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


Autoři: Duleeka Knipe aff001;  A. Jess Williams aff002;  Stephanie Hannam-Swain aff003;  Stephanie Upton aff004;  Katherine Brown aff005;  Piumee Bandara aff006;  Shu-Sen Chang aff007;  Nav Kapur aff008
Působiště autorů: Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom aff001;  Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom aff002;  Sheffield Hallam University, Sheffield, United Kingdom aff003;  University Hospital Bristol, Bristol, United Kingdom aff004;  University of Nottingham, Nottingham, United Kingdom aff005;  Translational Health Research Institute, Western Sydney University, Sydney, Australia aff006;  Institute of Health Behaviors and Community Sciences and Department of Public Health, College of Public Health, National Taiwan University, Taipei City, Taiwan aff007;  University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom aff008
Vyšlo v časopise: Psychiatric morbidity and suicidal behaviour in low- and middle-income countries: A systematic review and meta-analysis. PLoS Med 16(10): e32767. doi:10.1371/journal.pmed.1002905
Kategorie: Research Article
doi: 10.1371/journal.pmed.1002905

Souhrn

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.

Klíčová slova:

Behavior – Behavioral disorders – Collective human behavior – Diagnostic medicine – Metaanalysis – Morbidity – Pesticides – Suicide


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