Background: Suicidality is multi-determined and reflects a complex interaction of social, psychological and environmental risk and protective factors. Though there is extensive evidence for the causes of suicidality, some uncertainties surrounding risk factors remain. Stressful life events are a known risk factor, but the strength and nature of the association between stressful life events and suicidality is unclear. To investigate this, the current review examined the prospective relationship between stressful life events and suicidality.
Methods: MEDLINE, EMBASE, CINAHL, Cochrane, and PsycINFO databases were searched from inception to October 2018 (updated April 2019). Eligible studies included observational, quantitative longitudinal cohort studies which provided data on the association between stressful life events and a subsequent aspect of suicidality in adults or adolescents (≥14 years and older). The Effective Public Health Practice Project (EPHPP) quality assessment guidance was used to conduct a methodological quality assessment. Random-effects meta-analyses model was used to examine the strength of the prospective relationship between the experience of stressful life events and subsequent suicidality. Sub-group analyses and meta-regression analyses was used to examine factors moderating the relationship.
Results: Eight studies were identified in the systematic review, and nine independent comparisons on 2,639 participants from seven studies were included in the meta-analysis (mean age = 37 years, 54% female). Stressful life events were associated with a significantly increased risk for suicidality (9 comparisons: Odds Ratio (OR) = 1.37, 95% CI = 1.10 to 1.70). Statistical heterogeneity was high (I2 = 76. 48, 95% CI: 55.0 to 87.7%), publication bias was indicated, and methodological quality of the studies was mixed.
Discussion: The analyses suggested that stressful life events can statistically increase the risk of suicidality, which could have implications for subsequent clinical assessment and intervention. Further high-quality research is needed to confirm this tentative link between stressful life events and suicidality.
