Risk Factors for Suicide Attempts in Chinese Patients with Major Depressive Disorder: A Systematic Review and Meta-Analysis

BACKGROUND This meta-analysis aimed to identify risk factors for suicide attempts (SA) in patients with depression to inform clinical practice. MATERIAL AND METHODS We searched multiple databases up to January 1, 2025, including MEDLINE and Embase. Case-control and cohort studies reporting risk factors for SA in patients with depression were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS), and meta-analyses were performed using Rev Man 5.4 software. Results are expressed as odds ratios (OR) and 95% confidence intervals (CI). Heterogeneity was assessed using I² and P values, and publication bias was evaluated using funnel plots and Egger's test. The registration information was deposited in the International Register of Systematic Reviews and Meta-Analyses (PROSPERO) trial registry (CRD420251061401; Retrospective registration). RESULTS Out of a total of 3792 records, 22 case-control studies were included. The overall heterogeneity (I2) ranged from 0% to 91.9%. Significant risk factors for SA included suicidal ideation (OR=4.98, 95% CI 3.21-7.22), previous hospitalizations (OR=1.38, 95% CI 1.18-1.61), family history of suicide (OR=2.59, 95% CI 1.89-3.57), psychotic symptoms (OR=2.77, 95% CI 1.98-3.88), frequent depressive episodes (OR=2.58, 95% CI 1.58-4.22), self-blame (OR=2.43, 95% CI 1.78-3.31), negative life events (OR=3.77, 95% CI 2.85-5.51), and delusion (OR=3.14, 95% CI 1.99-4.96). Publication bias was detected for family history of suicide and suicidal ideation, but OR values remained significant after correction. CONCLUSIONS Our findings highlight the need for comprehensive risk assessments and targeted interventions in clinical practice to prevent suicide attempts in patients with depression. Future research should explore the mechanisms and interactions of these risk factors to refine prevention strategies.