Over 700,000 deaths annually are attributable to suicide. While psychiatric factors are often the focus of prevention efforts, growing evidence highlights the role of social determinants of health (SDOH) in shaping suicide risk. A recent systematic review and meta-analysis published in JAMA Psychiatry examined the relationship between SDOH and suicide-related outcomes, including suicide mortality, suicide attempts, and suicidal ideation.

The study revealed that justice system involvement, firearm accessibility, exposure to the suicide of others, divorce, foster care experience, unemployment in midlife, and release from incarceration are among the strongest risk factors for suicide mortality. Individuals released from incarceration had a tenfold higher suicide rate than the general population. Midlife unemployment was linked to a greater than 200% increase in risk.

For suicide attempts, childhood abuse, sexual assault, gender and sexual minority status, and parental suicide were identified as major risk factors. The prevalence of suicide attempts was particularly high among homeless individuals, incarcerated youth, and female prisoners. Suicidal ideation was strongly linked to bisexual identity, intimate partner violence, and cyberbullying, with homeless individuals reporting high lifetime prevalence of suicidal thoughts.

Protective factors for suicide mortality included being married and religious affiliation, suggesting the importance of social connectedness in reducing risk. For suicidal ideation and attempts, school connectedness was a notable protective factor.

The key takeaway from this study is that suicide prevention strategies need to address social and structural risk factors. Policies that provide targeted mental health support for justice-involved individuals, economic assistance for unemployed adults, firearm safety measures, and protections for marginalized populations could play a crucial role in reducing suicide deaths. Expanding school-based interventions and strengthening postvention support for suicide loss survivors may also be effective. Integrating SDOH into suicide prevention frameworks is essential for addressing the broader environmental and societal forces that contribute to suicide.

Reference:
Na PJ et al. JAMA Psychiatry 2025. Epub ahead of print. Abstract.