Risk factors for suicidal behaviour in late-life depression: A systematic review

Table 1 Summary of studies included in the review

Ref.	Sample size	Sex (% female)	Mean age (yr)	Methodological quality	Suicide outcome	Suicide assessment	Treatment study testing and result	Depression-related factors	Significant risk factors
Almeida et al[2], 2016	38170	0	72	5	Suicide attempt and completed suicide	National register			Chronic diseases (+)
Arslanoglou et al[20], 2019	63	73.02	80.52	4	Suicidal ideation	Scale: HDRS	Psychological: PATH. Better outcomes for the PATH intervention vs supportive care	Depressive episode onset (-)	Cognitive function, (+) disability, (-) and social factors (social support) (-)
Aslan et al[3], 2019	150	72.7	71.3	4	Suicidal ideation and suicide attempt	Clinical interview: DSM-IV			Education attainment, (-) anxiety symptoms (+)
Awata et al[40], 2005	1145	58.07	76.29	4	Suicidal ideation	Clinical interview: DSM-IV		Depressive symptoms (+)	Disability (+) and social factors (social support) (+)
Barak et al[53], 2006	202	58.41	76.55	5	Suicide attempt	Local/regional register		Antidepressant use (-)
Barnow et al[39], 2004	516	48.1	84.37	4	Wish to die and suicidal ideation	Scale: HDRS, GMS-A			Age, (+) sex (female), (+) subjective health status (-)
Bartels et al[41], 2002	2240	23.9		5	Suicidal ideation and suicide attempt	Scale: PSS			Ethnic group (Asians), (+)1 medical diseases, (+) social factors (social support), (-) comorbid anxiety disorder (+)
Bakkane Bendixen et al[59], 2018	218	67	75.6	4	Suicidality risk	Scale: MADRS			Anxiety symptoms (+)
Bickford et al[42], 2021	88	62.5	71.5	4	Suicidal ideation	Scale: GSIS		Depressive symptoms (+)	Frailty and disability (+)
Bickford et al[10], 2020	225	64.9	71.4	4	Suicidal ideation	Scale: GSIS			Perceived stress (+)
Bonnewyn et al[58], 2017	68	59.29	73.87	5	Wish to die	Scale: SSI
Brådvik and Berglund[54], 2009	1206			5	Suicide attempt and completed suicide	National register
Bruce et al[43], 2004	412			6	Suicidal ideation	Scale: SSI	Pharmacological: PROSPECT. Reductions in suicidal ideation due to treatment
Cole et al[44], 2006	113	63.4	79.2	5	Suicidal ideation and suicide attempt	Clinical interview: DSM-IV		Major depression (+)
Coupland et al[55], 2011	60746	66.7	75	6	Suicide attempt	Local/regional register	Pharmacological: Antidepressants. No effect of treatments on suicidal outcomes	Antidepressant use (+)	Self-harm (+)
Hwang et al[35], 2010	70	0	79.4	6	Suicide attempt	Clinical interview			Brain volume (i.e., reductions in dorsal medial prefrontal cortex) (+)
Innamorati et al[56], 2014	331	24.4		4	Suicide attempt and completed suicide	Autopsy			Social factors: Widowhood, (+) loneliness, (+) social support. (-) Life stressors (+)
Jokinen and Nordström[37], 2008	99	73.73	73	5	Suicide attempt and completed suicide	National register			Dexamethasone suppression (-)
Kiosses et al[45], 2017	74	73.66	80.90	4	Suicidal ideation and plan	Scale: MADRS	Psychological: PATH. Better outcomes for the PATH intervention vs supportive care		Negative emotions, (+) cognitive function (-)
La Pia et al[46], 2001	36	55.55		4	Suicidal ideation	Scale: HDRS	Pharmacological: Fluoxetine. Suicidal ideation reductions as a robust predictor of response
Lee et al[21], 2003	156	32.69	73.6	2	Suicidal ideation and suicide attempt	Scale: HDRS; Clinical interview: DSM-IV		Delusional symptoms, (+) depressive symptoms (+)	Cognitive function, (-) disability (+)
Liu et al[36], 2020	47	0	83.8	5	Suicidal ideation	Scale: SSI		Depressive symptoms (+)	Chemokines (MCP-2/CCL8) (+)
Lohman et al[47], 2016	112	69.6	76.5	6	Suicidal ideation	Scale: HDRS	Nurse-based: CAREPATH. Lower proportions (31.3%) of CAREPATH patients showing suicidal ideation at follow-up, vs TAU patients (63.6%)		Ethnic group (minorities), (-) disability, (+) burdensomeness (+)
Lutz et al[48], 2021	75	66	71.57	4	Suicidal ideation	Scale: GSIS	Psychological: 12-wk problem-solving therapy. Changes in functional disability predicted the changes in suicidal ideation		Disability (+)
Lynch et al[38], 2004	77	62.3	69.51	3	Suicidal ideation	Scale: ASIQ		Hopelesness (+)	Negative affect intensity and reactivity (+)
Mansour et al[25], 2020	5546	61.5	76.8	7	Suicidal ideation	Clinical Interview: ICD-10			Ethnic group (White) (+)
McIntyre et al[22], 2008	1763	28.59	73.68	4	Wish to die and suicidal ideation	Scale: GSIS			Subjective health status, (-) medical conditions, (+) disability, (+) health service utilization, (+) anxiety disorder (+)
Meeks et al[49], 2008	148	60	80.3	5	Suicidal ideation	Center admission record		Sleep difficulty (+)	Chronic pain, (+)
Morse and Lynch[50], 2004	65	69.2	70.3	4	Suicidal ideation	Scale: ASIQ
Nishida et al[33], 2015	24	41.67	78.7	8	Completed suicide	Autopsy			Stroke severity (+)
Richard-Devantoy et al[57], 2012	40	62.5	76.5	9	Suicide attempt	Clinical interview: DSM-IV			Cognitive function (-)
Sacco et al[60], 2015	8480	52.97	75.91	5	Suicidality risk	Clinical Interview: ICD-10		Depressive symptoms (+)	Alcohol use disorder, (+) liver disease (+)
Szanto et al[51], 2003	395	72.91	71.4	4	Suicidal ideation	Scale: HDRS	Pharmacological and psychological: Paroxetine, nortriptyline with or without psychotherapy. Participants with a higher risk of suicidality needed a greater time for suicidal ideation reduction	Depressive episode onset, (-) number of episodes, (+) depressive symptoms, (+) recurrence of depressive episode (+)	Psychiatric inpatient (+)
Tan and Wong[52], 2008	80	69.1	72.7	5	Suicidal ideation and suicide attempt	Scale: BDI, SSI. Clinical interview (not specified)		History of suicide behavior (+)	Sex (female), (+) psychiatric inpatient treatment (-)
Zivin et al[34], 2007	654232			7	Completed suicide	National register			Substance use disorder, (+) PTSD (-)

¹In comparison to black participants.

The methodological quality of the studies was assessed by means of the Newcastle-Ottawa Quality Assessment Scale. The relationships between the depression-related and risk factors with the suicide outcome were positive (+), indicating the higher the level of the factor (or the presence of this condition), the higher the risk of the suicide outcome. An inverse relationship between the depression-related and risk factors with the suicide outcome was indicated by (-), with higher levels of the factor (or the presence of this condition) associated with a lower suicide outcome risk. ASIQ: Adult suicidal ideation questionnaire; DSM: Diagnostic and statistical manual of mental disorders; BDI: Beck depression inventory; GMS-A: Geriatric mental state examination; GSIS: Geriatric suicide ideation scale; HDRS: Hamilton depression rating scale; ICD: International classification of diseases manual; MADRS: Montgomery-Asberg depression rating scale; SSI: Beck scale for suicidal ideation.