news-roundup-image-4CITATION: Psychiatric morbidity and suicidal behaviour in low- and middle-income countries: A systematic review and meta-analysis
Duleeka Knipe ,A. Jess Williams,Stephanie Hannam-Swain,Stephanie Upton,Katherine Brown,Piumee Bandara,Shu-Sen Chang,Nav Kapur
Published: October 9, 2019

Approximately 800,000 people die by suicide each year, with 75% of these deaths occurring in low- and middle-income countries (LMIC).
Psychiatric disorder is thought to be associated with 80% to 90% of those who engage in suicidal behaviour in high-income countries (HIC), but this association is less clear in LMIC.
A better understanding is needed of this association in LMIC to ensure effective and appropriate allocation of limited resources.

We searched the existing literature for studies conducted in LMIC that estimated the proportion of individuals who engaged in suicidal behaviour with psychiatric disorders and found 112 studies from 26 countries (mainly from China and India).
Even in the higher quality studies, there was wide variability in the proportion of psychiatric disorders in fatal (30%–80%) and nonfatal (3%–86%) suicidal behaviour, but on average, 58% of those who died by suicide and 45% of those who engaged in nonfatal suicidal behaviour had a psychiatric disorder.
Mood disorders were the most prevalent disorder identified in both fatal and nonfatal suicidal behaviour.

There were considerable differences in the estimates of psychiatric disorder between studies. This may reflect differences in the way studies were carried out or real differences, but there were too few high-quality studies to estimate the prevalence by individual country. More high-quality research is needed.
Psychiatric disorders may be less common in suicidal behaviour in LMIC than in HIC. Although treating psychiatric illness is important, the treatment and prevention of suicidal behaviour should include a wider range of activities.

COMMENT (NPW): I am not an expert in this field, but it seems to me that suicide is (almost) always associated with ‘psychiatric morbidity’ at the time of the suicide itself. What this paper seems to show is that suicide is not always preceded by a history of psychiatric disorder. s What seems most important to me is to understand the months, days and hours leading to individual suicides (social autopsy) so that common drivers can be identified – some of which may be due to misconceptions. For example, it is well known that many people who take their own lives indicate their intentions to someone beforehand, who often do no take the threat seriously or act appropriately.

Best wishes, Neil

Coordinator, HIFA Project on Information for Citizens, Parents and Children