Suicidal Ideation and Attempt among Homeless People: a Systematic Review and Meta-Analysis

Abstract

Globally, suicide is a major public health problem among homeless people. Suicidal ideation and attempt are remarkably higher among homeless people as compared to the general population and they are linked with greater risk of complete suicide. However, no systematic review and meta-analysis has been conducted to report the consolidated magnitude of suicidal ideation and attempt among homeless people. We searched PubMed, Embase, and Scopus to identify pertinent studies on suicidal ideation and attempt among homeless people. A meta-analysis of the studies was conducted using a random effect model. We also conducted a sensitivity analysis and Cochran's Q- and the I² test was employed to evaluate heterogeneity. Publication bias was assessed by Egger's test and visual inspection of the symmetry in funnel plots. In total, 20 eligible studies with 27,497 homeless people matched the inclusion criteria. Nineteen studies assessed suicidal attempt and thirteen studies assessed suicidal ideation among homeless people. The pooled current and lifetime prevalence of suicidal ideation was 17.83% (95% CI;10.73-28.14) and 41.60% (95% CI; 28.55-55.95), respectively whereas the pooled current and lifetime prevalence of suicidal attempt was 9.16% (95% CI;4.10-19.20) and 28.80% (95% CI; 21.66-37.18), respectively. We found a considerable heterogeneity between the studies, but we found no significant publication bias. The current review revealed a remarkably higher magnitude of suicidal ideation and attempt among homeless people as compared to the estimated prevalence in the general population. The concerned stakeholders need to give attention to address this problem emphasizing more on prevention and treatment strategies as well as utilizing holistic approaches to address the potential predictors of suicide among homeless people including physical, mental, and substance use problems.

Keywords: Homeless; Meta-analysis; Prevalence; Suicidal attempt; Suicidal ideation; Systematic review.