Risk of suicide and suicidal behavior in refugees. A meta-review of current systematic reviews and meta-analyses

Background: Despite the exposure to a wide combination of risk factors, evidence concerning risk of suicide among refugees is mixed. Aims: We aimed to establish more precise estimates of suicide and suicidal behavior in refugees and asylum seekers, investigate the role of somatic and psychiatric comorbidities, and the effectiveness of preventative interventions. Methods: We searched PubMed/Medline, EMBASE, CINAHL, and PsycInfo without time limitations from inception until June 5, 2024. Studies were included if systematic reviews or meta-analyses reporting data on suicide or suicidal behavior in refugees or asylum seekers, or detailing the results of preventive interventions. Quality was assessed using the National Institutes of Health Quality Assessment Tool for Systematic Reviews and Meta-Analyses. Results: Out of 49 papers, 10 systematic reviews and meta-analyses were included. Refugees showed significantly higher suicide death rates and suicidal ideation, suicide plan and suicide attempt prevalence compared to people living in the host countries. Refugees who arrived in low-income and lower-middle-income countries displayed lower suicidal ideation, but higher suicide death rates and suicide attempt prevalence compared to refugees who arrived in high-income and upper-middle- income countries. However, no review provided data regarding somatic comorbidity, psychiatric comorbidity, or the effectiveness of treatments, and evidence on specific categories of refugees is scarce. Conclusion: Refugees have been proven to be at risk for suicide and suicidal behavior. More research is required to identify the targets and procedures of intervention.