Prevalence of suicidal ideation, attempts and associated risk factors in oral cancer patients: a systematic review and meta-analysis

Abstract

Background

Oral cancer, including malignancies of the lip, and oral cavity, is associated with significant psychological distress, increasing the risk of suicidal ideation (SI) and suicide attempts (SA). Despite its severe morbidity and mortality, the prevalence of SI and SA and their associated risk factors remain unclear. This systematic review and meta-analysis aimed to quantify the prevalence of SI and SA among oral cancer patients and identify key psychosocial risk factors.

Methods

A comprehensive literature search was conducted across PubMed, Embase, and Web of Science databases, with an initial search on August 13, 2024, and an update on December 19, 2024. Observational studies reporting SI and SA prevalence in oral cancer patients were included. Study quality was assessed using a modified Newcastle-Ottawa Scale (NOS), and statistical analyses were performed using R version 4.4. Pooled prevalence rates were calculated using a random-effects model, heterogeneity was assessed with I² statistics, sensitivity analysis was performed using a leave-one-out approach, and publication bias was evaluated using Doi plots and LFK index values.

Results

From 5,145 articles, 13 studies from Taiwan, South Korea, Canada, Germany, and the United States, involving 899,765 participants, were included. The pooled prevalence of SI was 13.08% (95% CI, 7.41–22.03) with moderate heterogeneity (I² = 65%), while SA prevalence was 0.32% (95% CI, 0.1–0.7) with high heterogeneity (I² = 99%). Key risk factors included depression (OR = 42.83), dysphoria (OR = 8.06), prior cancer history (OR = 4.53), rural residence, and male gender.

Conclusion

This review revealed a substantial psychological impact faced by oral cancer patients, with notable prevalence rates of suicidal ideation and suicide attempts. Identifying major risk factors, such as depression and dysphoria, underscores the need for integrating tailored mental health interventions into routine oncological care.