Suicidal ideation and suicide attempts in eight low- and middle-income countries: A comparison of national surveys

Background: Suicide is a public health problem that causes around 720.000 deaths worldwide yearly. It is also one of the leading causes of death in the population globally. Therefore, it is relevant to assess the factors associated with suicidal ideation and suicide attempts across the life course in eight low- and middle-income countries (LMICs). Methods: A cross-sectional study based on data from 2014 to 2017 derived from the WHO STEPwise approach to surveillance (STEPS) was performed. Algeria, Azerbaijan, Eswatini, Guyana, Kiribati, Malawi, Tuvalu, and Zambia were included. The inclusion criteria were people between 15 and 69 years old with complete data for the variables of interest. A pooled Poisson regression model was performed to analyse the associations of study variables with the outcome variables, suicidal ideation in the last year and lifetime suicide attempts. Study variables included gender, age, marital status, education level, work activity, use of tobacco, use of alcohol, and family history of suicidal behaviour. Results: A total of 27,786 participants were included. The pooled prevalence of suicidal ideation was 5.7% and lifetime suicide attempt was 1.9%. Only 24.8% of people with suicidal ideation sought help for suicidal ideation and only 23.2% sought medical help for their last suicide attempt. Poisons and pesticides were the most frequent methods for the last suicide attempt, followed by medications. In the pooled analysis, having a relative that attempted suicide was significantly associated with suicidal ideation (aPR=1.07; 95%CI: 1.06–1.09). Also, suicidal ideation was directly associated with lifetime suicide attempts (aPR=1.21; 95%CI: 1.18–1.22). Conclusions: Our study found a high prevalence of suicidal ideation and lifetime suicide attempts in eight LMICs, making it an important public health concern. Characteristics such as seeking professional support or treatment were associated with lifetime suicidal ideation and suicide attempts.