When it comes to researching the prevalence of suicide across the world, much of it is focused on high-income earning individuals. But it turns out, the vast majority of suicides each year are by people living in low and middle-income countries.
That's the findings of new research by the University of Bristol, which was published in journal PLOS Medicine to coincide with World Mental Health Day.
Low and middle-income countries have additional factors that cause suicides
"The burden of suicide is greatest in low- and middle-income countries and this partly reflects the fact that this is where the majority of people live," Dr. Duleeka Knipe, Elizabeth Blackwell Institute (EBI) Vice Chancellor's Research Fellow at the Bristol Medical School told Interesting Engineering in an e-mail interview. "Suicide is a complex behaviour and people die for a variety of reasons. In these settings, there are additional factors which may contribute to a person’s suicide risk which are seen less commonly in a high-income setting."
According to the international research team, which is made up of academics from universities of Manchester, Birmingham, Sheffield Hallam, Nottingham, Western Sydney, and National Taiwan University, there are 800,000 suicide deaths each year with 76% from low and middle-income countries. The researchers analyzed data from 112 studies on 30,030 episodes of non-fatal suicide behaviors and 4,996 suicide deaths in 25 low and middle-income countries. They found 58% of the suicide deaths and 45% of the non-fatal suicidal behaviors were caused by psychiatric disorders.
"In high-income countries suicide prevention initiatives have focussed on the treatment of psychiatric disorders, and this approach is also being adopted in low- and middle-income settings. We conducted this review to find out whether psychiatric disorder was also an important target for suicide prevention in low and middle-income settings," Knipe said.
Psychiatric disorders vary from one country to the next
The study also revealed the psychiatric disorders found in the suicidal behaviors were variable which could be due to the differences in the countries. While treating the psychiatric disorder in high-income countries is the main way to prevent suicide in these low and middle-income countries it may require a wider approach for prevention.
"Our analyses show there is a lot of variability between studies and countries, and this suggests there is no one answer but does support our thinking that psychiatric disorder is perhaps not as important in these settings as in higher-income countries," said Knipe in a press release highlighting the results of the work. "Of course, the treatment of underlying psychiatric illness is important but prevention efforts should also incorporate a wider range of activities which aim to reduce access to lethal means, poverty, domestic violence and alcohol misuse. For example, population level solutions, such as banning highly toxic pesticides, have been shown to be effective in reducing the number of suicide deaths."
Knipe told Interesting Engineering more research needs to be done into suicidal behavior in low and middle-income countries. "We probably need to be more creative in the prevention approaches adopted in these settings. Activities should, for example, include reducing poverty, access to lethal means, and domestic violence," said Knipe.