Authors: Hatun Al-Rajeh , Sara Alharbi , Rawan Alrhaili , Bader Alghamdi

Abstract

Sympathomimetic drugs such as methamphetamine, amphetamine, and cocaine are widely used as stimulants that act on the central nervous system by increasing catecholaminergic activity. Rising global use of these substances has been associated with increased psychiatric morbidity, including suicidal ideation and behavior. However, the magnitude and consistency of this association remain unclear. This review aimed to evaluate and quantify the association between sympathomimetic drug use and suicidal ideation or suicide attempts. A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. PubMed, MEDLINE, EMBASE, and the International Journal of Emergency Medicine were searched for studies published between 2000 and 2024. Random-effects models were applied, and study quality was assessed using the Newcastle–Ottawa Scale and ROBINS-I tool. Twenty-six studies involving over 10,000 participants were included. Sympathomimetic drug use was associated with a significantly increased risk of suicidality (pooled OR = 2.85; 95% CI: 2.10-3.87). Injection use and psychiatric comorbidity were associated with a higher risk. Significant heterogeneity was observed (I² = 72.6%). Sympathomimetic drug use was found to be strongly associated with suicidal ideation and suicide attempts. These findings support the need for targeted mental health screening and harm-reduction interventions.

Keywords: Substance use disorders, suicidal behavior, stimulant drugs, mental health, harm reduction, systematic review.