Life events and suicidal ideation and behavior: A systematic review Richard T. Liu ⁎, Ivan Miller Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States HIGHLIGHTS • Provides a systematic review of life events and suicidal ideation and behavior • The relation with stressors was stronger for severe forms of ideation and behavior. • The relation with positive events was weak for suicidal ideation and behavior. • Several important methodological limitations characterize much of the literature. abstract article info Article history: Received 24 June 2013 Received in revised form 18 December 2013 Accepted 23 January 2014 Available online 4 February 2014 Keywords: Self-harm Positive life events Stressful life events Suicide Despite the sustained theoretical and empirical interest over the past 40 years in the association between life events and suicidal ideation and behavior, the literature in this area has yet to be systematically reviewed. The current article provides a comprehensive review of the empirical literature pertaining to life events in relation to at least one aspect of suicidal ideation and behavior (i.e., suicidal ideation, plans, attempts, degree of suicidal intent, medical severity of attempt, repeat versus first lifetime attempt status, and death by suicide). A total of 95 articles meeting inclusion criteria were identified by a literature search using Medline and PsycINFO. Evidence for an association between negative life events and suicidal ideation and behavior was generally consistent, with strongest support found for more severe than with less severe forms of suicidal ideation and behavior. Support for an inverse relation between positive events and suicidal ideation and behavior was generally lacking. Although there is general support for life stressors as a risk factor for suicidal ideation and behavior, interpretation of these findings is constrained by methodological limitations prevalent in much of the literature, particularly in the case of suicidal ideation and suicide plans. Recommendations for future research are provided. © 2014 Elsevier Ltd. All rights reserved. Contents 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 1.1. Developments in the conceptualization and measurement of life events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 2. Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 3.1. Suicidality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 3.2. Suicidal ideation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 3.3. Suicide plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 3.4. Suicide attempts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 3.5. Aspects of suicide attempts: suicidal intent, medical lethality, and number of attempts . . . . . . . . . . . . . . . . . . . . . . . . 185 3.6. Death by suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 3.7. Suicidal ideation versus attempts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 3.8. Suicide attempts versus death by suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 3.9. Positive life events and suicidal ideation and behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 4. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 4.1. Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 4.2. Summary and recommendations for future research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 Clinical Psychology Review 34 (2014) 181–192 ⁎ Corresponding author at: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, United States. E-mail address: rtliupsych@gmail.com (R.T. Liu). 0272-7358/$ – see front matter © 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.cpr.2014.01.006 Contents lists available at ScienceDirect Clinical Psychology Review