147 / 2019-11-15 09:33:30

Lifetime prevalence of suicidal attempt among homeless persons in North America: a meta-analysis

suicidal attempt, homeless persons, prevalence, North America, meta-analysis

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Background: Homelessness is a compelling public health problem in North America, and homeless persons are more likely to attempt suicide than the general population. A great disparity was observed across studies estimating the lifetime prevalence of suicidal attempt among homeless persons in North America. This meta-analysis aimed to estimate the pooled lifetime prevalence of suicidal attempt among homeless persons in North America.
Methods: A systematic literature search of the electronic databases of PubMed, Embase, Web of Science, PsycARTICLES, PsycINFO, and CINAHL was conducted to identify relevant articles. Observational studies exploring the lifetime prevalence of suicidal attempt among homeless persons in North America were included in this study. Heterogeneity across studies was evaluated using the Cochran Q test and quantified using the I^2 statistic. Publication bias was assessed using both the Bergg’s rank test and Egger's linear test. Subgroup analyses were conducted to identify the possible sources of heterogeneity.
Results: Literature search yielded 15 eligible studies with a total of 7,806 homeless persons, of which 2,200 were identified with suicidal attempt throughout their lifetime. A high degree of heterogeneity (I^2=96.5%, P<0.001) was observed across the studies, and the pooled lifetime prevalence of suicidal attempt among homeless persons in North America was 28.99% (95% Confidence Interval: 23.59%-34.69%) by a random effects model. Both Bergg’s rank test and Egger's linear test showed low possibility of publication bias. Subgroup analyses indicated that the lifetime prevalence of suicidal attempt among homeless persons differed significantly in relation to country, sample source, race, gender, sexual orientation, and childhood sexual abuse.
Conclusions: Nearly three tenth of homeless persons in North America have attempted suicide throughout their lifetime, indicating the importance of implementing regular screening for suicidal attempt among homeless persons in this region and the need for strengthening psychological interventions to prevent and/or reduce suicide.