Risk Factors of Suicidal Thoughts and Attempts among Individuals with Primary Depression:A Systematic Review of ۴۷Cohort Studies

Introduction: Suicidal thoughts (ST) and attempts (SA) are significant concerns among individuals with primary depression. This systematic review aims to explore risk factors associated with these phenomena to inform better prevention strategies.Methods: A systematic review was conducted. We searched ۴ databases (PubMed, Embase, Scopus, Web of Science) from ۲۰۰۰ to the ۷ February ۲۰۲۶, using "suicide," "self-killing," "suicidal," and "suicidium," while "depression" and "depressive" were used for depression, and "risk factor," "risk factors," "risk scores," and "relative risk” as keywords, and assessed for quality using the Newcastle-Ottawa Quality Assessment Form checklist. Relevant data were extracted and recorded from the eligible articles. Results: In ۴۷ cohort studies (۶۸۷,۱۵۶ participants), key risk factors for ST and SA in primary depression across MDD, BD, and dysthymia included depressive severity, hopelessness, childhood trauma, and prior attempts. ST were linked to cognitive-emotional factors (rumination, perceived burdensomeness, anxiety). In contrast, SA were predicted by behavioral/clinical indicators (psychiatric hospitalization, substance use, unemployment, personality pathology, especially Cluster B in BD). Age patterns emerged: younger age/early onset increased SA risk in BD, while older age/social isolation were prominent in MDD. Biological (lipid abnormalities) and medication factors showed diagnosis-specific associations.Conclusion: Suicide risk in primary depression follows a progressive cascade from early trauma and personality vulnerabilities to clinical deterioration and behavioral manifestation. Prevention requires diagnosis-specific, age-sensitive strategies incorporating routine trauma screening, severity monitoring, and comorbidity management.

کلیدواژه ها:

risk ، Thoughts ، Attempts ، Suicidal ، depression