize included studies.
After identifying 828 unique abstracts for screening, 11 studies were included for narrative synthesis. Suicide attempt assessment methods and definitions were heterogenous, often indirectly inferring lethality based on suicide attempt method. Individuals with repeat attempts may be more likely to continue using the same method.
There was no evidence to support increasing lethality across repeat suicide attempts. However, this should be interpreted along with the fact that the evidence base is scarce, heterogenous, and methodologically limited.
自杀是一个重大的全球公共卫生问题。虽然在了解自杀行为的风险因素方面已经取得了一些进展，但其他相关问题受到的关注较少。其中一个问题涉及多次自杀未遂者自杀行为的纵向过程。本系统评价调查了多次自杀未遂者的自杀致死性是否增加。
本系统评价遵循PRISMA 2020报告指南。从数据库建立至2023年8月，在MEDLINE、Embase和PsycINFO电子数据库中进行文献检索，以识别与多次自杀未遂和致死性相关的关键词的研究。该评价纳入了有多次自杀未遂数据及其致死性评级的纵向研究。使用Covidence软件指导筛选和提取过程。采用叙述性综合方法对纳入的研究进行描述性总结。
在识别出828篇待筛选的独特摘要后，纳入了11项研究进行叙述性综合。自杀未遂的评估方法和定义各不相同，通常基于自杀未遂方法间接推断致死性。多次自杀未遂者可能更倾向于继续使用相同的方法。
没有证据支持多次自杀未遂者的致死性会增加。然而，这一结论应结合证据基础稀缺、异质性大且方法学存在局限性这一事实来解读。
