Risk factors for suicide in individuals with depression: a systematic review
Abstract
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.
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Hopelessness doubled the odds of a self-induced death.
“Hawton et al. (2013) reviewed 28 publications dealing with suicide and found that hopelessness doubled the odds of a self-induced death.”
From A hope intervention for adolescents: a randomized controlled trial delivered by paraprofessionals (2025) · cites this paper as Hawton et al., 2013
Untreated depression is associated with adverse outcomes including poor physical health, suicidal thoughts and behaviors, and caregiver stress.
“untreated depression is associated with adverse outcomes (e.g., poor physical health, suicidal thoughts and behaviors (STBs), and caregiver stress; Cadman et al., 2021; Hawton et al., 2013)”
From Community-guided, autism-adapted group cognitive behavioral therapy for depression in autistic youth (CBT-DAY): Preliminary feasibility, acceptability, and efficacy (2024) · cites this paper as Hawton et al., 2013
Suicidal ideation is common in the context of depression.
“As suicidal ideation is common in the context of depression (Hawton et al., 2013), youth with low-grade STBs were not excluded.”
From Community-guided, autism-adapted group cognitive behavioral therapy for depression in autistic youth (CBT-DAY): Preliminary feasibility, acceptability, and efficacy (2024) · cites this paper as Hawton et al., 2013
This structure is quite stable cross-nationally.
“This structure is quite stable cross-nationally. 177”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [177]
Depression is associated with SIB.
“depression is associated with SIB”
From Loneliness as a predictor of suicidal ideation and behaviour: a systematic review and meta-analysis of prospective studies (2020) · cites this paper as Hawton et al., 2013
Assessment of suicide risk can be improved by considering somatic and psychiatric comorbidities.
“and assessment of suicide risk can be improved by considering somatic39 and psychiatric40 comorbidities.”
From Risk factors for suicide in adults: systematic review and meta-analysis of psychological autopsy studies (2022) · cites this paper as [40]
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- Authors
- Hawton, K., Casañas i Comabella, C., Haw, C., & Saunders, K.
- Affiliations
- University of Oxford (GB)
- Corresponding author
- Hawton, Keith
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2013-05
- Volume
- 147
- Issue
- 1-3
- Pages
- 17-28
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2010632490
- Cited by
- 1,469
- References
- 59
- Citations by year
- 2026: 75 · 2025: 130 · 2024: 146 · 2023: 142 · 2022: 153 · 2021: 191 · 2020: 175 · 2019: 94 · 2018: 97 · 2017: 77 · 2016: 77 · 2015: 52 · 2014: 44 · 2013: 15
- FWCI
- 9.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0508-10053)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- suicide risk factors, depression, suicide, male gender, family history of mental illness, previous suicide attempts, depression severity, hopelessness, comorbidities, anxiety, substance abuse, alcohol abuse, drug abuse, suicide risk assessment
- MeSH terms
- Adult, Anxiety Disorders, Depression, Depressive Disorder, Female, Humans, Male, Middle Aged, Risk Factors, Suicide
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