Background

: Homelessness is a compelling public health problem, and homeless individuals are at increased risk for attempting suicide. However, the reported lifetime prevalence of suicidal attempt among homeless individuals in North America varied considerably. Therefore, this meta-analysis aimed to estimate the pooled lifetime prevalence of suicidal attempt among homeless individuals in North America and explore factors that may moderate this estimation.

Methods

: The protocol was registered in PROSPERO database (CRD42018102593). A systematic literature search was conducted in the electronic databases of PubMed, Embase, Web of Science, PsycINFO, and Google Scholar. Observational studies exploring the lifetime prevalence of suicidal attempt among homeless individuals in North America were included. Heterogeneity across studies was evaluated using the Cochran Q test and quantified using the I² statistic. Subgroup analyses were performed to identify possible sources of heterogeneity.

Results

: Twenty-two eligible studies with a total of 9,727 homeless individuals were included, of which 2,986 reported having attempted suicide in their lifetime. A high degree of heterogeneity (I²=96.4%, P<0.001) was observed, and the pooled lifetime prevalence was 31.83% (95% confidence interval: 26.87%-36.99%). Subgroup analyses showed that the heterogeneity was quite low when estimating the pooled lifetime prevalence of suicidal attempt among heterosexual (I²=0.0, P=0.401) and non-heterosexual homeless individuals (I²=0.0, P=0.405).

Limitations

: All eligible studies were exclusively conducted in the US and Canada.

Conclusions

: Nearly three tenths of homeless individuals in North America have attempted suicide in their lifetime, and the differences in sexual orientation might have contributed to the heterogeneity.

中文翻译：

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北美无家可归者自杀企图的终生流行：一项荟萃分析

背景

：无家可归是一个迫在眉睫的公共卫生问题，无家可归的人自杀的风险增加。但是，据报道，北美无家可归者终生自杀企图的发生率差异很大。因此，这项荟萃分析旨在估计北美无家可归者自杀企图的终生患病率，并探索可能缓和这一估计的因素。

方法

：该协议已在PROSPERO数据库（CRD42018102593）中注册。在PubMed，Embase，Web of Science，PsycINFO和Google Scholar的电子数据库中进行了系统的文献检索。观察性研究探讨了在北美无家可归者中自杀企图的终生流行率。使用Cochran Q检验评估研究的异质性，并使用I ²统计量进行量化。进行亚组分析以鉴定异质性的可能来源。

结果

：包括22项合格研究，总共9,727名无家可归者，其中2,986名报告说其一生中曾尝试自杀。观察到高度的异质性（I ² = 96.4％，P <0.001），合并的寿命患病率为31.83％（95％置信区间：26.87％-36.99％）。亚组分析显示，在估算异性恋者（I ² = 0.0，P = 0.401）和非异性恋无家可归者（I ² = 0.0，P = 0.405）时自杀企图的合并终生患病率时，异质性非常低。

局限性

：所有符合条件的研究仅在美国和加拿大进行。

结论

：在北美，近十分之三的无家可归者曾尝试自杀，而性取向的差异可能助长了异质性。