Suicide and Self‐Harm in Intellectual Disability: A Systematic Review and Meta‐Analysis

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Abstract
Background: Individuals with intellectual disabilities (ID) are disproportionately exposed to several risk factors for suicidality. However, no meta‐analysis has yet quantified the relative risk of suicide and self‐harm, including suicide attempts, within this population. The aim of this project was to bring together and synthesise the research on suicidality among individuals with ID. Methods: A systematic review and meta‐analysis was carried out. Medline, Embase, Web of Science and PsycInfo were searched from inception through 4 August 2025. Observational studies with a quantitative design, evaluating the relative risk of suicide or self‐harm, including suicide attempts, in individuals with and without ID, were included. Risk of bias was assessed using a shortened version of the Risk Of Bias In Non‐randomized Studies–of Exposure (ROBINS‐E) checklist. A random effects model was used to synthesise the results. Results: Eleven primary studies were included in the review ( n = 241 438). The level of ID severity was only presented in two articles. Compared to the general population, the pooled relative risk for death by suicide was 0.54 (95% CI 0.33 to 0.89, k = 6, I 2 = 77%) and the relative risk for self‐harm was 3.16, (95% CI 2.3 to 4.35, k = 6, I 2 = 89%). Conclusion: The findings suggest that individuals with ID have an elevated risk of self‐harm but a lower risk of dying by suicide compared to the general population. However, these results should be interpreted with caution due to the limited number of primary studies and substantial between‐study heterogeneity. Further, separate analyses of mild versus moderate‐to‐profound ID are warranted.

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