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=1.03-245) 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. (C) 2013 Elsevier B.V. All rights reserved.