Risk factors for violence and suicide in the general population: an umbrella review

Thesis

BACKGROUND: Violence and suicide account for an estimated 1.4 million global annual deaths. There is a large volume of literature examining single risk factors or small groups of related risk factors for violence, and separately for suicide. This thesis is an umbrella review that created an overview of this literature and compared risk factors across multiple risk categories for both violence and suicide, assessed overlap and estimated the impact of risk factors at a population level.

METHODS: A systematic search was conducted to identify reviews analysing risk factors for violence and suicide in the general population. Effect sizes were extracted and synthesized. Population attributable fractions were calculated where possible. Quality analyses were performed on reviews eligible for inclusion.

RESULTS: Twenty-two meta-analyses reporting on violence risk factors and 12 metaanalyses reporting on suicide risk factors were eligible for quantitative analysis. A further 37 reviews were included in a qualitative analysis. The strongest associations and most distinct overlap were found between neuropsychiatric risk factors for both violence and suicide, with particularly strong effect sizes found for neuropsychiatric risk factors and suicide. The neuropsychiatric risk factors which had the largest impact at a population level were substance abuse for violence (14.8%) and depression for suicide (27.9%).

DISCUSSION & CONCLUSION: This review demonstrated that neuropsychiatric risk factors for violence and suicide often have stronger associations with both outcomes than other types of risk factors, such as socio-demographic and childhood-related factors. This suggests that neuropsychiatric risk factors are of upmost importance in clinical risk assessment and as targets for intervention for violence and suicide reduction. Nevertheless, neuropsychiatric risk factors were found to account for only a small proportion of violence at a population level and appeared to have a stronger impact on suicide. Risk assessment for violence and suicide is complex and will always be imperfect. Further research is required to elucidate the areas of uncertainty found by this review.

Authors: Smith, E

• DOI: 10.5287/ora-0nyopdz9m
• Type of award: MSc by Research
• Level of award: Masters
• Awarding institution: University of Oxford
• Language: English
• Keywords: Violence; Suicide; Psychiatry; Risk
• Subjects: Psychiatry