Multidimensional perspective of dissociation and suicide-related outcomes: A Meta-analysis and systematic review

Background: The relationship between suicide-related outcomes and dissociation is a critical issue. In recent years, research has focused on understanding dissociation as an acquired capacity factor for suicide attempts. Moreover, meta-analysis findings demonstrate the relationship between dissociation and suicidal ideation. To unravel the role of dissociation in the development of suicidal ideation and attempt, this study adopts a multidimensional perspective, that conceptualizes a complex construct comprising distinct but related domains which reflects disruptions in perception, cognition, emotion, and somatic experience. Methods: We conducted systematic research on the main databases (PubMed, Medline, APA PsycInfo, Scopus, Web of Science, APA PsycArticles), collecting the literature of the last 30 years. A total of 84 studies (Ntotalsample = 129.582) studies were included in the systematic review. Of these, 68 studies were included in the meta-analysis. The analyses are based on the Pearson correlation coefficient as the effect size for the relationship between suicide-related outcomes and dissociation domains. The outcome variables included suicidal ideation, suicide attempts, and suicide risk-a composite or dimensional construct reflecting the likelihood of suicidal thoughts or behaviors, as well as specific psychological factors associated with the emergence of suicidal outcomes, as reported in the selected studies. We used a random effects model, conducted moderation analyses to explain the heterogeneity of study variance, controlled for publication bias, and assessed the methodological quality of the included studies. Results: General dissociation was significantly correlated with suicidal risk (r = 0.29; p < .001), suicidal ideation (r = 0.25; p < .001), and suicide attempts (r = 0.27; p < .001). A positive and significant relationship was found between suicidal ideation and detachment (r = 0.31; p < .001), as well as with maladaptive daydreaming (r = 0.27; p < .001). A statistically significant but small association was also observed between suicide attempts and somatoform dissociation (r = 0.02; p < .001), whereas a stronger connection was found with suicidal ideation (r = 0.31; p < .001). Moderator effects related to sample characteristics, sociocultural factors, and methodological quality of studies were identified with no evidence of publication bias. Conclusions: These findings support the importance of a multidimensional approach to examining dissociation and suicide-related outcomes, revealing differential relationships based on the specific domains assessed. The resulting clinical implications and future directions are discussed.