Prevalence and associated factors of suicidal ideation, suicide plans, and suicide attempts among nurses: a systematic review and meta-analysis.

Abstract

Background: Suicide-related outcomes among nurses represent an important occupational mental health concern; however, evidence regarding their prevalence and associated factors remains fragmented. This systematic review and meta-analysis aimed to estimate the pooled prevalence of suicidal ideation (SI) and suicide plans (SP) among nurses, narratively summarize suicide attempts (SA), and synthesize associated factors.

Methods: A systematic search was conducted in PubMed, Scopus, Embase, PsycINFO, Web of Science, the Cochrane Library, and four Chinese databases (CNKI, CBM, VIP, and Wanfang) from inception to November 1, 2025. Random-effects models were used to estimate pooled prevalence, 95% confidence intervals (CIs), and 95% prediction intervals (PIs) for SI and SP. Subgroup analyses and meta-regression were conducted to explore heterogeneity. Publication bias for SI was assessed using a funnel plot and Egger's test. Associated factors were synthesized narratively, and SA-related findings were summarized narratively because of limited available data and substantial heterogeneity.

Results: A total of 1,840 records were initially identified, and 55 articles representing 54 independent studies across 18 countries were included. The pooled prevalence was 12.8% (95% CI: 10.1%-15.7%; 95% PI: 3.2%-36.3%; I² = 99.0%) for SI and 5.0% (95% CI: 3.8%-6.4%; 95% PI: 1.6%-17.6%; I² = 70.2%) for SP, indicating substantial heterogeneity for SI and moderate-to-high heterogeneity for SP. In subgroup analyses, SI prevalence varied by country, geographical region, and recall period. By country, SI prevalence ranged from 6.1% in Spain to 15.5% in Ireland. Regionally, Asia showed the highest SI prevalence (15.7%), followed by Europe (10.8%) and North America (8.6%). Across recall periods, SI prevalence was highest for past-week recall (18.1%) and lowest for past-month recall (8.1%). Meta-regression indicated a negative association between mean age and SI prevalence (R² = 25.86%). SA was reported in a limited number of studies and was summarized narratively because of heterogeneity in measurement and populations. Associated factors spanned multiple domains, with psychological and occupational factors most frequently reported.

Conclusions: SI and SP are relatively common among nurses, whereas evidence on SA remains limited. The wide prediction intervals suggest that pooled prevalence estimates should be interpreted as summary measures of heterogeneous evidence rather than precise estimates applicable to all nurse populations. Suicide-related outcomes among nurses appear to be influenced by individual psychological factors as well as occupational and contextual conditions, highlighting the need for targeted mental health support and workplace-based preventive strategies.