Na Peter Jongho, Shin Jeonghyun, Kwak Ha Rim, Lee Jaewon, Jester Dylan J, Bandara Piumee, Kim Jim Yong, Moutier Christine Y, Pietrzak Robert H, Oquendo Maria A, Jeste Dilip V
VA Connecticut Healthcare System, West Haven, Connecticut.
Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.
JAMA Psychiatry. 2025 Apr 1;82(4):337-346. doi: 10.1001/jamapsychiatry.2024.4241.
Preventing suicide is one of the top priorities in public health policy. Identifying key social determinants of health (SDOH) in suicide risk is critical for informing clinical practices, future research, and policy solutions to prevent suicide.
To examine the associations of SDOH with suicide-related outcomes.
Studies published before July 2023 were searched through PubMed, PsycINFO, Embase, and Web of Science. The date of the search was August 4, 2023.
We included the most up-to-date meta-analyses reporting associations between SDOH and suicide-related outcomes.
Three independent reviewers extracted data and conducted quality assessment using the Joanna Briggs Institute Checklist for Systematic Reviews and Research Syntheses.
The main outcomes of interest were suicide mortality, suicide attempt, and suicidal ideation.
A total of 46 meta-analyses met inclusion criteria. For suicide mortality, justice system-involved individuals in the community, exposure to others' and parental suicide, firearm accessibility, divorce, experience in foster care, release from incarceration, and midlife (age 35-65 years) unemployment were the SDOH with consistently strong effects. Individuals released from incarceration demonstrated a high prevalence of suicide mortality (114.5 per 100 000 persons). With regard to suicide attempt, experience of childhood abuse and maltreatment and sexual assault, gender and sexual minority status, and parental suicide mortality were the strongest risk factors. The prevalence of suicide attempt among homeless individuals (28.9%; 95% CI, 21.7%-37.2%) and incarcerated female youths (27%; 95% CI, 20%-34%) and adults (12.2%; 95% CI, 7.1%-17.2%) was high. For suicidal ideation, identification as bisexual and intimate partner violence in women were the strongest risk factors. The prevalence of lifetime suicidal ideation in homeless individuals was 41.6% (95% CI, 28.6%-56.0%). Protective factors associated with reduced risk of suicide mortality were religious affiliation and being married. School connectedness showed protective associations against suicide attempt and suicidal ideation.
Tailoring interventions and future research for identified priority subpopulations, such as justice system-involved individuals in the community, and implementing policy measures addressing the SDOH that showed strong associations with suicide mortality, attempts, and ideation, such as gun licensing requirements, are critical to counteracting social and environmental forces that increase suicide risk.
预防自杀是公共卫生政策的首要任务之一。确定自杀风险中健康的关键社会决定因素（SDOH）对于指导临床实践、未来研究以及预防自杀的政策解决方案至关重要。
研究SDOH与自杀相关结局之间的关联。
通过PubMed、PsycINFO、Embase和Web of Science检索2023年7月之前发表的研究。检索日期为2023年8月4日。
我们纳入了报告SDOH与自杀相关结局之间关联的最新荟萃分析。
三名独立评审员提取数据，并使用乔安娜·布里格斯循证卫生保健中心系统评价和研究综合核对清单进行质量评估。
主要关注的结局是自杀死亡率、自杀未遂和自杀意念。
共有46项荟萃分析符合纳入标准。对于自杀死亡率，社区中涉及司法系统的个体、接触他人自杀和父母自杀、枪支可及性、离婚、寄养经历、出狱以及中年（35 - 65岁）失业是具有持续强烈影响的SDOH。出狱个体的自杀死亡率很高（每10万人中有114.5人）。关于自杀未遂，童年期虐待和忽视经历、性侵犯、性别和性少数群体身份以及父母自杀死亡率是最强的危险因素。无家可归者（28.9%；95%置信区间，21.7% - 37.2%）、被监禁的女性青少年（27%；95%置信区间，20% - 34%）和成年人（12.2%；95%置信区间，7.1% - 17.2%）的自杀未遂患病率很高。对于自杀意念，女性被认定为双性恋和亲密伴侣暴力是最强的危险因素。无家可归者终身自杀意念的患病率为41.6%（95%置信区间，28.6% - 56.0%）。与自杀死亡率风险降低相关的保护因素是宗教信仰和已婚。学校归属感显示出对自杀未遂和自杀意念的保护关联。
为已确定的优先亚人群（如社区中涉及司法系统的个体）量身定制干预措施和未来研究，并实施针对与自杀死亡率、未遂和意念有强烈关联的SDOH的政策措施（如枪支许可要求），对于对抗增加自杀风险的社会和环境力量至关重要。
