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Suicide in Low- and Middle-Income Countries

Abstract

With the publication of the Preventing Suicide: A global imperative (WHO 2014) report, suicide has been highlighted as an issue of urgent concern. This is particularly the case for low- and middle-income countries (LMICs), where majority of the world’s population live. This chapter synthesises research findings from case-control psychological autopsy studies conducted in recent years in LMICs to understand risk factors associated with suicide. Suicide is presented as a consequence of a complex web of diverse interacting factors ranging from intrapersonal through interpersonal to distal factors. Mental ill-health, interpersonal stress and structural constraints such as economic challenges are among the factors evidenced to confer suicide risk in LMICs. To enrich understanding about the contexts in which suicide occurs, the chapter incorporates ethnographic evidence relating to suicide in China and India, the two most populous countries in the LMICs’ category who face correspondingly large suicide burdens. Major findings are that suicide may commonly be an indication of strained family ties in China and an expression of disillusionment from frustrations of modern consumerist living in India. This highlights the importance of understanding suicide in the sociocultural context in which people live their lives and in particular the impact that social disadvantage might have on the risk of suicide. The practical difficulties in conducting suicide research and consequent methodological complexities are highlighted. The dearth of available evidence relating to suicide in low-income countries is noted as a major concern for understanding suicide in the majority world. The implications of the findings for practical suicide intervention and prevention measures as well as recommendations for future research are discussed.

Keywords

  • Suicide Risk
  • Suicide Prevention
  • Gross National Income
  • Suicide Mortality
  • Global Mental Health

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Fig. 17.1

Notes

  1. 1.

    The characterisation of a country’s economy as low and middle income is based on the World Bank’s annual computation of a country’s Gross National Income (GNI) per capita, the computation carried out through the use of the World Bank Atlas method (World Bank 2013a). The current chapter uses the World Bank’s 2013 country income-level classifications. The 2013 classifications are low income, US$ 1035 or less; lower-middle income, $1036–$4085; upper-middle income, $4086–$12,615; and high income, $12,616 or more (World Bank 2013a). The present chapter therefore focuses on all countries with GNI per capita not exceeding $12,615 per the 2013 classification.

  2. 2.

    Proxy participants refer to the informants who are interviewed upon which impressions are formed about the lifestyles, living circumstances, personalities, physical and psychological health of the actual suicide decedent cases (and controls) (Hjelmeland et al. 2012; Sher 2013).

  3. 3.

    All the studies were conducted in middle-income countries {MIC}. Twelve of the studies were conducted in upper-middle-income countries: eight studies were from China (Fang et al. 2012; Kong and Zhang 2010; Li et al. 2008; Zhang et al. 2010, 2011, 2013, 2004; Zhang and Wang 2012), two were conducted in Hungary (Almasi et al. 2009; Zonda 2006), one from Colombia (Palacio et al. 2007) and one from Turkey (Altindag et al. 2005). The remainder were conducted in lower-middle-income countries: two from India (Gururaj et al. 2004; Manoranjitham et al. 2010), one from Indonesia (Kurihara et al. 2009) and one from Pakistan (Khan et al. 2008).

  4. 4.

    Table 1 displayed multivariate data on suicide risk factors extracted from the reviewed studies on the basis that multivariate analysis yields outcomes with independent influence in the interactive context of multiple variables (see: Roberts and Browne 2011; Cheng et al. 2000). In a study with no such multivariate data provided, the risk factors highlighted from its analysis were extracted.

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Boahen-Boaten, B.B., White, R.G., O’Connor, R.C. (2017). Suicide in Low- and Middle-Income Countries. In: White, R., Jain, S., Orr, D., Read, U. (eds) The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health. Palgrave Macmillan, London. https://doi.org/10.1057/978-1-137-39510-8_17

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