Prescribed benzodiazepines and suicidal behaviors: a systematic review, meta-analysis, and clinical implications.

BACKGROUND

Benzodiazepines are among the most prescribed psychotropic drugs worldwide, yet their potential association with suicide remains poorly understood and often overlooked, raising questions that current clinical practice and safety guidelines have yet to address. This study aimed to conduct a meta-analysis to quantitatively synthesize existing evidence on the association between prescribed benzodiazepine use and suicidal behaviors, explore potential mechanisms underlying this relationship, and identify gaps in the current literature.

METHODS

Following PRISMA guidelines, we conducted a systematic review and meta-analysis of studies published in PubMed between 2016 and 2025, supplemented with earlier studies identified in a prior systematic review. Eligible studies examined the association between prescribed benzodiazepines and suicidal behaviors. Pooled estimates were calculated using a random-effects model to assess heterogeneity, and publication bias was evaluated using Egger’s regression test.

RESULTS

Twenty-one studies met inclusion criteria. Benzodiazepine use was associated with a significantly elevated risk of suicide (pooled effect size = 2.74; 95% CI: 2.06–3.63).

CONCLUSIONS

Prescribed benzodiazepines are associated with a more than twofold higher likelihood of suicide outcomes (attempted or completed), representing a public health concern that warrants further investigation. This consistent association underscores the need to investigate underlying biological and behavioral mechanisms, refine and standardize prescribing guidelines, and implement rigorous suicide risk assessment and monitoring protocols, particularly for high-risk patient groups. CLINICAL TRIAL NUMBER: not applicable. TRIAL REGISTRATION: This systematic review was conducted in accordance with a registered protocol (PROSPERO ID: CRD420251074013) and adheres to PRISMA 2020 guidelines.