Background: Suicide deaths remain a major public health concern worldwide, accounting for one in every 100 deaths in 2019. One potential strategy for prevention is to identify and target the social determinants of suicide. We aimed to examine the potential associations between the social determinants of health and suicide mortality.
Methods: In this umbrella review, six bibliographic databases were systematically searched for articles published from database inception to August 24 2023. We included peer-reviewed systematic reviews and meta-analyses of studies which examined the association between any listed social determinant of health (as defined by the World Health Organisation) and suicide mortality and published in English. Due to the heterogeneity between studies, a meta-analysis was not possible however effect sizes from included meta-analyses were synthesised and compared across domains. Results were narratively synthesised. The quality of included studies was assessed using an adapted version of the AMSTAR-2 tool. The protocol was preregistered with PROSPERO (ID: CRD42023447175; July 31 2023).
Results: We identified 53 studies, 23 meta-analyses and 20 systematic reviews. Eight out of ten social determinants were identified including, housing basic amenities and the environment (n=22), early childhood development (n=6), social inclusion and non-discrimination (n=3), education (n=4), income and social protection (n=15), unemployment and job insecurity (n=8), working life conditions (n=3) and food insecurity (n=1). There were no reviews identified from the determinants representing access to healthcare or structural conflict. The majority of reviews were either critically low (n=23) or low (n=16) in quality and the remainder with moderate (n=8) or high (n=6). Education, income/ social protection and unemployment/ job security had the strongest associations with suicide.
Discussion: Many of the variables representing the eight studied social determinants were associated with risk of suicide, however, the strength of the association varied. The quality of included studies needs to be considered when interpreting results.
Conclusion: This umbrella review will help to understand how social determinants influence suicide, which is critical for informing the establishment of, or changes to, policies and practices which can prevent suicide.