Association between suicidal thoughts and behaviours and markers of autonomic functioning and regulation in adults: A systematic review and meta-analysis
Association between suicidal thoughts and behaviours and markers of autonomic functioning and regulation in adults: A systematic review and meta-analysis
Currently, the identification of individuals experiencing suicidal thoughts and behaviours (STBs) rely predominantly on self-report. Previous research on children and young people highlighted an association between difficulties in arousal regulation (reflected, for example, in reduced heart rate variability and altered electrodermal activity patterns) and STBs, but this has not been meta-analytically explored in adults. This systematic review and meta-analysis aimed to quantify the association between STBs and markers of autonomic functioning/regulation in adults. Based on a pre-registered protocol (PROSPERO CRD42024596886), we searched PubMed/MEDLINE, Embase, PsycINFO and Web of Science until 2nd August 2025 for empirical studies assessing the association between measures of autonomic functioning and/or regulation and STBs in adults. Quality of cross-sectional and cohort studies was assessed through the Newcastle-Ottawa Scale. Pooled effect sizes (Hedge's g) were estimated with random-effects meta-analytic models in R. Out of 2726 articles screened, 40 studies were included in the systematic review, and 22 in the meta-analyses (6290 individuals, 28% with STBs). We found reduced heart rate variability in adults with STBs (g = −0.2469, p = 0.0069) but no significant associations between electrodermal activity patterns and STBs (g = −0.2563, p = 0.3953). Our results highlight the relationship between reduced cardiac regulation and STBs, providing a rationale for further exploration of cardiac regulation as a potential objective marker for assessing and monitoring STBs in adults. Further research is warranted to understand how these markers can be used in clinical practice to assess and support the management of suicide risk in adults.
Adult, Autonomic nervous system, Electrodermal, Heart rate variability, Parasympathetic, Suicide
Chowdhury, Fabbiha
318c16bc-02eb-4501-bdf8-ceb72fb736f7
Scoppola, Chiara
76a9fdc0-839b-406e-bcdb-1528ec4ba215
Parlatini, Valeria
6cdfb200-40ce-43ce-84da-dcb6eba0f67a
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Bellato, Alessio
0ee4c34f-3850-4883-8b82-5717b74990f7
10 April 2026
Chowdhury, Fabbiha
318c16bc-02eb-4501-bdf8-ceb72fb736f7
Scoppola, Chiara
76a9fdc0-839b-406e-bcdb-1528ec4ba215
Parlatini, Valeria
6cdfb200-40ce-43ce-84da-dcb6eba0f67a
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Bellato, Alessio
0ee4c34f-3850-4883-8b82-5717b74990f7
Chowdhury, Fabbiha, Scoppola, Chiara, Parlatini, Valeria, Cortese, Samuele and Bellato, Alessio
(2026)
Association between suicidal thoughts and behaviours and markers of autonomic functioning and regulation in adults: A systematic review and meta-analysis.
Neuroscience and Bioehavioral Reviews, 186, [106672].
(doi:10.1016/j.neubiorev.2026.106672).
Abstract
Currently, the identification of individuals experiencing suicidal thoughts and behaviours (STBs) rely predominantly on self-report. Previous research on children and young people highlighted an association between difficulties in arousal regulation (reflected, for example, in reduced heart rate variability and altered electrodermal activity patterns) and STBs, but this has not been meta-analytically explored in adults. This systematic review and meta-analysis aimed to quantify the association between STBs and markers of autonomic functioning/regulation in adults. Based on a pre-registered protocol (PROSPERO CRD42024596886), we searched PubMed/MEDLINE, Embase, PsycINFO and Web of Science until 2nd August 2025 for empirical studies assessing the association between measures of autonomic functioning and/or regulation and STBs in adults. Quality of cross-sectional and cohort studies was assessed through the Newcastle-Ottawa Scale. Pooled effect sizes (Hedge's g) were estimated with random-effects meta-analytic models in R. Out of 2726 articles screened, 40 studies were included in the systematic review, and 22 in the meta-analyses (6290 individuals, 28% with STBs). We found reduced heart rate variability in adults with STBs (g = −0.2469, p = 0.0069) but no significant associations between electrodermal activity patterns and STBs (g = −0.2563, p = 0.3953). Our results highlight the relationship between reduced cardiac regulation and STBs, providing a rationale for further exploration of cardiac regulation as a potential objective marker for assessing and monitoring STBs in adults. Further research is warranted to understand how these markers can be used in clinical practice to assess and support the management of suicide risk in adults.
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Accepted/In Press date: 31 March 2026
Published date: 10 April 2026
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Publisher Copyright:
© 2026 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC license. http://creativecommons.org/licenses/by-nc/4.0/
Keywords:
Adult, Autonomic nervous system, Electrodermal, Heart rate variability, Parasympathetic, Suicide
Identifiers
Local EPrints ID: 510818
URI: http://eprints.soton.ac.uk/id/eprint/510818
ISSN: 0149-7634
PURE UUID: 037b1984-1a22-4c2e-9a81-1b9d34ffa40b
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Date deposited: 22 Apr 2026 16:49
Last modified: 23 Apr 2026 02:19
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Contributors
Author:
Fabbiha Chowdhury
Author:
Chiara Scoppola
Author:
Valeria Parlatini
Author:
Alessio Bellato
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