Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Association of socio-economic position and suicide/attempted suicide in low and middle income countries in South and South-East Asia – a systematic review

Authors: Duleeka W. Knipe, Robert Carroll, Kyla H. Thomas, Anna Pease, David Gunnell, Chris Metcalfe

Published in: BMC Public Health | Issue 1/2015

Login to get access

Abstract

Background

Forty percent of the world’s suicide deaths occur in low and middle income countries (LAMIC) in Asia. There is a recognition that social factors, such as socioeconomic position (SEP), play an important role in determining suicidal risk in high income countries, but less is known about the association in LAMIC.

Methods

The objective of this systematic review was to synthesise existing evidence of the association between SEP and attempted suicide/suicide risk in LAMIC countries in South and South East Asia. Web of Science, MEDLINE, MEDLINE in Process, EMBASE, PsycINFO, and article reference lists/forward citations were searched for eligible studies. Epidemiological studies reporting on the association of individual SEP with suicide and attempted suicide were included. Study quality was assessed using an adapted rating tool and a narrative synthesis was conducted.

Results

Thirty-one studies from nine countries were identified; 31 different measures of SEP were reported, with education being the most frequently recorded. Most studies suggest that lower levels of SEP are associated with an increased risk of suicide/attempted suicide, though findings are not always consistent between and within countries. Over half of the studies included in this review were of moderate/low quality. The SEP risk factors with the most consistent association across studies were asset based measures (e.g. composite measures); education; measures of financial difficulty and subjective measures of financial circumstance. Several studies show a greater than threefold increased risk in lower SEP groups with the largest and most consistent association with subjective measures of financial circumstance.

Conclusion

The current evidence suggests that lower SEP increases the likelihood of suicide/attempted suicide in LAMIC in South and South East Asia. However, the findings are severely limited by study quality; larger better quality studies are therefore needed.

Systematic review registration

PROSPERO 2014:CRD42014006521
Appendix
Available only for authorised users
Literature
1.
WHO. Preventing suicide - A global imperative. Geneva: WHO; 2014.
2.
3.
Stack S. Suicide: a 15-year review of the sociological literature. Part I: cultural and economic factors. Suicide Life Threat Behav. 2000;30(2):145–62.PubMed
4.
Vijayakumar L, John S, Pirkis J, Whiteford H. Suicide in developing countries (2): risk factors. Crisis. 2005;26(3):112–9.CrossRefPubMed
5.
Rehkopf DH, Buka SL. The association between suicide and the socio-economic characteristics of geographical areas: a systematic review. Psychol Med. 2006;36(2):145–57.CrossRefPubMed
6.
Chiu H, Dai J, Xiang Y, Chan S, Leung T, Yu X, et al. Suicidal thoughts and behaviors in older adults in rural China: A preliminary study. Int J Geriatr Psychiatry. 2012;27(11):1124–30.CrossRefPubMedPubMedCentral
7.
Feroz AHM, Nurul Islam SM, Reza S, Mujibur Rahman AKM, Sen J, Mowla M, et al. A community survey on the prevalence of suicidal attempts and deaths in a selected rural area of Bangladesh. J. 2012;13(1):3–9.
8.
Gururaj G, Isaac MK, Subbakrishna DK, Ranjani R. Risk factors for completed suicides: a case–control study from Bangalore, India. Inj Control Saf Promot. 2004;11(3):183–91.CrossRefPubMed
9.
Jia CX, Zhao ZT, Hu MH, Gao LJ, Wang XT. A paired case–control study on related factors to attempted suicide. [Chinese]. Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi. 2005;26(5):339–43.PubMed
10.
Khan MM, Mahmud S, Karim MS, Zaman M, Prince M. Case–control study of suicide in Karachi, Pakistan. Br J Psychiatry. 2008;193(5):402–5.CrossRefPubMed
11.
12.
Ma X, Xiang Y-T, Cai Z-J, Li S-R, Xiang Y-Q, Guo H-L, et al. Lifetime prevalence of suicidal ideation, suicide plans and attempts in rural and urban regions of Beijing, China. Aust N Z J Psychiatry. 2009;43(2):158–66.CrossRefPubMed
13.
Zhang J, Xiao SY, Zhou LA. Mental Disorders and Suicide Among Young Rural Chinese: A Case–control Psychological Autopsy Study. Am J Psychiatry. 2010;167(7):773–81.CrossRefPubMedPubMedCentral
14.
Muntaner C, Eaton WW, Miech R, O'Campo P. Socioeconomic position and major mental disorders. Epidemiol Rev. 2004;26:53–62.CrossRefPubMed
15.
16.
O'connor RC. Towards an Integrated Motivational–Volitional Model of Suicidal Behaviour. In: O'connor RC, Platt S, Gordon J, editors. International Handbook of Suicide Prevention: Research, Policy and Practice. Chichester, UK: John Wiley & Sons, Ltd; 2011.CrossRef
17.
London L, Flisher AJ, Wesseling C, Mergler D, Kromhout H. Suicide and exposure to organophosphate insecticides: Cause or effect? Am J Ind Med. 2005;47(4):308–21.CrossRefPubMed
18.
Lund C, Breen A, Flisher AJ, Kakuma R, Corrigall J, Joska JA, et al. Poverty and common mental disorders in low and middle income countries: A systematic review. Soc Sci Med. 2010;71(3):517–28.CrossRefPubMedPubMedCentral
19.
Rajapakse T, Griffiths KM, Christensen H. Characteristics of non-fatal self-poisoning in Sri Lanka: a systematic review. BMC Public Health. 2013;13:331.CrossRefPubMedPubMedCentral
20.
Phillips MR, Yang G, Zhang Y, Wang L, Ji H, Zhou M. Risk factors for suicide in China: a national case–control psychological autopsy study. Lancet. 2002;360(9347):1728–36.CrossRefPubMed
21.
22.
Howe LD, Galobardes B, Matijasevich A, Gordon D, Johnston D, Onwujekwe O, et al. Measuring socio-economic position for epidemiological studies in low- and middle-income countries: a methods of measurement in epidemiology paper. Int J Epidemiol. 2012;41(3):871–86.CrossRefPubMedPubMedCentral
23.
24.
Patel V, Ramasundarahettige C, Vijayakumar L, Thakur JS, Gajalakshmi V, Gururaj G, et al. Suicide mortality in India: a nationally representative survey. Lancet. 2012;379(9834):2343–51.CrossRefPubMedPubMedCentral
25.
Fincher L. Leftover Women: The Resurgence of Gender Inequality in China (Asian Arguments). London: Zed Books Ltd; 2014.
26.
Reed SR. Analyzing secularization and religiosity in Asia. Jpn J Polit Sci. 2007;8:327–39.
27.
Innamorati M, Tamburello A, Lester D, Rigucci S, Amore M, Di Vittorio C, et al. Socioeconomic risk factors in the precipitation of suicide in the elderly. Open Geriatr Med J. 2009;2:28–33.CrossRef
28.
29.
30.
Blum R, Sudhinaraset M, Emerson MR. Youth at risk: suicidal thoughts and attempts in Vietnam, China, and Taiwan. J Adolesc Health. 2012;50(3 Suppl):S37–44.CrossRefPubMed
31.
Devries K, Watts C, Yoshihama M, Kiss L, Schraiber LB, Deyessa N, et al. Violence against women is strongly associated with suicide attempts: Evidence from the WHO multi-country study on women's health and domestic violence against women. Soc Sci Med. 2011;73(1):79–86.CrossRefPubMed
32.
Sisask M, Varnik A, Kolves K, Bertolote JM, Bolhari J, Botega NJ, et al. Is religiosity a protective factor against attempted suicide: a cross-cultural case–control study. Arch. 2010;14(1):44–55.
33.
34.
Feinstein AR. Quantitative ambiguities in matched versus unmatched analyses of the 2x2 table for a case–control study. Int J Epidemiol. 1987;16(1):128–34.CrossRefPubMed
35.
Chowdhury AN, Banerjee S, Das S, Sarkar P, Chatterjee D, Mondal A, et al. Household survey of suicidal behaviour in a coastal village of Sundarban Region, India. Int Med J. 2005;12(4):275–82.
36.
Dai J, Chiu HFK, Conner KR, Chan SSM, Hou ZJ, Yu X, et al. Suicidal ideation and attempts among rural Chinese aged 16–34 years--socio-demographic correlates in the context of a transforming China. J Affect Disord. 2011;130(3):438–46.CrossRefPubMed
37.
Jollant F, Malafosse A, Docto R, Macdonald C. A pocket of very high suicide rates in a non-violent, egalitarian and cooperative population of South-East Asia. Psychol Med. 2014;44(11):2323–9.CrossRefPubMed
38.
Kulkarni RR, Rao KN, Sudarshan CY, Begum S. Comorbidity of psychiatric and personality disorders in survivors following their first suicide attempt: A case - Control study. In: Indian J Psychiatry: April. 2011;2011:S64.
39.
Lee S, Fung SC, Tsang A, Liu ZR, Huang YQ, He YL, et al. Lifetime prevalence of suicide ideation, plan, and attempt in metropolitan China. Acta Psychiatr Scand. 2007;116(6):429–37.CrossRefPubMed
40.
Li Z-H, Xiao S-Y, Xiao Y-Z. Suicidal behavior among elderly in a rural community of Hunan Province. Chinese Mental Health Journal. 2011;25(12):949–54.
41.
Ma W-j, Xu YQ-h, Xu Y-j, X-j CQ-m, Xu H-f, X-l S, et al. [Features on suicide attempts and its influencing factors among residents in Guangdong province]. Chung Hua Liu Hsing Ping Hsueh Tsa Chih. 2010;31(4):413–6.PubMed
42.
Manoranjitham S, Rajkumar A, Thangadurai P, Prasad J, Jayakaran R, Jacob K. Risk factors for suicide in rural South India. Br J Psychiatry. 2010;196(1):26–30.CrossRefPubMed
43.
Maselko J, Patel V. Why women attempt suicide: the role of mental illness and social disadvantage in a community cohort study in India. J Epidemiol Community Health. 2008;62(9):817–22.CrossRefPubMed
44.
Rebholz CM, Gu D, Yang W, Chen J, Wu X, Huang J-f, et al. Mortality from suicide and other external cause injuries in China: a prospective cohort study. BMC Public Health. 2011;11:56.CrossRefPubMedPubMedCentral
45.
Sauvaget C, Ramadas K, Fayette JM, Thomas G, Thara S, Sankaranarayanan R. Completed suicide in adults of rural Kerala: rates and determinants. Natl Med J India. 2009;22(5):228–33.PubMed
46.
Sun SH, Jia CX. Completed suicide with violent and non-violent methods in rural Shandong, China: a psychological autopsy study. PLoS One. 2014;9(8), e104333.CrossRefPubMedPubMedCentral
47.
Sun X-L, Li K-Q, Cui L-J, Jiang Q-P, Gao L-H, Liu Y-Q, et al. The prevalence of suicide attempters in people aged 18 and older in Hebei Province. Chinese Mental Health J. 2010;24(5):362–5.
48.
Kumar SP, George B. Life events, social support, coping strategies, and quality of life in attempted suicide: A casecontrol study. Indian J Psychiatry. 2013;55(1):46–51.CrossRefPubMedPubMedCentral
49.
Vijayakumar L, Rajkumar S. Are risk factors for suicide universal? A case–control study in India. Acta Psychiatr Scand. 1999;99(6):407–11.CrossRefPubMed
50.
Zhang J, Conwell Y, Zhou L, Jiang C. Culture, risk factors and suicide in rural China: a psychological autopsy case control study. Acta Psychiatr Scand. 2004;110(6):430–7.CrossRefPubMedPubMedCentral
51.
Diener E, Suh ME. Subjective well-being and age: an international analysis. In: Schaie KW, Lawton MP, editors. Focus on emotion and adult development. Volume 17th ed. New York: Springer publishing company; 1997.
52.
Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet. 2009;374(9686):315–23.CrossRefPubMed
53.
Wilkinson RG. Unhealthy societies: the afflictions of inequality. London: Routledge; 2002.
54.
Rao AV. Suicide in the elderly: a report from India. Crisis. 1991;12(2):33–9.PubMed
55.
Welch SS. A review of the literature on the epidemiology of parasuicide in the general population. Psychiatr Serv. 2001;52(3):368–75.CrossRefPubMed
56.
Metadata
Title
Association of socio-economic position and suicide/attempted suicide in low and middle income countries in South and South-East Asia – a systematic review
Authors
Duleeka W. Knipe
Robert Carroll
Kyla H. Thomas
Anna Pease
David Gunnell
Chris Metcalfe
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-2301-5

Other articles of this Issue 1/2015

BMC Public Health 1/2015 Go to the issue

Research article

Energy expenditure during common sitting and standing tasks: examining the 1.5 MET definition of sedentary behaviour

Research article

Health care access dimensions and cervical cancer screening in South Africa: analysis of the world health survey

Research article

Parents' perception of stroller use in young children: a qualitative study

Research article

What happens when you tell someone you self-injure? The effects of disclosing NSSI to adults and peers

Research article

Decomposing contribution of age and non-age factors to rapid growth of lung cancer in Xuanwei over past 30 years

Research article

Human immunodeficiency virus, syphilis and hepatitis C virus prevalence trends among cross-border migrant Vietnamese female sex workers in Guangxi, China