SS07 - Suicide Prevention Based on Social Determinants of Health: Insights from Informatics, Epidemiology, and Economic Modeling

A Comprehensive Review of Up-to-Date Meta-Analyses of Social Determinants of Health for Suicide Mortality, Suicide Attempts, and Suicidal Ideation
August, 30 | 17:30 - 19:00

Mitigating suicide is a top priority in public health policy. Identifying key social determinants of health (SDoH) in relation to suicide-related outcomes is thus critical for informing clinical guidelines and policy solutions. In this session, Dr. Na will present the results of a comprehensive review of more than 45 pre-existing meta-analyses that examined the associations of SDoH with suicide-related outcomes –suicide mortality (SM), suicide attempts (SAs), and suicidal ideation (SI). Studies on SDoH and SM, SA, and SI published before July 2023 were searched through PubMED, PsycINFO, Embase, and Web of Science. Three independent reviewers assessed the strength of relationships between SDoH and SM, SA, and SI. Quality assessment was performed using the Joanna Briggs Institute (JBI) Checklist for Systematic Reviews and Research Syntheses. For SM, community offenders without incarceration, history of community offenses, exposure to others’ SM/SAs, and firearm accessibility demonstrated large effect size increases (Cohen's d>0.8). With regard to marital status, divorced status demonstrated medium effect size increase in SM (Cohen's d>0.5), and small effect size increases in SM were observed for single and non-married (Cohen's d>0.2). For SAs, sexual minority status (identification as lesbian-gay-bisexual-transgender-intersex-queer), childhood complex abuse, and sexual assault demonstrated large effect size increases (Cohen's d>0.8). Exposure to other's SA, childhood sexual abuse, cyber-victimization and cyber bullying had medium effect size increases in SA (Cohen's d>0.5). Associations of SDoH and SI were largely similar to those for SAs. Positive factors associated with reduced risk of SM, SA, and SI included being married, greater religiosity, and school connectedness. Based on our findings, we suggest that clinicians closely assess and monitor suicide risk of individuals with the SDoH that showed medium-to-large effect size increases in SM, SAs, and SI. A significant limitation of this review is that most of the studies included in the meta-analyses came from developed countries rather than low- and middle-income regions where 80% of the world’s suicides occur and where the risk profiles are likely different. SDoH for SM, SA, and SI may differ in developing countries, as access to lethal means and cultural values will influence patterns of suicide. Notwithstanding such limitation, this study provides the most comprehensive review to date of extant meta-analyses on SDoH and suicide related outcomes. Tailoring interventions for identified priority sub-populations and implementing policy measures addressing the SDoH that show strong associations with SM, SA, and SI is critical to helping counteract the social forces that contribute to suicide risk.

Speakers