Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Jan 19, 2022; 12(1): 187-203
Published online Jan 19, 2022. doi: 10.5498/wjp.v12.i1.187
Risk factors for suicidal behaviour in late-life depression: A systematic review
Veronica Fernandez-Rodrigues, Yolanda Sanchez-Carro, Luisa Natalia Lagunas, Laura Alejandra Rico-Uribe, Andres Pemau, Patricia Diaz-Carracedo, Marina Diaz-Marsa, Gonzalo Hervas, Alejandro de la Torre-Luque
Veronica Fernandez-Rodrigues, Andres Pemau, Patricia Diaz-Carracedo, Gonzalo Hervas, Department of Psychology, Universidad Complutense de Madrid, Madrid 28223, Spain
Yolanda Sanchez-Carro, Department of Psychiatry, Universidad Autonoma de Madrid, Madrid 28046, Spain
Yolanda Sanchez-Carro, Laura Alejandra Rico-Uribe, Marina Diaz-Marsa, Alejandro de la Torre-Luque, Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid 28029, Spain
Luisa Natalia Lagunas, Marina Diaz-Marsa, Alejandro de la Torre-Luque, Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, Madrid 28046, Spain
Laura Alejandra Rico-Uribe, Department of Psychology, La Rioja International University, Logrono 26006, Spain
Marina Diaz-Marsa, Institute of Psychiatry and Mental Health, San Carlos Clinical Hospital, Madrid 28040, Spain
Author contributions: Fernandez-Rodrigues V and de la Torre-Luque A conceptualised the research questions, interpreted the study results, wrote the original draft, elaborated the study protocols, and conducted the searches; Fernandez-Rodrigues V, Sanchez-Carro Y, Rico-Uribe LA, and Lagunas LN conducted the study review; de la Torre-Luque A, Hervas G, and Diaz-Marsa M were involved in study supervision; all the authors contributed to this study and were involved in reviewing and editing the final manuscript.
Supported by Instituto de Salud Carlos III-FIS, co-supported by European Regional Development Fund (ERDF) 'a way to build Europe', No. PI20/00229 and No. PI19/01256.
Conflict-of-interest statement: The authors report that they have no conflict of interest to be disclosed.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Luisa Natalia Lagunas, PhD, Academic Fellow, Assistant Professor, Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid, 2 Seneca Avenue, Madrid 28046, Spain.
Received: May 4, 2021
Peer-review started: May 4, 2021
First decision: September 5, 2021
Revised: September 17, 2021
Accepted: November 24, 2021
Article in press: November 24, 2021
Published online: January 19, 2022

Suicide is a leading cause of preventable death worldwide, with its peak of maximum incidence in later life. Depression often puts an individual at higher risk for suicidal behaviour. In turn, depression deserves particular interest in old age due to its high prevalence and dramatic impact on health and wellbeing.


To gather integrated evidence on the potential risk factors for suicide behaviour development in depressive older adults, and to examine the effects of depression treatment to tackle suicide behaviour in this population.


A systematic review of empirical studies, published from 2000 onwards, was conducted. Suicidal behaviour was addressed considering its varying forms (i.e., wish to die, ideation, attempt, and completed suicide).


Thirty-five papers were selected for review, comprising both clinical and epidemiological studies. Most of studies focused on suicidal ideation (60%). The studies consistently pointed out that the risk was related to depressive episode severity, psychiatric comorbidity (anxiety or substance use disorders), poorer health status, and loss of functionality. Reduced social support and loneliness were also associated with suicide behaviour in depressive older adults. Finally, the intervention studies showed that suicidal behaviour was a robust predictor of depression treatment response. Reductions in suicidal ideation were moderated by reductions in risk factors for suicide symptoms.


To sum up, common and age-specific risk factors seem to be involved in suicide development in depressive older adults. A major effort should be made to tackle this serious public health concern so as to promote older people to age healthily and well.

Keywords: Late-life depression, Suicide behaviour, Disability, Chronic disease, Loneliness

Core Tip: Suicide constitutes a global health concern. In this regard, suicide is one of the leading ten causes of death in five of the 21 Global Burden of Disease defined regions. Suicide mortality is more prevalent in older adults in comparison to younger adults, due to the cumulated influence of multiple risk factors over time. The role of depression in late-life suicide deserves particular interest due to its elevated prevalence and relationship with functional disability and chronic disease development. Results from this study may contribute to planning intensive assessment protocols in older adults with depression to target suicide, as well as to monitoring suicide behaviour as a key indicator of depression treatment success.