Bantjes, Jason

Channer, Kerrie

Coast, Ernestina

Iemmi, Valentina

Leone, Tiziana

Lund, Crick

McDaid, David

Palfreyman, Alexis

LSE Research Online

 Suicide and Poverty in Low and Middle Income Countries:  systematic review   Preliminary findings  London School of Economics and Political Science Valentina Iemmi Ernestina Coast Tiziana Leone  David McDaid Alexis Palfreyman   Stellenbosch University Jason Bantjes   University of Cape Town  Crick Lund Kerrie Channer Background  • Suicidal behaviour is considered a global public health crisis.  • Suicidal behaviour is associated with mental illness and individual personality factors.  • Growing awareness that socio-cultural, economic and contextual factors also play a role in the aetiology of suicidal behaviours.  Source: WHO 2010; Rihmer 2011; Fliege et al. 2009; Hawton et al. 2005; Krysinkska & Lester 2010; Wulsin et al. 1999; Brinkmann 2009; Chan 2013;  Platt 2011; Vijayakumar et al. 2005  • Growing research on the relationship between suicidal behaviour and socio-economic variables, such as poverty, financial crisis, indebtedness and unemployment.   • Understanding the nature of the relationship between economic factors and suicidal behaviour is important for suicide prevention, especially in developing countries where rates of poverty are high.    Aim  To conduct a systematic review of research conducted on the relationship between poverty  and suicidal behaviour  in low and middle income countries.  Methods • 11 databases specialised in medical (CINHAL Plus, EMBASE, Global Health, PsycINFO, MEDLINE) and social sciences (EconLit, HTA Database, IBSS, NHSEED, PAIS International, Web of Science)   • Last 10 years (January 2004  - April 2014)  • In English  • Poverty + suicidal behaviour + low and middle income countries Methods (cont.) • Poverty: monetary-related poverty indicators at the individual level (i.e. absolute poverty, relative poverty, economic status and wealth, unemployment, economic/financial problems, debt, support from the welfare system) and country level (economic crisis, GDP, Gini, HDI). • Suicidal behaviour: suicidal ideation, suicidal plans, suicide gestures, self-harm, attempted suicide, completed suicide  • Low and middle income countries: World Bank Atlas method Methods (cont.) • Screening by abstract: independently by pairs of authors – Poverty – Suicidal behaviour – Relationship between poverty and suicidal behaviour – Low and middle income countries • Screening by full-text: independently by pairs of authors • Data extraction: by two authors  • Quality assessment: by two authors (SIGN50 checklists) • Data analysis: descriptive statistics, narrative synthesis Data extraction 1. Study characteristics (author, year, country of study, rural versus urban,  community- clinic- or hospital based, main purpose of the study, design, study population, sample size and characteristics, duration of the study) 2. Suicide dimensions (with instruments) 3. Poverty dimensions (with instruments)  4. Relationship between suicide and poverty (statistical methods used and nature of the association)  Results: number of studies 3652 Records screened 187 Full-text screened 95 Studies included Results: study characteristics World Bank region n % East Asia and Pacific 12 14.1% Europe and Central Asia 11 12.9% Latin America & the Caribbean 2 2.4% Middle East and North Africa 19 22.4% South Asia 28 32.9% Sub-Saharan Africa 9 10.6% Multiple 4 4.7% World Bank income group n % Low income country 5 5.9% Lower middle income country 24 28.2% Upper middle income country 51 60.0% Multiple 5 5.9% Setting n % Community-based 49 57.6% Clinic-based 1 1.2% Hospital based 28 32.9% National/regional registers 0 0.0% Other 5 5.9% n/a 2 2.4% Location n % Rural 17 20.0% Urban 18 21.2% Rural and Urban 31 36.5% Other 1 1.2% n/a 18 21.2% Study design n % Interrupted-time series 5 5.9% Cohort studies 8 9.4% Case-control studies 12 14.1% Cross-sectional studies 44 51.8% Case report/case series 7 8.2% Ecological studies 6 7.1% Economic studies 3 3.5% Age* n % Child (0-12 year old) 26 30.6% Adolescent (13-18 year old) 57 67.1% Adult (19-64 year old) 63 74.1% Older people (over 65 year old) 42 49.4% n/a 16 18.8% Poverty dimension* n % Absolute poverty 0 0.0% Relative poverty 2 2.4% Economic status and wealth assets 33 38.8% Unemployment 48 56.5% Economic/financial problems 19 22.4% Debt 5 5.9% Support from the welfare system 1 1.2% Economic crisis 2 2.4% National income 6 7.1% National inequality 0 0.0% Composite poverty measure 1 1.2% Suicide dimension* n % Fatal suicide 65 76.5% Non-fatal suicide 64 75.3% *The same study may have been evaluating more than one age group and/or poverty measure  and/or suicide dimension.  Results: Relationships between suicide-poverty Statistical method n Descriptive statistics 68 Bivariate analysis 36 Multivariate analysis  31 Relationship between poverty-suicide n Positive 22 Negative 0 Null 12 Unclear 1 Relationship between poverty-suicide n Positive 15 Negative 1 Null 13 Unclear 2 Relationship between poverty-suicide n Unclear 68 Results: Relationship between unemployment and suicidal behaviours Number of studies reporting on the relationship between unemployment and fatal and non-fatal suicidal behaviours by method of statistical analysis and nature of association  Positive Negative Null Unclear Total Fatal suicide Descriptive 14 14 Bivariate 2 0 1 0 3 Multivariate  1 0 1 1 3 Non-fatal suicide  Descriptive 17 17 Bivariate 5 0 3 0 8 Multivariate 2 0 4 0 6 Number of studies reporting on the relationship between debt and fatal and non fatal suicidal behaviours by method of statistical analysis and nature of association Positive Negative Null Unclear Total Fatal suicide Descriptive 2 2 Bivariate 2 0 0 0 2 Multivariate  0 0 1 0 1 Non-fatal suicide  Descriptive 0 0 Bivariate 0 0 0 0 0 Multivariate 0 0 0 0 0 Results: Relationship between debt and suicidal behaviours Examples of country level analysis  Number of studies reporting on the relationship between national income and fatal and non fatal suicidal behaviour by method of statistical analysis and nature of association   Positive Negative Null Unclear Total Fatal suicide Descriptive 1 1 Bivariate 0 0 0 1 1 Multivariate  2 0 1 1 4 Non-fatal suicide  Descriptive 0 0 Bivariate 0 0 0 0 0 Multivariate  0 0 0 0 0 Number of studies reporting on the relationship between income inequality and fatal and non-fatal suicidal behaviour by method of statistical analysis and nature of association   Positive Negative Null Unclear Total Fatal suicide Descriptive 0 0 Bivariate 0 0 0 0 0 Multivariate  0 0 0 0 0 Non-fatal suicide  Descriptive 0 0 Bivariate 0 0 0 0 0 Multivariate  0 0 0 0 0 Conclusion:  • Most evidence in South Asia and Middle, East and North Africa, with a relative dearth of studies from countries in Sub-Saharan Africa • Most evidence in upper middle income countries, with only 6% of studies coming from low income countries. • Most evidence on unemployment and economic status, while neglecting dimensions such as debt, relative and absolute poverty, support from welfare  system or food security.  • Most descriptive studies, which makes drawing meaningful conclusions difficult. • Most studies (55%) using bivariate and multivariate analysis suggest a positive association between poverty and suicide in LMICs, whilst a lower number (35%) suggests null association. • More robust evidence is needed in this area, with studies which focus on a wider range of poverty dimensions and employ more sophisticated statistical methods. Thanks for your attention!  Jason Bantjes  jbantjes@sun.ac.za  

Relationship between suicidal behaviours and poverty in low and middle income countries: systematic review

http://eprints.lse.ac.uk/62769/1/__lse.ac.uk_storage_LIBRARY_Secondary_libfile_shared_repository_Content_Iemmi.V_Iemmi_Suicide%20and%20poverty_2015.pdf

Relationship between suicidal behaviours and poverty in low and middle income countries: systematic review

Abstract

Similar works

Full text

Available Versions

LSE Research Online