Risk factors for suicidal behaviour in people with dementia: A systematic review and meta-analysis

Dementia-related affective symptoms and social withdrawal increase vulnerability to suicidal behaviour. This study evaluates the magnitude of this risk and its determinants, focusing specifically on suicide attempts and deaths.

A systematic review and meta-analysis of observational studies was conducted. Eight English- and Chinese-language databases were searched from inception to May 2025. Pooled odds ratios (OR) were estimated using random-effects models to compare people with dementia (PwD) with controls and to identify risk factors within the dementia population.

Thirty-seven studies met the inclusion criteria. Dementia was associated with a 62% increased risk of suicidal behaviour compared with non-dementia controls (pooled OR = 1.62; 95% CI 1.32-1.98). Risk was notably concentrated in specific subgroups: younger patients were nearly three times more likely to die by suicide than older patients, and men faced 28% higher odds of suicide attempts and 188% increased odds of suicide deaths compared to women. Social isolation and psychiatric history-particularly depression-were robust risk markers. Notably, the exhaustive search of Chinese-language databases yielded no eligible publications, revealing a significant geographical evidence gap.

PwD face a significant increase in suicidal behaviour, concentrated within subgroups with psychiatric and social vulnerabilities. Prevention should prioritise younger patients, men, and socially isolated individuals. The identified lack of diverse data necessitates future cross-cultural qualitative research in English and Chinese to bridge the gap between Western and Eastern perspectives and capture culturally situated risk factors currently missing from the literature.