Skip to main content
×
×
Home

Suicidal ideation and behaviour among community and health care seeking populations in five low- and middle-income countries: a cross-sectional study

  • M. Jordans (a1) (a2), S. Rathod (a3), A. Fekadu (a2) (a4), G. Medhin (a5), F. Kigozi (a6), B. Kohrt (a7) (a8), N. Luitel (a8), I. Petersen (a9), R. Shidhaye (a10) (a11), J. Ssebunnya (a6), V. Patel (a12) (a13) and C. Lund (a2) (a14)...
Abstract
Aims

Suicidal behaviour is an under-reported and hidden cause of death in most low- and middle-income countries (LMIC) due to lack of national systematic reporting for cause-specific mortality, high levels of stigma and religious or cultural sanctions. The lack of information on non-fatal suicidal behaviour (ideation, plans and attempts) in LMIC is a major barrier to design and implementation of prevention strategies. This study aims to determine the prevalence of non-fatal suicidal behaviour within community- and health facility-based populations in LMIC.

Methods

Twelve-month prevalence of suicidal ideation, plans and attempts were established through community samples (n = 6689) and primary care attendees (n = 6470) from districts in Ethiopia, Uganda, South Africa, India and Nepal using the Composite International Diagnostic Interview suicidality module. Participants were also screened for depression and alcohol use disorder.

Results

We found that one out of ten persons (10.3%) presenting at primary care facilities reported suicidal ideation within the past year, and 1 out of 45 (2.2%) reported attempting suicide in the same period. The range of suicidal ideation was 3.5–11.1% in community samples and 5.0–14.8% in health facility samples. A higher proportion of facility attendees reported suicidal ideation than community residents (10.3 and 8.1%, respectively). Adults in the South African facilities were most likely to endorse suicidal ideation (14.8%), planning (9.5%) and attempts (7.4%). Risk profiles associated with suicidal behaviour (i.e. being female, younger age, current mental disorders and lower educational and economic status) were highly consistent across countries.

Conclusion

The high prevalence of suicidal ideation in primary care points towards important opportunities to implement suicide risk reduction initiatives. Evidence-supported strategies including screening and treatment of depression in primary care can be implemented through the World Health Organization's mental health Global Action Programme suicide prevention and depression treatment guidelines. Suicidal ideation and behaviours in the community sample will require detection strategies to identify at risks persons not presenting to health facilities.

Copyright
Corresponding author
*Address for correspondence: Dr M. Jordans, Lizzy Ansinghstraat 163, 1072 RG Amsterdam, The Netherlands (Email: mark.jordans@hntpo.org)
References
Hide All
Babor, TF, Higgins-Biddle, JC, Saunders, JB, Monteiro, MG (2001). AUDIT: The Alcohol Use Disorders Identification Test Guidelines for Use in Primary Care. World Health Organization: Geneva.
Borges, G, Nock, M, Haro Abad, J, Hwang, I, Sampson, N, Alonso, J, Andrade, L, Angermeyer, M, Beautrais, A, Bromet, EJ (2010). Twelve-month prevalence of and risk factors for suicide attempts in the World Health Organization World Mental Health Surveys. Journal of Clinical Psychiatry 71, 16171628.
De Silva, MJ, Rathod, SD, Hanlon, C, Breuer, E, Chisholm, D, Fekadu, A, Jordans, MJD, Kigozi, F, Petersen, I, Shidhaye, R (2015). Evaluation of district mental healthcare plans: the PRIME consortium methodology. British Journal of Psychiatry bjp. bp. 114.153858.
Demyttenaere, K, Bruffaerts, R, Posada-Villa, J, Gasquet, I, Kovess, V, Lepine, JP, Angermeyer, MC, Bernert, S, de Girolamo, G, Morosini, P, Polidori, G, Kikkawa, T, Kawakami, N, Ono, Y, Takeshima, T, Uda, H, Karam, EG, Fayyad, JA, Karam, AN, Mneimneh, ZN, Medina-Mora, ME, Borges, G, Lara, C, de Graaf, R, Ormel, J, Gureje, O, Shen, Y, Huang, Y, Zhang, M, Alonso, J, Haro, JM, Vilagut, G, Bromet, EJ, Gluzman, S, Webb, C, Kessler, RC, Merikangas, KR, Anthony, JC, Von Korff, MR, Wang, PS, Brugha, TS, Aguilar-Gaxiola, S, Lee, S, Heeringa, S, Pennell, BE, Zaslavsky, AM, Ustun, TB, Chatterji, S, Consortium. WWMHS. (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 291, 25812590.
Dupéré, V, Leventhal, T, Lacourse, E (2009). Neighborhood poverty and suicidal thoughts and attempts in late adolescence. Psychological Medicine 39, 12951306.
Fekadu, A, Hanlon, C, Medhin, G, Alem, A, Selamu, M, Giorgis, TW, Shibre, T, Teferra, S, Tegegn, T, Breuer, E (2016). Development of a scalable mental healthcare plan for a rural district in Ethiopia. British Journal of Psychiatry 208, s4s12.
Fleischmann, A, Bertolote, JM, Wasserman, D, De Leo, D, Bolhari, J, Botega, NJ, De Silva, D, Phillips, M, Vijayakumar, L, Värnik, A, Schlebusch, L, Thanh, HT. (2008). Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries. Bulletin of the World Health Organization 86, 703709.
Fleischmann, A, Arensman, E, Berman, A, Carli, V, De Leo, D, Hadlaczky, G, Howlader, S, Vijayakumar, L, Wasserman, D, Saxena, S (2016). Overview evidence on interventions for population suicide with an eye to identifying best-supported strategies for LMICs. Global Mental Health p. e5.
Hagaman, AK, Maharjan, U, Kohrt, BA (2016). Suicide surveillance and health systems in Nepal: a qualitative and social network analysis. International Journal of Mental Health Systems 10, 1.
Hanlon, C, Luitel, NP, Kathree, T, Murhar, V, Shrivasta, S, Medhin, G, Ssebunnya, J, Fekadu, A, Shidhaye, R, Petersen, I, Jordans, MJD, Kigozi, F, Thornicroft, G, Patel, V, Tomlinson, M, Lund, C, Breuer, E, De Silva, M, Prince, M (2014). Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries. PLoS ONE 9, e88437.
Jordans, MJD, Luitel, NP, Tomlinson, M, Komproe, IH (2013). Setting priorities for mental health care in Nepal: a formative study. BMC Psychiatry 13.
Jordans, MJD, Kohrt, BA, Luitel, NP, Komproe, IH, Lund, C (2015). Accuracy of pro-active case finding for mental disorders by community informants in Nepal. British Journal of Psychiatry 207, 16.
Jordans, MJD, Luitel, NP, Pokhrel, P, Patel, V (2016). Development and pilot testing of a mental healthcare plan in Nepal. British Journal of Psychiatry 208, s21s28.
Kigozi, FN, Kizza, D, Nakku, J, Ssebunnya, J, Ndyanabangi, S, Nakiganda, B, Lund, C, Patel, V (2015). Development of a district mental healthcare plan in Uganda. British Journal of Psychiatry bjp. bp. 114.153742.
Kroenke, K, Spitzer, RL, Williams, JBW (2001). The PHQ-9. Journal of General Internal Medicine 16, 606613.
Lund, C, Tomlinson, M, De Silva, M, Fekadu, A, Shidhaye, R, Jordans, MJD, Petersen, I, Bhana, A, Kigozi, F, Prince, M, Thornicroft, G, Hanlon, C, Kakuma, R, McDaid, D, Saxena, S, Chisholm, D, Raja, S, Kippen-Wood, S, Honikman, S, Fairall, L, Patel, V (2012). PRIME: a programme to reduce the treatment gap for mental disorders in five low- and middle-income countries. PLoS Medicine 9, e1001359.
Lund, C, Tomlinson, M, Patel, V (2015). Integration of mental health into primary care in low- and middle-income countries: the PRIME mental healthcare plans. British Journal of Psychiatry.
Mann, JJ, Apter, A, Bertolote, JM, Beautrais, A, Currier, D, Haas, A, Hegerl, U, Lonnqvist, J, Malone, K, Marusic, A (2005). Suicide prevention strategies: a systematic review. JAMA 294, 20642074.
Milner, A, Page, A, Lamontagne, AD (2014). Cause and effect in studies on unemployment, mental health and suicide: a meta-analytic and conceptual review. Psychological Medicine 44, 909917.
Ng, N, Van Minh, H, Juvekar, S, Razzaque, A, Bich, TH, Kanungsukkasem, U, Ashraf, A, Ahmed, SM, Soonthornthada, K (2009). Using the INDEPTH HDSS to build capacity for chronic non-communicable disease risk factor surveillance in low and middle income countries. Global Health Action 2.
Nock, MK, Borges, G, Bromet, E, Cha, C, Kessler, R, Lee, S (2008 a). Suicide and suicidal behavior. Epidemiologic Reviews 30, 133154.
Nock, MK, Borges, G, Bromet, EJ, Alonso, J, Angermeyer, M, Beautrais, A, Bruffaerts, R, Chiu, WT, De Girolamo, G, Gluzman, S (2008 b). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry 192, 98105.
Ojagbemi, A, Oladeji, BD, Abiona, T, Gureje, O (2013). Suicidal behaviour in old age-results from the Ibadan Study of Ageing. BMC Psychiatry 13.
Oladeji, BD, Gureje, O (2011). Parental mental disorders and suicidal behavior in the Nigerian survey of mental health and well-being. Archives of Suicide Research 15, 372383.
Petersen, I, Fairall, L, Bhana, A, Kathree, T, Selohilwe, O, Brooke-Sumner, C, Faris, G, Breuer, E, Sibanyoni, N, Lund, C, Patel, V (2016). Integrating mental health into chronic care in South Africa: the development of a district mental healthcare plan. British Journal of Psychiatry 208, s29s39.
Rathod, SD, De Silva, MJ, Ssebunnya, J, Breuer, E, Murhar, V, Luitel, NP, Medhin, G, Kigozi, F, Shidhaye, R, Fekadu, A (2016). Treatment contact coverage for probable depressive and probable alcohol use disorders in four low-and middle-income country districts: the PRIME cross-sectional community surveys. PLoS ONE 11, e0162038.
Rehkopf, DH, Buka, SL (2006). The association between suicide and the socio-economic characteristics of geographical areas: a systematic review. Psychological Medicine 36, 145157.
Robins, LN, Wing, J, Wittchen, HU, Helzer, JE, Babor, TF, Burke, J, Farmer, A, Jablenski, A, Pickens, R, Regier, DA (1988). The Composite International Diagnostic Interview: an epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry 45, 10691077.
Saunders, JB, Aasland, OG, Babor, TF, De La Fuente, JR, Grant, M (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction 88, 791804.
Shidhaye, R, Shrivastava, S, Murhar, V, Samudre, S, Ahuja, S, Ramaswamy, R, Patel, V (2016). Development and piloting of a plan for integrating mental health in primary care in Sehore district, Madhya Pradesh, India. British Journal of Psychiatry 208, s13s20.
Streatfield, PK, Khan, WA, Bhuiya, A, Alam, N, Sié, A, Soura, AB, Bonfoh, B, Ngoran, EK, Weldearegawi, B, Jasseh, M (2014). Cause-specific mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites. Global Health Action 7.
Üstün, TB, Kostanjsek, N, Chatterji, S, Rehm, J (2010). Measuring Health and Disability: Manual for WHO Disability Assessment Schedule WHODAS 2.0. World Health Organization: Geneva.
Värnik, P (2012). Suicide in the world. International Journal of Environmental Research and Public Health 9, 760771.
Vijayakumar, L, Nagaraj, K, Pirkis, J, Whiteford, HA (2005). Suicide in developing countries: frequency, distribution, and association with socioeconomic indicators. Crisis 26, 104111.
Vijayakumar, L, Phillips, MR, Silverman, MM, Gunnell, D, Carli, V (2016). Suicide. In Disease Control Priorities: Mental, Neurological, and Substance Abuse Disorders. (ed. Patel, V, Chisholm, D, Dua, T, Laxminarayan, R and Medina-Mora, ME), pp. 163181. World Bank: Washington.
Vyas, S, Kumaranayake, L (2006). Constructing socio-economic status indices: how to use principal components analysis. Health Policy and Planning 21, 459468.
WHO (2010). mhGAP Intervention Guide for Mental, Neurological and Substance use Disorders in Non-Specialized Health Settings. World Health Organization: Geneva.
WHO (2012). Public Health Action for the Prevention of Suicide: a Framework. World Health Organization: Geneva.
WHO (2014). Preventing Suicide: A Global Imperative. World Health Organization: Geneva.
Zou, G (2004). A modified Poisson regression approach to prospective studies with binary data. American Journal of Epidemiology 159, 702706.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology and Psychiatric Sciences
  • ISSN: 2045-7960
  • EISSN: 2045-7979
  • URL: /core/journals/epidemiology-and-psychiatric-sciences
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed