Date Published: July 10, 2017
Publisher: Public Library of Science
Author(s): Xieyining Huang, Jessica D. Ribeiro, Katherine M. Musacchio, Joseph C. Franklin, Ulrich S Tran.
Certain demographic factors have long been cited to confer risk or protection for suicidal thoughts and behaviors. However, many studies have found weak or non-significant effects. Determining the effect strength and clinical utility of demographics as predictors is crucial for suicide risk assessment and theory development. As such, we conducted a meta-analysis to determine the effect strength and clinical utility of demographics as predictors.
We searched PsycInfo, PubMed, and GoogleScholar for studies published before January 1st, 2015. Inclusion criteria required that studies use at least one demographic factor to longitudinally predict suicide ideation, attempt, or death. The initial search yielded 2,541 studies, 159 of which were eligible. A total of 752 unique statistical tests were included in analysis.
Suicide death was the most commonly studied outcome, followed by attempt and ideation. The average follow-up length was 9.4 years. The overall effects of demographic factors studied in the field as risk factors were significant but weak, and that of demographic factors studied as protective factors were non-significant. Adjusting for publication bias further reduced effect estimates. No specific demographic factors appeared to be strong predictors. The effects were consistent across multiple moderators.
At least within the narrow methodological constraints of the existing literature, demographic factors were statistically significant risk factors, but not protective factors. Even as risk factors, demographics offer very little improvement in predictive accuracy. Future studies that go beyond the limitations of the existing literature are needed to further understand the effects of demographics.
The national suicide rate in the United States has risen 24% since 2000, reaching 13.4 deaths per 100,000 in 2014. Both completed suicide and non-fatal self-injuries cast tremendous burden on the health care system, resulting in approximately $48.3 billion economic loss annually . Under such circumstances, there is an urgent need to identify risk and protective factors for suicidal behaviors in order to allocate treatment resources to high-risk individuals. Research has long noted distinct suicide rates in different demographic groups. Unraveling these differences will not only inform risk assessment, but also increase understanding of suicidal thoughts and behaviors. Accordingly, the present study summarizes the existing literature to determine whether and to what extent demographic factors confer risk or protection for suicidal thoughts and behaviors.
Although demographics have been frequently examined as potential risk and protective factors for suicidal thoughts and behaviors, study results have often conflicted with one another and with national statistics. This meta-analysis aimed to estimate the effects of demographic factors in suicide risk and protection, and to test whether these effects were moderated by methodological differences among studies. Our major findings include: 1) the overall effects of demographic characteristics as risk or protective factors were weak; 2) no specific demographic factor appeared to be particularly strong; and 3) the effects of demographics were highly consistent across moderators. Each of these findings is discussed in more detail below.