Understanding suicide risk in mild cognitive impairment: a systematic review of suicide epidemiology in older adults

Late-life suicide represents a major public health issue, with older adults showing the highest lethality and completion rates. Mild Cognitive Impairment (MCI), a critical stage of increased psychological vulnerability, may represent an acute phase of suicide vulnerability. This systematic review aimed to synthesize existing evidence on suicide risk among older adults with MCI, examining the prevalence of suicide ideation and behaviors, as well as associated factors and therapeutic outcomes. Following PRISMA guidelines, four databases (PubMed, Scopus, MEDLINE, PsycINFO) were searched. Eligible studies included participants aged ≥ 65 years, presence of MCI, and an assessment of suicide risk. Methodological quality was appraised using JBI Critical Appraisal Checklists. Seventeen records published between 2002 and 2024 met inclusion criteria. Across studies, individuals with MCI consistently reported higher rates of suicide ideation compared both with cognitively intact controls and older adults showing more severe cognitive impairment. Prevalence estimates ranged from 0.5% in a large community sample to as high as 84% in a clinical cohort. Depressive symptoms, particularly late-life depression, emerged as the strongest correlate, along with social isolation, female gender, younger age, being single, and multimorbidity. Across three randomized controlled trials, psychotherapeutic interventions and supportive care conditions were associated with reductions in suicide ideation, likely mediated by improvements in emotional regulation and depression. MCI may represent a particularly vulnerable stage of cognitive decline, marked by preserved insight, loss of autonomy, and heightened existential distress. Standardizing diagnostic criteria and suicidality measures, and implementing tailored psychotherapeutic approaches, are essential steps toward prevention and early interventions in this high-risk population.