Association between rumination, suicidal ideation and suicide attempts in persons with depressive and other mood disorders and healthy controls: A systematic review and meta-analysis

Gia Han Le; Sabrina Wong; Hezekiah Au; Sebastian Badulescu; Hartej Gill; Shreya Vasudeva; Kayla M Teopiz; Taeho Greg Rhee; Roger Ho; Angela T H Kwan; Rodrigo B Mansur; Joshua D Rosenblat; Roger S McIntyre

doi:10.1016/j.jad.2024.09.118

Association between rumination, suicidal ideation and suicide attempts in persons with depressive and other mood disorders and healthy controls: A systematic review and meta-analysis

J Affect Disord. 2025 Jan 1:368:513-527. doi: 10.1016/j.jad.2024.09.118. Epub 2024 Sep 18.

Authors

Affiliations

¹ Mood Disorder and Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada. Electronic address: hanny.le@mail.utoronto.ca.
² Mood Disorder and Psychopharmacology Unit, University Health Network, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Canada. Electronic address: sabrina.wong@mail.utoronto.ca.
³ Brain and Cognition Discovery Foundation, Toronto, Canada. Electronic address: hezekiah.au@mail.utoronto.ca.
⁴ Mood Disorder and Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada. Electronic address: sebastian.badulescu@mail.utoronto.ca.
⁵ Mood Disorder and Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada. Electronic address: hartej.gill@utoronto.ca.
⁶ Mood Disorder and Psychopharmacology Unit, University Health Network, Toronto, Canada. Electronic address: shreya.vasudeva@mail.utoronto.ca.
⁷ Brain and Cognition Discovery Foundation, Toronto, Canada. Electronic address: kayla.teopiz@mail.utoronto.ca.
⁸ Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA. Electronic address: taeho.rhee@yale.edu.
⁹ Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore; Institute for Health Innovation and Technology (iHealthtech), National University of Singapore; Division of Life Science (LIFS), Hong Kong University of Science and Technology, Hong Kong. Electronic address: rogercmho@ust.hk.
¹⁰ Brain and Cognition Discovery Foundation, Toronto, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada. Electronic address: angela.kwan@mail.utoronto.ca.
¹¹ Mood Disorder and Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada. Electronic address: rodrigo.mansur@uhn.ca.
¹² Mood Disorder and Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Canada. Electronic address: joshua.rosenblat@uhn.ca.
¹³ Mood Disorder and Psychopharmacology Unit, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada. Electronic address: roger.mcintyre@bcdf.org.

PMID: 39303880
DOI: 10.1016/j.jad.2024.09.118

Abstract

Introduction: Suicidal ideation and behaviors are a leading cause of disability worldwide. Approximately 90 % of suicide completers have a diagnosable mood disorder. Extant literature reports rumination mediates functional impairment across mood disorders. Herein, we report the association between rumination and suicidality amongst persons with psychiatric disorders and healthy controls.

Methods: Our systematic review and meta-analysis included relevant articles retrieved from Web of Science, OVID and PubMed from inception to March 20, 2024. Random effects model was used to calculate the correlation between rumination, suicidal ideation and attempt.

Results: A total of 27 eligible studies were included in our systematic review and meta-analysis. Rumination (r = 0.25 [95 % CI: -0.03, 0.49]), reflection (r = 0.15 [-0.71, 0.83]) and brooding (r = 0.13 [-0.58, 0.73]) were nonsignificantly correlated with suicidal ideation in mood disorders. Suicide attempt history was significantly associated with greater odds of rumination in persons with depressive disorders (OR = 1.13 [0.42, 3.02]). In healthy controls, rumination (r = 0.30 [0.21, 0.38]), reflection (r = 0.23 [0.13, 0.32]) and brooding (r = 0.24 [0.12, 0.36]) were significantly correlated with suicidal ideation. Rumination also predicted lifetime history of suicide attempts in healthy controls (OR = 1.70 [1.16, 2.49]).

Limitations: There were inadequate sample sizes of persons with different mood and psychiatric disorders which may have underpowered our ability to detect clinically meaningful associations.

Discussion: Our study reports a transdiagnostic association between measures of rumination and suicidality. Future research vistas should parse the neurobiological substrates subserving rumination and identify targeted therapies and their association with general cognition and treatment response.

Keywords: Depressive disorders; Psychiatric disorders; Rumination; Suicidal ideation; Suicidality; Suicide attempts.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Depressive Disorder / epidemiology
Depressive Disorder / psychology
Humans
Mood Disorders* / epidemiology
Mood Disorders* / psychology
Rumination, Cognitive* / physiology
Suicidal Ideation*
Suicide, Attempted* / psychology
Suicide, Attempted* / statistics & numerical data