Suicide is a leading cause of death worldwide; however, little information is available about the treatment of suicidal people, or about barriers to treatment.
To examine the receipt of mental health treatment and barriers to care among suicidal people around the world.
Twenty-one nationally representative samples worldwide (n=55 302; age 18 years and over) from the World Health Organization's World Mental Health Surveys were interviewed regarding past-year suicidal behaviour and past-year healthcare use. Suicidal respondents who had not used services in the past year were asked why they had not sought care.
Two-fifths of the suicidal respondents had received treatment (from 17% in low-income countries to 56% in high-income countries), mostly from a general medical practitioner (22%), psychiatrist (15%) or non-psychiatrist (15%). Those who had actually attempted suicide were more likely to receive care. Low perceived need was the most important reason for not seeking help (58%), followed by attitudinal barriers such as the wish to handle the problem alone (40%) and structural barriers such as financial concerns (15%). Only 7% of respondents endorsed stigma as a reason for not seeking treatment.
Most people with suicide ideation, plans and attempts receive no treatment. This is a consistent and pervasive finding, especially in low-income countries. Improving the receipt of treatment worldwide will have to take into account culture-specific factors that may influence the process of help-seeking.
See editorial, pp. 8–10, this issue.
The World Health Organization World Mental Health (WMH) Survey Initiative is supported by the US National Institute of Mental Health (NIMH; R01–MH070884 and MH077883), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13–MH066849, R01–MH069864 and R01–DA016558), the Fogarty International Center (FIRCA R03–TW006481), the Pan American Health Organization, Eli Lilly & Co., Ortho-McNeil Pharmaceutical, GlaxoSmithKline and Bristol-Myers Squibb. The work of L.D. was funded by an Australian National Health and Medical Research Council Senior Research Fellowship. The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP Thematic Project Grant 03/00204–3). The Bulgarian Epidemiological Study of common mental disorders is supported by the Ministry of Health and the National Centre for Public Health Protection. The Chinese World Mental Health Survey Initiative is supported by the Pfizer Foundation. The Shenzhen Mental Health Survey is supported by the Shenzhen Bureau of Health and the Shenzhen Bureau of Science, Technology and Information. The Colombian National Study of Mental Health is supported by the Ministry of Social Protection. The European Study of the Epidemiology of Mental Disorders (ESEMeD) is funded by the European Commission (contracts QLG5–1999–01042, SANCO 2004123), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000–158–CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM–TAP) and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. The World Mental Health India study was funded by WHO (India) and helped by Dr R. Chandrasekaran, Jawaharlal Institute of Postgraduate Medical Education and Research. Implementation of the Iraq Mental Health Survey (IMHS) and data entry were carried out by the staff of the Iraqi Ministry of Health and Ministry of Planning with direct support from the Iraqi IMHS team with funding from both the Japanese and European Funds through United Nations Development Group Iraq Trust Fund. The Israel National Health Survey is funded by the Ministry of Health with support from the Israel National Institute for Health Policy and Health Services Research and the National Insurance Institute of Israel. The World Mental Health Japan Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13–SHOGAI–023, H14–TOKUBETSU–026, H16–KOKORO–013) from the Japan Ministry of Health, Labour and Welfare. The Lebanese National Mental Health Survey (LEBANON) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), Fogarty International, anonymous private donations to the Institute for Development, Research, Advocacy and Applied Care, Lebanon, and unrestricted grants from Janssen Cilag, Eli Lilly, GlaxoSmithKline, Roche and Novartis. The Mexican National Comorbidity Survey is supported by the National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT–G30544–H), with supplemental support from the Pan American Health Organization. Te Rau Hinengaro: The New Zealand Mental Health Survey is supported by the New Zealand Ministry of Health, Alcohol Advisory Council and Health Research Council. The Nigerian Survey of Mental Health and Wellbeing is supported by the WHO (Geneva), WHO (Nigeria) and the Federal Ministry of Health, Abuja, Nigeria. The Romania WMH study projects ‘Policies in Mental Health Area’ and ‘National Study regarding Mental Health and Services Use’ were carried out by National School of Public Health and Health Services Management (former National Institute for Research and Development in Health) with technical support from Metro Media Transilvania, the National Institute of Statistics – National Centre for Training in Statistics, Cheyenne Services SRL, Statistics Netherlands and were funded by the Ministry of Public Health (formerly Ministry of Health) with supplemental support from Eli Lilly Romania SRL. The South Africa Stress and Health Study is supported by the US National Institute of Mental Health (R01–MH059575) and the National Institute of Drug Abuse with supplemental funding from the South African Department of Health and the University of Michigan. The Ukraine Comorbid Mental Disorders during Periods of Social Disruption study is funded by NIMH (R01–MH61905). The US National Comorbidity Survey Replication is supported by NIMH (U01–MH60220) with supplemental support from the National Institute of Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation (RWJF Grant 044708) and the John W. Alden Trust. A complete list of all within-country and cross-national WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/.
Declaration of interest
R.C.K. has been a consultant for GlaxoSmithKline, Kaiser Permanente, Pfizer, Sanofi-Aventis, Shire Pharmaceuticals and Wyeth-Ayerst; has served on advisory boards for Eli Lilly & Co. and Wyeth-Ayerst; and has had research support for his epidemiological studies from Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Johnson & Johnson Pharmaceuticals, Ortho-McNeil Pharmaceuticals, Pfizer and Sanofi-Aventis.
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