Suicide risk in type 1 diabetes mellitus: A systematic review

Background: Research has shown that suicide risk is often present in patients suffering from type 1 diabetes mellitus (DM-1). Objectives: The aim of the present paper was to investigate whether there was a relationship between DM-1 and suicidal behavior and to determine whether or not people affected by DM-1 are at an increased risk of completed suicide, attempted suicide, and suicidal ideation. Data sources: We performed a careful MedLine, ExcerptaMedica, PsycLit, PsycInfo and Index Medicus search to identify all papers on the topic for the period 1970 to 2013 written in English. The following search terms were used: (suicide OR suicide attempt OR ideation) AND (diabetes mellitus). Where a title or abstract seems to describe a study eligible for inclusion, the full article was examined. Eligibility criteria: We included only original articles published in English peer-reviewed journals. We excluded meta-analyses and systematic reviews, studies that were not clear about follow-up times, the method of statistical analysis, diagnostic criteria or the number of patients included, and studies only on patients affected by type 2 diabetes mellitus (DM-2). Results: The research reviewed indicated that patients with DM-1 are at an increased risk for suicide, although no clear consensus exists regarding the level of the increased risk. Limitations: The studies used different measurement techniques and different outcomes, and they assessed patients at different time points. Conclusions and implications: Our findings support the recommendation that a suicide risk assessment of patients with DM-1 should be part of the routine clinical assessment. The assessment of patients at risk should consist of the evaluation of current and previous suicidal behaviors (both suicidal ideation and attempted suicide). (C) 2014 Elsevier Inc. All rights reserved.