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

The DOI matches its Crossref record; 166 of the 171 references it cites were found in a registry or an index.

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
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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.

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Crossref · 10.1371/journal.pmed.1002905

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Figures

Fig 1 Flowchart of studies included in this review. Includes manuscripts that are multiple reports of the same study sample. Only one instance of each study population is retained and included in the analysis. LMIC, low- and middle-income countries.
Fig 1 Flowchart of studies included in this review. Includes manuscripts that are multiple reports of the same study sample. Only one instance of each study population is retained and included in the analysis. LMIC, low- and middle-income countries.CC BY · PubMed Central
Fig 2 Overall prevalence of psychiatric disorder in high versus low/moderate quality studies of fatal suicidal behaviour. ES, Effect size.
Fig 2 Overall prevalence of psychiatric disorder in high versus low/moderate quality studies of fatal suicidal behaviour. ES, Effect size.CC BY · PubMed Central
Fig 3 Overall prevalence of psychiatric disorder in high versus low/moderate quality studies of nonfatal suicidal behaviour. ES, Effect size.
Fig 3 Overall prevalence of psychiatric disorder in high versus low/moderate quality studies of nonfatal suicidal behaviour. ES, Effect size.CC BY · PubMed Central

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Citations

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Research works printed but not linked: 23

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  17. SA Santos, 2009, Prevalence of mental disorders associated with suicide attempts treated at an emergency hospital in Rio de Janeiro, Brazil [Portuguese]., Cad Saude Publica, 25, 2064
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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
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
  • 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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