Poverty and suicide research in low- and middle-income countries: systematic mapping of literature published in English and a proposed research agenda

Abstract

Approximately 75% of suicides occur in low- and middle-income countries (LMICs) where rates of poverty are high. Evidence suggests a relationship between economic variables and suicidal behaviour. To plan effective suicide prevention interventions in LMICs we need to understand the relationship between poverty and suicidal behaviour and how contextual factors may mediate this relationship. We conducted a systematic mapping of the English literature on poverty and suicidal behaviour in LMICs, to provide an overview of what is known about this topic, highlight gaps in literature, and consider the implications of current knowledge for research and policy. Eleven databases were searched using a combination of key words for suicidal ideation and behaviours, poverty and LMICs to identify articles published in English between January 2004 and April 2014. Narrative analysis was performed for the 84 studies meeting inclusion criteria. Most English studies in this area come from South Asia and Middle, East and North Africa, with a relative dearth of studies from countries in Sub-Saharan Africa. Most of the available evidence comes from upper middle-income countries; only 6% of studies come from low-income countries. Most studies focused on poverty measures such as unemployment and economic status, while neglecting dimensions such as debt, relative and absolute poverty, and support from welfare systems. Most studies are conducted within a risk-factor paradigm and employ descriptive statistics thus providing little insight into the nature of the relationship. More robust evidence is needed in this area, with theory-driven studies focussing on a wider range of poverty dimensions, and employing more sophisticated statistical methods.

Non-fatal suicidal behaviour, depression and poverty among young men living in low-resource communities in South Africa

“…It is significant that in this community, problems related to unemployment, low income, frequent changes of jobs and receiving financial assistance from a partner or parent, are endemic and may thus constitute more of a shared experience among young men and consequently may not precipitate intense feelings of shame. This is an area that may warrant further investigation in order to better understand what it is about these particular experiences of poverty that precipitate non-fatal suicidal behaviours among young men living under conditions of endemic poverty [ 20 ].…”

“…There is a growing body of literature suggesting that socio-economic factors, such as poverty and living circumstances, may also constitute risk factors for suicidal behaviour [ 3 ]. However, the overwhelming majority of studies on poverty and suicidal behaviour focus on narrow measures of poverty (such as unemployment) and measure associations between poverty and suicidal behaviour without exploring the potential influence of mental illnesses (such as depression) and co-factors (such as gender and age) [ 20 ].…”

“…There are good reasons for investigating how a wide range of poverty-related socio-economic factors interact with psychiatric factors to precipitate suicidal behaviour, particularly in LMICs where psychiatric and mental health care resources are scarce [ 20 ]. Understanding the interaction between proximal and distal factors has implications for targeted suicide prevention interventions and for planning non-psychiatric suicide prevention interventions in low-resource communities.…”

Capitalism versus narcissism: Death of a salesmans psychoanalytic critique

“…More reports show the indicators related to suicide rates in the economically advanced and capitalist countries since 2008 crisis, they show an unsettling similarity to that of the increase in the instances of self-harm. More results related to suicide tells us that, ''similar reports by a group of experts published in The British Medical Journal in 2013 directly reflect the increase in the suicide rate in many advanced capitalist countries with the instability caused by the crisis in 2008 and its ongoing effects'' (Chang et al, 2013;Bantjes et al, 2016;Nordt et al, 2015). He also anticipates that ''the native discovers reality and transforms it into the pattern of his customs, into the practice of violence and into his plan for freedom'' (58).…”

Transtornos mentais em adolescentes, jovens e adultos do Consórcio de Coortes de Nascimento brasileiras RPS (Ribeirão Preto, Pelotas e São Luís)

“…Suicide also frequently causes harm to persons close to the direct victim, including ideation, planning, suicide attempts, psychiatric morbidity such as depression, and/or physical health problems, further overloading health services, especially those providing mental healthcare 40 . The high percentage of individuals with suicide risk in these studies thus has evident practical connotations, with the need to expand and qualify prevention strategies, mainly among youth, women, and socioeconomically vulnerable persons 41 .…”