Key points are not available for this paper at this time.
Background : Depression and suicidal behavior have been increasingly reported among rural workers exposed to pesticides. However, epidemiological findings remain heterogeneous, and it remains unclear whether occupational pesticide exposure constitutes an independent risk factor for adverse mental health outcomes in agricultural populations. Methods We conducted a systematic review and multilevel meta-analysis following PRISMA guidelines (PROSPERO: CRD420251036360). Eligible studies included human populations occupationally exposed to pesticides, a non-exposed comparison group, and effect estimates for depression and/or suicidal behavior, including suicidal ideation, suicide attempts, or suicide. Random-effects multilevel models accounting for within-study dependency were fitted using the metafor package in R. Between-study heterogeneity, publication bias, and potential moderators, including exposure characteristics, outcome definition, sociodemographic variables, and methodological features, were examined using univariate and multivariate meta-regression. Results Eighteen studies comprising 22 independent comparisons met inclusion criteria. Occupational pesticide exposure was associated with increased odds of depression and suicidal behavior (OR = 2.22; 95% CI: 1.68–2.93). Stratified analyses showed elevated odds for major depression (OR = 2.31; 95% CI: 1.63–3.29) and suicidal behavior (OR = 2.17; 95% CI: 1.44–3.26). No moderator reached conventional statistical significance in the updated multilevel meta-regression. Exposure type showed the strongest signal, with pesticide poisoning yielding larger estimates than general pesticide exposure, although this association remained marginal (p = 0.070). Conclusions Occupational pesticide exposure is associated with an approximately two-fold increased risk of depression and suicidal behavior among rural workers. These findings support stronger occupational safety policies and systematic mental health surveillance in agricultural populations.
Leal et al. (Fri,) studied this question.