Are suicide and poverty associated in low and middle income countries?
This post originally appeared on the London School of Economics' 'Health and Social Care' blog.
The article can be accessed via the MHIN Resource page.
Over 800 000 people die by suicide every year – approximately one person every 40 seconds. Three out of four suicides take place in low and middle income countries where the majority of the world’s population live and where poverty is concentrated. Evidence supports a positive association between suicide and poverty in low-income and middle-income countries at the individual level. As a result of limited data it is not possible to draw firm conclusions about the association between poverty and suicide at the national level. These are the findings from our recent systematic review. The review was conducted by LSE in collaboration with the University of Cape Town and Stellenbosch University.
How was suicide defined?
Suicide is a multi-dimensional phenomenon that results from a complex interaction between personal characteristics and situational, socio-cultural and economic factors. Reflecting the classification used byWHO, we used the term suicidal ideations and behaviours in our systematic review to include the entire spectrum of suicidal phenomena, from thinking about suicide, to making suicide plans, self-harming, attempting suicide, and completing suicide.
© Video by World Health Organization
How was poverty defined?
Poverty is a complex and multifaceted concept; how to define and measure poverty is the subject of continuing debates. Poverty may be defined in terms of deprivation across the multiple dimensions of life, such as education, health, or housing. Recognising the multidimensionality of poverty, we focused on economic poverty, both at the individual level (absolute poverty, relative poverty, economic status, wealth, unemployment, economic or financial problems, debt, welfare support) and at the country level (national income, national level inequalities, composite poverty measures).
What was the association between suicide and poverty?
We identified 37 studies exploring the association between poverty and suicidal ideations and behaviours in low-income and middle-income countries. About the same number of studies reported on completed suicide and on non-fatal suicidal ideations and behaviours. The majority of the studies investigated individual-level poverty, in particular economic status, wealth assets, and unemployment. The majority of the studies took place in upper middle-income countries, and in the South-East Asia and Western Pacific Regions.
At the individual level, we found consistent trends supporting a positive association between poverty and suicidal ideations and behaviours, with substantial variations across different poverty dimensions. The evidence was more substantial for worse economic status, diminished wealth and unemployment, but limited for relative poverty, economic or financial problems, debt and welfare support. No evidence was found for absolute poverty.
At the country level, the few studies found did not allow us to draw conclusions. There was limited evidence on national income and composite poverty measures. No evidence was found for economic crisis and national-level inequalities.
Both chronic poverty and acute economic events, such as crop failure, were found to constitute possible risk factors for suicidal ideations and behaviours.
Call to action!
Understanding the role of poverty as a risk factor for suicide in low-income and middle-income countries is crucial to inform the design of suicide prevention strategies and policies. The soil has been prepared… now it is up to researchers and policy-makers to lay the seeds!
Iemmi V, Bantjes J, Coast E, Channer K, Leone T, McDaid D, Palfreyman A, Lund C (2016) Suicidal behaviour and poverty in low-income and middle-income countries: a systematic review, The Lancet Psychiatry, 3, 8, 774–783.
About the authors
Valentina Iemmi is Research Fellow within the Personal Social Services Research Unit at the LSE.
Jason Bantjes is Senior Lecturer within the Department of Psychology at Stellenbosch University, South Africa.