Socioeconomic Difficulties and Health Problems in Suicide Decedents of Middle Age: A Systematic Review and Meta-Analysis

Background: Suicide is a growing cause of death in middle-aged adults with significant impact on both family and the society; however, knowledge to guide prevention is limited. In this first systematic review with meta-analysis on suicide in the middle-aged, we aim to provide an overview of published research and to synthesize the evidence on contributing factors to this mortality. Methods: We searched Medline, Embase, PsycINFO, Scopus and Web of Science (June 2020) according to PRISMA guidelines for English-language publications that presented individual-level data, involved participants aged 35 to 65, and reported prevalence of exposure(s) or relative risks. Data were pooled with meta-analyses. The protocol was registered on PROSPERO (CRD42019128799). Findings: We identified 62 research articles reporting suicide of middle age and associated factors (28 for socioeconomic status, 22 for psychiatric disorder and 23 for physical illness). All studies were from high income countries, and most (80.6%) used data from population registries. Meta-analyses showed that the pooled prevalence in suicide decedents was 43.2% for unemployment, 56.3% for low income, 57.8% for psychiatric disorder, and 27.3% for physical illness. The associated pooled risk ratio was 3.97 (95% confidence intervals: 2.42-6.51) for unemployment, 3.26 (2.71-3.91) for being separated or divorced, 2.09 (1.41-3.11) for low income, 11.83 (5.14-27.23) for psychiatric illness, 12.74 (8.89-18.24) for mood disorders, 2.64 (2.26-3.10) for cancer and 2.52 (1.17-5.42) for central nervous system illness. Interpretation: Suicide in midlife is strongly associated with socioeconomic difficulties and physical and psychiatric illnesses that are common in this age population. More research is needed, particularly with data from low- and middle-income countries. Registration Details: The protocol was registered on PROSPERO (CRD42019128799). Funding Information: This research received no specific grant from any funding agency, commercial or not-for-profit sectors. Declaration of Interests: We declare no competing interests.