Are we using the right evidence to inform suicide prevention in low- and middle-income countries?



Suicide is a major health issue globally with the majority of deaths occurring in low- and middle- income countries (LMICs). [1] Because of this one would think that the majority of academic publications on suicide would be conducted in this setting. However, that is not the case and studies have shown that the majority of suicide research originates from high-income countries (HICs). [2]


Suicidal behaviour is complex with a wide range of contributing factors. Cultural, economic, and medical factors amongst others differ vastly between low- and middle-income countries and as a result of this, it would be reasonable to assume that the research conducted and recommendations made would only be applicable to a high-income setting. Psychiatric behaviours [3] and attitudes towards mental health [4] differ in low- and middle-income settings compared to high-income settings and it has been argued that these could play a role.


Current suicide prevention measures that have been derived from research in HICs may not be appropriate for groups of people with languages, cultures and experiences that differ greatly from the intended target group. It is incredibly important to account for the differing lived experiences of individuals in a low-income setting in order for us to understand the barriers that we must overcome in ensuring adequate suicide prevention measures are in place for these individuals.


In the upcoming months, we will be working to synthesise the literature included in systematic reviews of suicide prevention and evaluate their relevance to LMICs.

Editor:


Ivie Itua is a second-year graduate medical student at UCL. She has conducted a systematic review on miRNAs in Parkinson's disease, written reports as part of Public Health England, and worked as a research assistant on studies researching Alzheimer's disease and ageing. Ivie’s interests lie in mental health, public health and tackling inequalities in healthcare practices.


Researchers:

Faiza Chaudhry is a second-year medical student at Imperial College London.


Kamal Shah is a fifth-year medical student at Imperial College London. He recently completed his iBSc in Biomedical Engineering.


Tatiana Georgiadi is a second-year medical biosciences student at Imperial College London.


Commissioner:


Dr Duleeka Knipe is a mental health epidemiologist with an interest in life course risk factors for suicide and self-harm. Her work has explored the social determinants of mental ill health and has looked at the impact of national policies in reducing suicide deaths. Her work has primarily been in low- and middle-income countries.

References:

  1. World Health Organization. Suicide. 2019. Available from: https://www.who.int/news-room/fact-sheets/detail/suicide.

  2. Knipe D, Williams J, Hannam-Swain S, Upton S, Brown K, Bandara P, et al. Psychiatric morbidity and suicidal behaviour in low- and middle-income countries: A systematic review and meta-analysis. PLoS Med. 2019; 16 (10): e002905. doi: https://doi.org/10.1371/journal.pmed.1002905. Available from: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002905.

  3. Colluci E, Lester D, Hjelmeland H, Park B. Suicide and culture: Understanding the context. Hogrefe Publishing; 2013.

  4. Rathod S, Pinninti N, Irfan M, Gorczynski P, Rathod P, Gega L, et al. Mental Health Service Provision in Low- and Middle-Income Countries. Health Serv Insights. 2017; 10. doi: 10.1177/1178632917694350. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398308/.

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