Suicide among university students in China constitutes a critical public health challenge. Although numerous studies have examined risk factors, most have relied on cross-sectional designs. Evidence from longitudinal studies, particularly regarding protective factors, remains limited. This systematic review and meta-analysis synthesizes longitudinal evidence to identify risk and protective factors for suicidal ideation and suicide attempts among Chinese university students. Six electronic databases (three English-language and three Chinese-language databases) were systematically searched for longitudinal studies published up to October 2024. Eligible studies investigated predictors of suicidal ideation or suicide attempts among Chinese university students. Random-effects meta-analyses were conducted to estimate pooled effect sizes, expressed as odds ratios (ORs). Meta-regression analyses were used to examine temporal moderators, and heterogeneity and publication bias were assessed. Twenty-two longitudinal studies comprising 953,651 participants were included. The strongest predictors of subsequent suicidal ideation were prior suicidal ideation, anxiety, and early morning awakening. Suicide attempts were most strongly associated with prior non-suicidal self-injury, insomnia symptoms, and academic pressure. Higher levels of social support were associated with a reduced risk of suicidal ideation, whereas other examined protective factors were not statistically significant. Meta-regression analyses indicated that the predictive strength of depressive symptoms for suicidal ideation attenuated with longer follow-up periods. Sleep disturbances, academic pressure, and prior suicidal ideation may represent important targets for early identification among Chinese university students. The findings highlight the importance of addressing both psychological vulnerabilities and contextual stressors in suicide prevention efforts. Future longitudinal research should adopt standardized measurements to enhance comparability and inform culturally tailored population-level prevention strategies.
Song et al. (Mon,) studied this question.