CoChat
Sign Up
Cited by 174Suicide and Self-Harm StudiesMental Health Treatment and AccessHomicide, Infanticide, and Child Abuse

Psychiatric morbidity and suicidal behaviour in low- and middle-income countries: a systematic review and meta- analysis

Open access
Knipe, Duleeka, Williams, A. Jess, Hannam-Swain, Stephanie, Upton, Stephanie, Brown, Katherine, Bandara, Piumee, Chang, Shu-Sen, Kapur, Nav·2019·PLOS Medicine
DOI 10.1371/journal.pmed.1002905PMC PMC6785653
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Psychiatric disorders are reported to be present in 80% to 90% of suicide deaths in high-income countries (HIC), but this association is less clear in low- and middle-income countries (LMIC). There has been no previous systematic review of this issue in LMIC. The current study aims to estimate the prevalence of psychiatric morbidity in individuals with suicidal behaviour in LMIC. METHODS AND FINDINGS: PubMed, PsycINFO, and EMBASE searches were conducted to identify quantitative research papers (any language) between 1990 and 2018 from LMIC that reported on the prevalence of psychiatric morbidity in suicidal behaviour. We used meta-analytic techniques to generate pooled estimates for any psychiatric disorder and specific diagnosis based on International classification of disease (ICD-10) criteria. A total of 112 studies (154 papers) from 26 LMIC (India: 25%, China: 15%, and other LMIC: 60%) were identified, including 18 non-English articles. They included 30,030 individuals with nonfatal suicidal behaviour and 4,996 individuals who had died by suicide. Of the 15 studies (5 LMIC) that scored highly on our quality assessment, prevalence estimates for psychiatric disorders ranged between 30% and 80% in suicide deaths and between 3% and 86% in those who engaged in nonfatal suicidal behaviour. There was substantial heterogeneity between study estimates. Fifty-eight percent (95% CI 46%-71%) of those who died by suicide and 45% (95% CI 30%-61%) of those who engaged in nonfatal suicidal behaviour had a psychiatric disorder. The most prevalent disorder in both fatal and nonfatal suicidal behaviour was mood disorder (25% and 21%, respectively). Schizophrenia and related disorders were identified in 8% (4%-12%) of those who died by suicide and 7% (3%-11%) of those who engaged in nonfatal suicidal behaviour. In nonfatal suicidal behaviour, anxiety disorders, and substance misuse were identified in 19% (1%-36%) and 11% (7%-16%) of individuals, respectively. This systematic review was limited by the low number of high-quality studies and restricting our searches to databases that mainly indexed English language journals. CONCLUSIONS: Our findings suggest a possible lower prevalence of psychiatric disorders in suicidal behaviour in LMIC. We found very few high-quality studies and high levels of heterogeneity in pooled estimates of psychiatric disorder, which could reflect differing study methods or real differences. There is a clear need for more robust evidence in order for LMIC to strike the right balance between community-based and mental health focussed interventions.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1371/journal.pmed.1002905

Cites

166 of 166 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

5 of the 171 references couldn’t be matched to a known paper.

Research works printed but not linked: 21

  1. [13]Spitzer R, Williams J, Gibbon M, First M. Structured Clinical Interview for DSM-III-R Washington DC: American Psychiatric Press; 1990.
  2. [33]Haddad S.Y., Haddadin K.J., Abu-Samen M., Wreikat M.W., A.I. H. Suicide attempted by burning: A three-year study. Annals of Burns and Fire Disasters. 1998; 6(4): 1– 4.
  3. [49]Maksuti P, Kola V, Simaku A. Epidemiological overview on pattern of suicide in the district of Tirana in Albania, over the period 2001–2010. Int J Neuropsychopharmacol. 2012; 1: 229.
  4. [59]Du C-J, Li X-Y, Zhang Y-P. Comparison of the characteristics of completed suicide in people with and without mental disorders older than 55 and with no serious physical illnesses. [Chinese]. Chinese Mental Health Journal. 2008; 22(6): 397– 400.
  5. [60]Zhang Y, Li X, Wang L, Zhao Y, Meng M, Zhang F, et al National case-control study of suicide and accidental death Chinese Mental Health Journal. 2004; 18: 861– 4.
  6. [80]Zhou R, Zhang J, Qiu H-M. Identification of mental disorders in rural youth suicides. [Chinese]. Chinese Mental Health Journal. 2014; 28(4): 248– 52.
  7. [86]Bansal PD, Barman R. Psychiatric morbidity and the socio-demographic determinants of deliberate self harm. Journal of Clinical and Diagnostic Research. 2011; 5(3): 601– 4.
  8. [87]Bansal P, Gupta A, Kumar R. The Psychopathology and the Sociodemographic Determinants of Attempted Suicide Patients. Journal of Clinical and Diagnostic Research. 2011; 5(5): 917– 20.
  9. [88]Barrimi M, Zaidi K, Hlal H, Kettani N, Khelafa S, Rammouz I, et al Violent suicide attempts in the general hospital of Fez (Morocco): Evaluation and management in liaison psychiatry. Prospective study over a period of 6 months. [French]. L'Evolution Psychiatrique. 2014; 79(4): 619– 28.
  10. [95]Chatterjee S, Kadam M. Study of psychiatric comorbidity and psychosocial stress factors in patients attempting suicide. Indian J Psychiatry. 2015; 1: S78.
  11. [96]Cherif L, Ayedi H, Sahnoun F, Walha A, Moalla Y, Rekik N, et al Psychopathology of suicide attempts among adolescents. [French]. Neuropsychiatr Enfance Adolesc. 2012; 60(6): 454– 60..
  12. [104]Grau AG, Sanchez AC, Mendez NR, Ramirez GB. Suicide attempts and related risk factors in Cartagena, Colombia. [Spanish]. Acta Psiquiatr Psicol Am Lat. 2013; 59(4): 240– 52.
  13. [115]Kulkarni RR, Nagaraja Rao K, Begum S. Clinical profile of first suicide attempters in a general hospital. Indian J Psychiatry. 2013; 55: S56.
  14. [124]Ma C, Fang M. Psychological factors and clinical features of attempted suicides. [Chinese]. Chinese Mental Health Journal. 1999; 13(2): 110– 2.
  15. [135]Pandey A, Singh H, Dalai P, Tripathi A, Dutt K, Sinha P. Psychiatric Morbidity in Suicide attempters attending University Hospital of North India. Delhi Psychiatry Journal. 2013; 16(1): 128– 33.
  16. [143]Risal A, Sharma PP. Psychiatric manifestations of patients admitted for intentional self harm in a tertiary care hospital. Indian J Psychiatry. 2011; 1: S61.
  17. [145]Sathish S, Kishan P, Sanjay Kumar ND, Sharma S. Psychiatric morbidity in suicide attempters. Indian J Psychiatry. 2016; 58: S80.
  18. [159]Wang W, Ding L, Wen C, Liao Z, Wu S. Attempters suicide in people aged 18 and older in Xiamen City [Chinese]. Chinese Mental Health Journal. 2012; 26: 332– 6.
  19. [162]Xiao C-L, Li X-Y, Zhang Y-P, Phillips MR. Characteristics of suicide attempters who ingested pesticides and those who used other methods. [Chinese]. Chinese Mental Health Journal. 2011; 25(2): 128– 33.
  20. [164]Li X, Xu Y, Wang Y, Yang R, Zhang C, Ji H, et al Characteristics of serious suicide attempts treated in general hospitals. [Chinese]. Chinese Mental Health Journal. 2002; 16(10): 681– 4.
  21. [166]Li X, Phillips MR, Wang Y, Yang R, Zhang C, Ji H, et al The comparison of impulsive and non-impulsive attempted suicide [Chinese]. Chinese Journal of Mental and Nervous Diseases. 2003; 29(27–31).

Cited by

Sorted by citations

Related

Authors
Knipe, D., Williams, A. J., Hannam-Swain, S., Upton, S., Brown, K., Bandara, P., Chang, S.-S., & Kapur, N.
Affiliations
  • University of Bristol (GB)
  • University of Birmingham (GB)
  • Sheffield Hallam University (GB)
  • University of Nottingham (GB)
  • Western Sydney University (AU)
  • National Taiwan University (TW)
Corresponding author
Knipe, Duleeka
ORCID
Venue
PLOS Medicine
Publisher
Public Library of Science (PLoS)
Published
2019-10-09
Volume
16
Issue
10
Pages
e1002905
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
DOI
10.1371/journal.pmed.1002905
PMC
PMC6785653
OpenAlex
W2980106730
Cited by
174
References
171
Citations by year
2026: 19 · 2025: 23 · 2024: 27 · 2023: 42 · 2022: 24 · 2021: 23 · 2020: 13 · 2019: 2
FWCI
2.45
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (publishedVersion, cc-by)
  • SHURA (Sheffield Hallam University Research Archive) (Sheffield Hallam University) (acceptedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Bristol Research (University of Bristol) (submittedVersion, cc-by)
Funders
  • Wellcome Trust
  • University of Bristol
  • Elizabeth Blackwell Institute for Health Research, University of Bristol
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
Keywords
psychiatric morbidity, suicidal behavior, suicide, low- and middle-income countries, mood disorders, schizophrenia, anxiety disorders, substance abuse, prevalence of mental disorders, suicide mortality, ICD-10 diagnoses, India, China, South Asia, Southeast Asia, Africa, Latin America, Caribbean, Pacific Islands, Middle East
MeSH terms
Suicide, Completed, China, Developing Countries, Humans, India, Morbidity, Poverty, Risk Factors, Suicide, Attempted, Prevalence, Mood Disorders, Suicidal Ideation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review