Document Type : Systematic Review
Authors
1
Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.
2
Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran.
3
School of Medicine, Islamic Azad University of Medical Sciences, Tehran, Iran.
4
Ph.D. Student, Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
5
Assistant Professor of Reproductive Health, School of Nursing and Allied Medical Sciences, Maragheh University of Medical Sciences, Maragheh, Iran.
6
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
7
School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
8
Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
9
School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran.
10
Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
11
Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
12
Department of Public Health and Community Medicine, Tufts University, Boston, MA, USA
10.30491/tm.2026.588694.1951
Abstract
Introduction: Suicidal thoughts (ST) and attempts (SA) are significant concerns among individuals with primary depression. This systematic review aims to explore risk factors associated with these phenomena to inform better prevention strategies.
Methods: A systematic review was conducted. We searched 4 databases (PubMed, Embase, Scopus, Web of Science) from 2000 to the 7 February 2026, using "suicide," "self-killing," "suicidal," and "suicidium," while "depression" and "depressive" were used for depression, and "risk factor," "risk factors," "risk scores," and "relative risk” as keywords, and assessed for quality using the Newcastle-Ottawa Quality Assessment Form checklist. Relevant data were extracted and recorded from the eligible articles.
Results: In 47 cohort studies (687,156 participants), key risk factors for ST and SA in primary depression across MDD, BD, and dysthymia included depressive severity, hopelessness, childhood trauma, and prior attempts. ST were linked to cognitive-emotional factors (rumination, perceived burdensomeness, anxiety). In contrast, SA were predicted by behavioral/clinical indicators (psychiatric hospitalization, substance use, unemployment, personality pathology, especially Cluster B in BD). Age patterns emerged: younger age/early onset increased SA risk in BD, while older age/social isolation were prominent in MDD. Biological (lipid abnormalities) and medication factors showed diagnosis-specific associations.
Conclusion: Suicide risk in primary depression follows a progressive cascade from early trauma and personality vulnerabilities to clinical deterioration and behavioral manifestation. Prevention requires diagnosis-specific, age-sensitive strategies incorporating routine trauma screening, severity monitoring, and comorbidity management.
Keywords
Subjects
