Suicide Prevention Across the Lifespan in Low- and Middle-Income Countries

Presenter:

Andrea Horvath Marques, M.D., Ph.D., M.P.H.
Center for Global Mental Health Research

Goal:

This concept aims to address the gaps in our knowledge about suicide risk, protective factors, and suicide preventive interventions and strategies for people across the lifespan in low- and middle-income countries (LMICs) and to strengthen and sustain local research capacity. This concept would support innovative experimental (e.g., hybrid effectiveness-implementation research) and non-experimental (e.g., ecological studies, simulation studies) research to evaluate scalable and financially sustainable multilevel preventive interventions and strategies to reduce suicide risk (suicide ideation and behavior, including acts of self-harm and suicide) and promote resilience.

Rationale:

Suicide is a significant global public health problem. Around 703,000 people die by suicide each year, with a worldwide age-adjusted suicide rate of 9.0 per 100,000 people. It is estimated that 77% of the world’s suicides occur in LMICs; however, the overall suicide rate in LMICs is likely substantially underestimated since many LMICs lack a national suicide surveillance system.

Globally, mental illnesses are strong predictors of suicide attempts. However, in LMICs, significant gaps in our knowledge remain related to other relevant risks and protective factors such as health system barriers (e.g., access to care), economic (e.g., financial insecurity), societal (e.g., discrimination), community (e.g., social isolation), relationship (e.g., sexual violence), and individual risk factors (e.g., abuse and trauma). Understanding risk factors for suicide is critical to determining relevant multilevel suicide preventive interventions or strategies that should be prioritized and implemented in different contexts.

Globally, there is a critical need to evaluate and implement culturally adapted multilevel preventive approaches at the population level (universal prevention, such as restricting access to means, interactions with media for responsible reporting, and addressing social determinants of health), individual level (e.g., indicated interventions (e.g., crisis intervention for individuals with suicide ideation, acts of self-harm and who have attempted suicide) and selective prevention  (e.g., school and community-based prevention programs targeting vulnerable groups), and across community settings with a focus on multiple risks and protective factors. NIMH aims to support a diverse set of approaches (e.g., World Health Organization LIVE LIFE and United Nations human rights) and multisectoral collaborations across government  (e.g., health, finance, education, labor, agriculture), international development agencies (USAID, UNICEF, WHO), and non-government partners.