Suicide and suicidal ideation among survivors of acute coronary syndrome: A systematic review and meta-analysis of prevalence and risk factors.

INTRODUCTION

Survivors of acute coronary syndrome (ACS) often face significant psychological stress. Emerging evidence suggests a potential link between ACS and increased risk of suicidal ideation (SI) and suicide attempts. This review aimed to evaluate the prevalence of SI and suicide attempts among ACS survivors and identify associated risk factors.

METHODS

A systematic literature search was conducted in four databases up to April 5, 2025. Observational studies reporting the prevalence of SI or suicide attempts in ACS survivors, or assessing ACS as a risk factor for SI, were included. Two reviewers independently performed data extraction and risk of bias assessment. Meta-analyses were conducted using RStudio.

RESULTS

Seven studies involving 431,738 participants were included. ACS was significantly associated with increased SI risk compared to controls (RR = 1.45; 95 % CI: 1.36-1.54; I2 = 32.4 %). Among ACS survivors, 1.4 % (95 % CI: 0.4 %-5.6 %) attempted suicide, and 14.1 % (95 % CI: 10.2 %-19.2 %) reported SI, with the highest rates within the first 6 months. Female sex (RR = 1.50), unemployment (RR = 1.36), depression (RR = 2.64), and DSM-IV-defined depressive disorder (RR = 2.82) were significant risk factors of SI in ACS survivors. Chronic diseases (hypertension, diabetes), living alone, and family history of depression or ACS were not significantly associated with SI risk.

CONCLUSION

ACS is associated with a higher risk of SI and suicide attempts, especially in the early post-event period. Screening and psychosocial support are essential, particularly for women, unemployed individuals, and those with depressive symptoms.