The global prevalence of suicidal ideation in older adults: A systematic review and Meta-analysis

The global population is aging rapidly, and suicide among older adults aged 60 and over is a critical public health issue. Suicidal ideation (SI) is the strongest precursor to suicidal behavior. However, a comprehensive global synthesis of the prevalence and distribution of SI among older adults worldwide has been lacking.

This study aimed to systematically review the global prevalence of SI in older adults and explore its distribution across demographic, geographical, and methodological dimensions through subgroup analyses.

We systematically searched nine databases from inception to November 3, 2025, for observational studies. Two reviewers independently conducted study selection, data extraction, and quality assessment. Data were pooled using a random-effects model in Stata15.0 to calculate prevalence and perform subgroup analyses. The review was registered with PROSPERO (CRD420251233412).

Seventy-two studies comprising 625,891 older adults were included and the pooled prevalence was 12.8% (95%CI: 11.4% -14.1%). However, extreme heterogeneity was observed (I²=99.9%), and significant publication bias was present. The trim-and-fill adjusted prevalence was 5.7%. Subgroup analyses revealed significantly higher prevalence among the oldest old (≥80 years, 13.7%), women (17.8%), residents of Asia (13.8%), and developing countries (14.7%), and assessment of "current" SI reported significantly higher rates than other timeframes.

Although the precise pooled prevalence is uncertain due to substantial heterogeneity and publication bias, this study confirms that SI is prevalent concern among older adults globally, with risk disproportionately concentrated among the oldest old, women, and those in developing countries. The findings call for targeted public health strategies and underscore the imperative to use standardized assessment tools and address critical evidence gaps in future research.