背景:在气候变化的全球背景下,粮食不安全已成为日益严重的负担,灾难,战争,叛乱越来越普遍。几项研究报告了自杀行为之间的关联(即,自杀意念,plans,和尝试)和粮食不安全。这是第一次元分析综述,综合了现有文献,以确定经历粮食不安全的个体中自杀行为的汇总患病率,并检查了他们协会的力量。
方法:数据库(Ovid,PubMed,WebofScience,和CINAHL)从开始到2022年7月使用适当的搜索词进行搜索。纳入了符合条件的研究,这些研究报告了经历粮食不安全或粮食不安全与自杀行为之间的关联的个体中自杀行为的数量/患病率。使用随机效应模型确定自杀行为的合并患病率。该审查已在PROSPERO(CRD42022352858)注册。
结果:共纳入47项研究,包括75,346名经历过粮食不安全的个体。合并的自杀意念患病率为22.3%(95%CI:14.7-29.9;I2=99.6%,p<0.001,k=18),自杀计划为18.1%(95%CI:7.0-29.1;I2=99.6%,p<0.001,k=4),自杀未遂为17.2%(95%CI:9.6-24.8;I2=99.9%,p<0.001,k=12),未指定的自杀行为为4.6%(95%CI:2.8-6.4;I2=85.5%,p<0.001,k=5)。经历粮食不安全与(i)自杀观念之间存在正相关关系(aOR=1.049[95%CI:1.046-1.052;I2=99.6%,p<0.001,k=31]),(ii)自杀计划(aOR=1.480[95%CI:1.465-1.496;I2=99.1%,p<0.001,k=5]),和(iii)未指定的自杀行为(aOR=1.133[95%CI:1.052-1.219;I2=53.0%,p=0.047,k=6])。然而,在经历粮食不安全和自杀未遂之间观察到负相关(aOR=0.622[95%CI:0.617-0.627;I2=98.8%,p<0.001,k=15])。进行研究的大陆和国家的收入状况是经历粮食不安全和自杀行为之间关系的几率差异的常见原因-北美和高收入国家(HIC)的几率更高。对于自杀未遂,所有非HIC都与粮食不安全呈负相关。
结论:纳入研究存在显著异质性。
结论:在经历粮食不安全的个体中,自杀行为的发生率很高。减少粮食不安全的举措可能有利于心理健康,并减轻粮食不安全人口中自杀行为的风险。自杀企图与粮食不安全呈负相关的矛盾发现值得进一步研究。
Food insecurity has become a growing burden within a global context where climate change, catastrophes, wars, and insurgencies are increasingly prevalent. Several studies have reported an association between suicidal behaviors (i.e., suicide ideation, plans, and attempts) and food insecurity. This meta-analytic review synthesized the available literature to determine the pooled prevalence of suicidal behaviors among individuals experiencing food insecurity, and examined the strength of their association.
Databases (Ovid, PubMed, Web of Science, and CINAHL) were searched from inception to July 2022 using appropriate search terms. Eligible studies reporting the number/prevalence of suicidal behaviors among individuals experiencing food insecurity or the association between food insecurity and suicidal behaviors were included. The pooled prevalence of suicidal behaviors was determined using the random-effects model. The review was registered with PROSPERO (CRD42022352858).
A total of 47 studies comprising 75,346 individuals having experienced food insecurity were included. The pooled prevalence was 22.3 % for suicide ideation (95 % CI: 14.7-29.9; I2 = 99.6 %, p < 0.001, k = 18), 18.1 % for suicide plans (95 % CI: 7.0-29.1; I2 = 99.6 %, p < 0.001, k = 4), 17.2 % for suicide attempts (95 % CI: 9.6-24.8; I2 = 99.9 %, p < 0.001, k = 12), and 4.6 % for unspecified suicidal behavior (95 % CI: 2.8-6.4; I2 = 85.5 %, p < 0.001, k = 5). There was a positive relationship between experiencing food insecurity and (i) suicide ideation (aOR = 1.049 [95 % CI: 1.046-1.052; I2 = 99.6 %, p < 0.001, k = 31]), (ii) suicide plans (aOR = 1.480 [95 % CI: 1.465-1.496; I2 = 99.1 %, p < 0.001, k = 5]), and (iii) unspecified suicide behaviors (aOR = 1.133 [95 % CI: 1.052-1.219; I2 = 53.0 %, p = 0.047, k = 6]). However, a negative relationship was observed between experiencing food insecurity and suicide attempts (aOR = 0.622 [95 % CI: 0.617-0.627; I2 = 98.8 %, p < 0.001, k = 15]). The continent and the countries income status where the study was conducted were the common causes of heterogeneity of the differences in the odds of the relationships between experiencing food insecurity and suicidal behaviors - with North America and high-income countries (HICs) having higher odds. For suicide attempts, all non HICs had a negative relationship with food insecurity.
There was significant heterogeneity among the included studies.
There is a high prevalence of suicidal behaviors among individuals experiencing food insecurity. Initiatives to reduce food insecurity would likely be beneficial for mental wellbeing and to mitigate the risk of suicidal behaviors among population experiencing food insecurity. The paradoxical finding of suicide attempts having a negative relationship with food insecurity warrants further research.