Breast cancer and suicide: A comprehensive systematic review and meta-analysis of suicidal behaviours mortality and risk factors among women with breast cancer

Background: Suicidal behaviours, including ideation, attempts, and mortality, are significant yet often overlooked concerns among women with breast cancer. While the psychological burden of breast cancer has been studied, comprehensive data on the prevalence and risk factors of suicidal behaviours in this population remain limited. Objective: This systematic review and meta-analysis aim to assess the prevalence, incidence, and risk factors associated with suicidal behaviours among women with breast cancer. Methods: A literature search was conducted using Embase, MEDLINE, CINAHL, Web of Science, and Academic Search Complete for studies published up to June 2024. Search terms included 'breast cancer,' 'suicidal behaviour,' 'suicide ideation,' 'suicide attempts,' 'self-harm,' and 'self-injury.' Eligible studies included primary data on suicidal ideation, attempts, or completed suicides among women with breast cancer. Meta-analyses were performed using random-effects models, and heterogeneity was assessed with the I-2 statistic. Results: Twenty studies comprising 3450,022 participants were included. The pooled prevalence of suicidal ideation was 10 % (95 % CI 0.01-0.63, p < 0.001), while suicide attempts were reported at 2 % (95 % CI 0.01-0.03, p < 0.001). Suicide mortality was observed in 0.001 % (95 % CI 0.001-0.002, p < 0.001). Younger age (18-45 years), advanced cancer stages (stage IV), and unmarried status were significant risk factors. Conclusion: Suicidal behaviours are prevalent among women with breast cancer, particularly in younger, unmarried patients with advanced cancer stages. Comprehensive mental health support is crucial in reducing suicide risk.