Correlates of suicidality in young people with depressive disorders: A systematic review

Abstract

Objective: Depression is one of the most prevalent and disabling mental health conditions among young people worldwide. The health and economic burdens associated with depressive illness are substantial. Suicide and depression are closely intertwined, yet a diagnosis of depression itself lacks predictive specificity for suicidal behaviour. To better inform suicide prevention and early intervention strategies for young people, improved identification of modifiable intervention targets is needed. The objective of this review was to identify clinical, psychosocial and biological correlates of suicidality in young people diagnosed with a broad range of unipolar and bipolar depressive disorders. Method: Systematic searches were conducted across MEDLINE, Embase and PsycINFO to identify studies of young people aged 15–25 years diagnosed with unipolar or bipolar depressive disorders. An assessment of suicidality was required for inclusion. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Synthesis Without Meta-analysis guidelines. Results: We integrated findings from 71 studies including approximately 24,670 young people with clinically diagnosed depression. We identified 26 clinical, psychosocial and biological correlates of suicidality. Depression characteristics (type and severity), psychiatric comorbidity (particularly anxiety and substance use disorders) and neurological characteristics emerged as having the most evidence for being associated with suicidal outcomes. Our ability to pool data and conduct meaningful quantitative synthesis was hampered by substantial heterogeneity across studies and incomplete reporting; thus, meta-analysis was not possible. Conclusion: Findings of this review reinforce the notion that suicidality is a complex phenomenon arising from the interplay of multiple contributing factors. Our findings question the utility of considering a diagnosis of depression as a specific risk factor for suicidality in young people. Suicidality itself is transdiagnostic; adoption of a transdiagnostic approach to investigating its aetiology and treatment is perhaps warranted. Future research investigating specific symptoms, or symptom networks, might help to further our understanding of suicidality among young people experiencing mental illness.

Predictors of suicidal ideation severity among treatment-seeking young people with major depressive disorder: The role of state and trait anxiety

“…Selection of correlates in our analysis was conducted a priori based on previous comprehensive systematic review findings (Moller et al, 2022). However, our investigation was limited to the measures that were included in the YoDA trials.…”

“…Our selection of correlates was primarily based on recent systematic review findings characterising associations between suicidal outcomes and a broad range of psychosocial correlates in young people with clinically diagnosed depressive disorders (Moller et al, 2022). Treatment allocation was not included as a correlate, as the treatments under investigation in both YoDA studies did not result in any significant difference in clinical outcomes, compared with treatment as usual (Berk et al, 2020; Davey et al, 2019).…”

Relations of Childhood Trauma and Emotional Dysregulation with Suicide Ideation and Suicidal Behaviour Severity in a Clinical Sample of Depressive Female Adolescents

“…Suicidality is a transdiagnostic concept resulting from the interaction of various contributing factors ( 34 ). Our regression analysis revealed significant relations between the BDI scores and current C-SSRS scores.…”

Suicidal ideation and attempts in adults seeking outpatient psychodynamic psychotherapy

“…Poor mental health is one of the main drivers of death by suicide (Cavanagh et al, 2003; Glaesmer et al, 2020; Moller et al, 2022; Roy et al, 2021). A systematic review and meta‐analysis of 203 studies showed that mortality due to unnatural causes (suicides and injuries) is seven times higher in patients with mental disorders compared to the general population (Walker et al, 2015).…”