The social determinants of health: an umbrella review

Previous research has highlighted the role of social determinants of health on mental health outcomes, but their impact on suicide mortality is less understood. The aim of this umbrella review was to systematically examine the association between 10 social determinants of health, as defined by the World Health Organization, and suicide mortality. A keyword search of titles and abstracts was conducted in six digital databases for studies published to 24 August 2023. Inclusion criteria were peer-reviewed systematic reviews and meta-analyses in English examining the association between these determinants and suicide. Methodological quality was assessed using an adapted AMSTAR-2 tool. Due to significant heterogeneity in the included studies, a meta-analysis was not undertaken. A narrative synthesis, structured by social determinant, was conducted. 49 records (25 meta-analyses and 24 systematic reviews) were eligible for inclusion in this review. The social determinants with the most available evidence were housing, basic amenities and the environment (n=21), income and social protection (n=13), unemployment (n=8) and early childhood development (n=6). Limited evidence was identified for education (n=3), social inclusion and non-discrimination (n=3) and working life conditions (n=3). No reviews examined the relationship between affordable healthcare services, structural conflict or food insecurity and suicide mortality. There was evidence of a modest effect of social determinants on suicide mortality. Most evidence related to unemployment, job insecurity, income and social protection and childhood adversity. The methodological quality of the included reviews varied considerably. High-quality research fully exploring the relationship between social and environmental factors and suicide risk is needed.