Abstract
Introduction Previous literature on risk factors for suicide thoughts and behaviors has demonstrated that many identified risk factors do not consistently or meaningfully differentiate between ideators and attempters. In the last twenty years, ideation-to-action frameworks have identified novel risk factors and constructs that may better clarify the small proportion of ideators who go on to make a suicide attempt. Objective: This study aims to provide an update to previous research to investigate suicide risk and examine factors that distinguish between those who exclusively contemplate suicide and those who survive a suicide attempt. Methods: An extensive literature search was completed to identify studies that compare participants who have experienced suicide ideation, without a lifetime attempt, with those who survived an attempted suicide in their lifetime. Utilizing 3 English databases, 2,560 potential articles were identified. Of these, 39 studies (1.5%) met study inclusion criteria and provided sufficient data to be used in this meta-analysis. Standardized Mean Difference (SMD) with 95% confidence intervals were implemented to measure the effect sizes across risk factors. Results: Results indicated that none of the 17 risk factors exhibited large effect size differences between attempters and ideators. Non-suicidal self-injury (g = -0.43) and acquired capability (g = -0.50) yielded moderate effect sizes between groups, these factors being more common in ideators than attempers. Effect sizes across each of the other risk factors were negligible. Taken together, these findings are consistent with other relevant studies, which suggest that risk factors that are commonly presumed to be associated with suicidality provide limited evidence in the transition from ideation to attempts, though they may still be clinically relevant in the treatment to manage suicide-related concerns.