Psychological Autopsy Studies of Suicide in South East Asia

Abstract

Background: Psychiatric disorders have been identified as an important risk factor for suicide. However, different psychological autopsy studies have revealed different prevalences at different times and places. Objective: We aimed to see the distribution of psychological autopsy studies and the prevalence of mental disorders among suicides and identify major risk factors in Southeast Asian countries. Method: We scrutinized psychological autopsy studies published in the World Health Organization (WHO) South-East Asia (SEA) region countries. We also searched the available bibliographies to identify the studies in the region so that all the possible articles could be included. Results: Out of the 11 countries, 14 psychological autopsy studies were identified in five SEA countries (Bangladesh [1], India [9], Indonesia [1], Nepal [1], and Sri Lanka [2]). Seven studies (50%) used a case-control study design, and eight (57.1%) were carried out in urban settings. The prevalence of psychiatric disorders in case-control studies was from 37% to 88%. Stressful life event was identified as a major risk factor in all the case-control studies. Conclusion: Psychological autopsy studies have not been conducted in 6 out of 11 countries of the SEA region. The presence of pre-existing psychiatric morbidity and stressful life events were the two most common risk factors noted across settings, even though there is wide heterogeneity in samples, study design, instruments, and study settings.

Suicide in the geriatric population of South East Asia - contexts and attributes

“…9 Chandrasekaran and Gnanaselane (2008) investigated the predictors of repeated suicide attempts of 348 samples from India and found that repeat suicide attempts are associated with depression, hopelessness and suicidal intent, and presence of major depression and social dissidence are predictive factors for repeat attempts. 10 A recent scoping review by Arafat et al (2022) revealed that the prevalence of depression among fatal (37.3%) and nonfatal suicidal attempts (32.7%) in South Asian countries seems to be lower compared to other regions of the world. 11 In another research, Arafat et al found that the presence of preexisting psychiatric morbidities and stressful life events are the most common risk factors for suicide in South Asia.…”

“…11 In another research, Arafat et al found that the presence of preexisting psychiatric morbidities and stressful life events are the most common risk factors for suicide in South Asia. 12…”

“…35 A review related to the psychological autopsy of the SEA region, which is related to suicide amongst the overall population, reports variable estimates for various countries ranging between as low as 5% to as high as 95%. 12 It is also stated that around 5% of suicides may be committed due to sub-clinical conditions. 36 It can be said that poor mental health conditions or persistent stress can lead to suicidal thoughts in each segment of the population, and thus in the elderly.…”

Psychological autopsy study and risk factors for suicide in Muslim countries

“…These findings concur with reports from Asian settings where life events and interpersonal conflicts have been noted to be major drivers of suicide, unlike the West where psychiatric morbidity remains the principal risk factor. 8,10,19,44 Previous studies from Turkey, a transcontinental country located both in Asia and in Europe, have shown the key role of stressful life events and poor social support in triggering suicidal behavior across age groups. 45,46 Our findings imply that suicide prevention efforts in Muslim nations must also focus adequately on the social determinants of suicide, apart from addressing barriers to seeking mental health services, to effectively tackle the menace of suicide.…”

Association between Suicide Rate and Human Development Index, Income, and the Political System in 46 Muslim-Majority Countries: An Ecological Study

“…As a result, any risk factor with a specific cause–effect association with suicide is difficult to identify [ 3 ]. Although psychiatric disorders have been identified as important risk factors for suicide consistently, the rate varies between Western countries and LMICs as studies from the former report rates around 90% whilst the LMICs show a much lower rate of mental disorders among suicides [ 3 , 4 , 5 , 6 , 7 , 8 , 9 ].…”