Abstract
BackgroundForty 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.MethodsThe 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.ResultsThirty-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.ConclusionThe 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 registrationPROSPERO 2014:CRD42014006521Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2301-5) contains supplementary material, which is available to authorized users.
Highlights
Forty percent of the world’s suicide deaths occur in low and middle income countries (LAMIC) in Asia
Suicide is a major cause of premature mortality in low and middle income countries (LAMIC); 40 % of deaths occur in LAMIC in Asia [1]
Another review looking at only area level measures of socioeconomic position (SEP) and suicide risk indicated that lower levels of area level SEP increased the risk of suicide in both high income and LAMIC [5]
Summary
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. The mechanism by which SEP impacts on the risk of suicide and suicide attempt is important to understand in order to better inform public health policy, and plan more effective suicide prevention programs It maybe that individuals with a lower SEP experience higher levels of adversity/stress and fewer life chances which could increase their susceptibility to mental illness [14] and psychological distress (e.g. feelings of hopelessness, entrapment)[15, 16], and increase the risk of suicide. A further, more novel, mechanism could be that individuals with a lower SEP may be exposed to higher levels of environmental toxins (e.g. pesticides) which may impact on their propensity for engaging in impulsive behaviour and/or the prevalence of depression [17]
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