The social determinants of suicide: an umbrella review.

Abstract

Previous research has highlighted the role of social determinants of health on mental health, but their impact on suicide is less understood. The aim of this umbrella review was to systematically examine the association between 10 social determinants of health, as defined by the World Health Organization, and suicide mortality. A key word search of titles and abstracts was conducted in six digital databases for studies published up to August 24, 2023. Inclusion criteria were peer-reviewed systematic reviews and meta-analyses examining the association between these determinants and suicide. Methodological quality was assessed using an adapted AMSTAR-2 tool. A narrative synthesis, structured by social determinant, was conducted. A total of 49 records (n = 25 meta-analyses and 24 systematic reviews) were included in this review. Determinants with the most available evidence were housing, basic amenities and the environment (n = 21); income and social protection (n = 13); unemployment (n = 8); and early childhood development (n = 6). Limited evidence was identified for education (n = 3), social inclusion and nondiscrimination (n = 3), and working-life conditions (n = 3). No reviews examined the relationship between affordable health care services, structural conflict, or food insecurity and suicide. There was evidence of a modest effect of social determinants on suicide mortality. Most evidence related to unemployment, job insecurity, income and social protection, and childhood adversity. The methodological quality of the included reviews varied considerably. High-quality research fully exploring the relationship between social and environmental factors and suicide risk is needed.