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Psychiatric morbidity and suicidal behaviour in low- and middle-income countries: a systematic review and meta- analysis
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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.
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“These syndromes constitute a risk factor for subsequent onset of depression, and may be the sequelae of partial remission of an episode of major depression. 173”
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“some of the key drivers of recent trends in suicide rates differ between low- and high-income countries, for example the prevalence of underlying mental health problems in the population (Knipe et al., 2019).”
From Social media use, economic recession and income inequality in relation to trends in youth suicide in high-income countries: a time trends analysis (2020) · cites this paper as Knipe et al., 2019
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“The most prevalent diagnosis is mood disorder, followed by schizophrenia, anxiety disorder, and substance abuse [113].”
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“4,16 Therefore, a comprehensive public health approach, targeting the entire health system and promoting universal access to preventive, promotive, and responsive care, has the potential to exert a broader and more sustainable impact on suicide prevention across diverse populations in Latin America.”
Suicide Attempts and Reattempts in Cape Town: A Mixed-Methods Study of Lifetime Suicidal BehaviourPreprint
Rabie, S., Tlali, M., Maniwe, O., Allenby, R., Bossert, B., Rm, P., van den Heuvel, L. L., Joska, J. A., Orrell, C., Seedat, S., et al. (2026) · Research Square · doi:10.21203/rs.3.rs-10537400/v1
The Role of Family Problems in Self-Harm: A 5-Year Retrospective Chart Review
Savani, S., Douglas, J., Sudha, J. N., & Sreedaran, P. (2026) · Families in Society The Journal of Contemporary Social Services · doi:10.1177/10443894261450657
Umer, A., Heman, N., Aibani, A., Amin, M., Arshad, A., & Sethi, S. M. (2026) · BJPsych Open · doi:10.1192/bjo.2026.12110
“12 In Pakistan, psychiatric disorders are often underdiagnosed and poorly integrated into healthcare systems.”
Metadata
- 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
- 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
- gold
- doi.org
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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
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