Persistent suicidality: A systematic scoping review of the literature

Background: Suicidality can extend beyond the acute phase and be a long-term condition. Known by various terms, including chronic or persistent suicidality (PS), this phenomenon is well recognized in clinical practice. However, a comprehensive synthesis and evaluation of the literature is missing, leaving the scope and focus of the current scientific evidence on PS unclear. Aims: This review aims to identify and critically appraise the literature on PS. It seeks to provide an overview of how the evidence defines and operationalises PS, its occurrence, and the characteristics of individuals affected by it. Method: A systematic scoping review was conducted following the PRISMA-ScR guidelines. After preregistration, searches were conducted in six databases: Embase, PubMed, APA PsycInfo, Web of Science, Scopus, and ERIC. Articles describing individuals with suicidal ideation or a death wish lasting a year or longer were included. Quality appraisal was performed using the National Institute of Health's quality assessment tools. Due to the pluriformity of the literature a narrative synthesis was conducted. Results: In total, 63 articles met the criteria for inclusion. Around one-third of individuals experience suicidal ideation that persists over the long term. There is a strong overall association between PS and psychiatric or psychological distress. Results suggest that specific variables may help differentiate between individuals with transient suicidal ideation and those at risk for PS. Conclusions: Despite sufficient quality of most studies reporting PS, the field is hindered by inconsistent operationalisations and a lack of study replication. This study highlights the need for a uniform understanding of PS and proposes a provisional definition.