Do reasons for living protect against suicidal thoughts and behaviors? A systematic review of the literature

•A systematic review on links between reasons for living and suicidal behavior.•RFL have a protective effect against suicidal ideation and attempts.•RFL may moderate risk factors for suicide and be linked to resilience factors.•RFL depend on numerous factors and have “state” characteristics.•Therapies enhancing RFL should be developed to prevent suicidal behavior.

BackgroundFew studies have investigated protective factors against suicide.ObjectivesTo identify whether reasons for living (RFL), measured with the Reasons for Living Inventory (RFLI), protect against suicidal ideation (SI), attempts (SA) and suicide death.MethodThis systematic review followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) statement guidelines. PubMed database was searched for studies published until October 2015. Studies were eligible if they used RFLI or one of its versions. All eligible studies were included, regardless of study design, quality indicators, and target populations. No publication year limit was imposed. We included 39 studies.ResultsRFL may protect against SI and SA and yield a predictive value. The role of two specific reasons for living (Moral Objections to Suicide and Survival and Coping Beliefs) was particularly emphasized. No study investigating suicide death was found.ConclusionRFL may moderate suicide risk factors and correlate with resilience factors. Moreover, RFL may depend on and interact with numerous factors such as DSM-IV Axis I disorders, personality disorders and features, coping abilities and social support. Clinicians could develop therapeutic strategies aimed at enhancing RFL, like Dialectical Behavior Therapy and Cognitive Behavioral Therapies, to prevent suicidal thoughts and behaviors and improve the care management of suicidal patients.