Psychiatric morbidity and suicidal behaviour in low- and middle-income countries: A systematic review and meta-analysis

English version

Autoři: Duleeka Knipe ^aff001; A. Jess Williams ^aff002; Stephanie Hannam-Swain ^aff003; Stephanie Upton ^aff004; Katherine Brown ^aff005; Piumee Bandara ^aff006; Shu-Sen Chang ^aff007; Nav Kapur ^aff008
Působiště autorů: Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom ^aff001; Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom ^aff002; Sheffield Hallam University, Sheffield, United Kingdom ^aff003; University Hospital Bristol, Bristol, United Kingdom ^aff004; University of Nottingham, Nottingham, United Kingdom ^aff005; Translational Health Research Institute, Western Sydney University, Sydney, Australia ^aff006; Institute of Health Behaviors and Community Sciences and Department of Public Health, College of Public Health, National Taiwan University, Taipei City, Taiwan ^aff007; University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom ^aff008
Vyšlo v časopise: Psychiatric morbidity and suicidal behaviour in low- and middle-income countries: A systematic review and meta-analysis. PLoS Med 16(10): e32767. doi:10.1371/journal.pmed.1002905
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1002905

Souhrn

Background

Psychiatric disorders are reported to be present in 80% to 90% of suicide deaths in high-income countries (HIC), but this association is less clear in low- and middle-income countries (LMIC). There has been no previous systematic review of this issue in LMIC. The current study aims to estimate the prevalence of psychiatric morbidity in individuals with suicidal behaviour in LMIC.

Methods and findings

PubMed, PsycINFO, and EMBASE searches were conducted to identify quantitative research papers (any language) between 1990 and 2018 from LMIC that reported on the prevalence of psychiatric morbidity in suicidal behaviour. We used meta-analytic techniques to generate pooled estimates for any psychiatric disorder and specific diagnosis based on International classification of disease (ICD-10) criteria. A total of 112 studies (154 papers) from 26 LMIC (India: 25%, China: 15%, and other LMIC: 60%) were identified, including 18 non-English articles. They included 30,030 individuals with nonfatal suicidal behaviour and 4,996 individuals who had died by suicide. Of the 15 studies (5 LMIC) that scored highly on our quality assessment, prevalence estimates for psychiatric disorders ranged between 30% and 80% in suicide deaths and between 3% and 86% in those who engaged in nonfatal suicidal behaviour. There was substantial heterogeneity between study estimates. Fifty-eight percent (95% CI 46%–71%) of those who died by suicide and 45% (95% CI 30%–61%) of those who engaged in nonfatal suicidal behaviour had a psychiatric disorder. The most prevalent disorder in both fatal and nonfatal suicidal behaviour was mood disorder (25% and 21%, respectively). Schizophrenia and related disorders were identified in 8% (4%–12%) of those who died by suicide and 7% (3%–11%) of those who engaged in nonfatal suicidal behaviour. In nonfatal suicidal behaviour, anxiety disorders, and substance misuse were identified in 19% (1%–36%) and 11% (7%–16%) of individuals, respectively. This systematic review was limited by the low number of high-quality studies and restricting our searches to databases that mainly indexed English language journals.

Conclusions

Our findings suggest a possible lower prevalence of psychiatric disorders in suicidal behaviour in LMIC. We found very few high-quality studies and high levels of heterogeneity in pooled estimates of psychiatric disorder, which could reflect differing study methods or real differences. There is a clear need for more robust evidence in order for LMIC to strike the right balance between community-based and mental health focussed interventions.

Klíčová slova:

Diagnostic medicine – Behavior – Suicide – Collective human behavior – Morbidity – Pesticides – Behavioral disorders

Zdroje

1. World Health Organisation. Preventing suicide—A global imperative. Geneva: WHO, 2014.

2. Gunnell D, Lewis G. Studying suicide from the life course perspective: implications for prevention. Br J Psychiatry. 2005;187:206–8. doi: 10.1192/bjp.187.3.206 16135856.

3. Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM. Psychological autopsy studies of suicide: a systematic review. Psychol Med. 2003;33(3):395–405. doi: 10.1017/s0033291702006943 12701661.

4. Cho SE, Na KS, Cho SJ, Im JS, Kang SG. Geographical and temporal variations in the prevalence of mental disorders in suicide: Systematic review and meta-analysis. J Affect Disord. 2016;190:704–13. Epub 2015/11/26. doi: 10.1016/j.jad.2015.11.008 26600412.

5. Arsenault-Lapierre G, Kim C, Turecki G. Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry. 2004;4:37. Epub 2004/11/06. doi: 10.1186/1471-244X-4-37 15527502; PubMed Central PMCID: PMC534107.

6. Hawton K, Saunders K, Topiwala A, Haw C. Psychiatric disorders in patients presenting to hospital following self-harm: a systematic review. J Affect Disord. 2013;151(3):821–30. Epub 2013/10/05. doi: 10.1016/j.jad.2013.08.020 24091302.

7. Colucci E, Lester D, editors. Suicide and Culture: Understanding the Context. Cambridge, MA: Hogrefe Publishing; 2012.

8. Radhakrishnan R, Andrade C. Suicide: An Indian perspective. Indian J Psychiatry. 2012;54(4):304–19. doi: 10.4103/0019-5545.104793 23372232; PubMed Central PMCID: PMC3554961.

9. Phillips MR, Yang G, Zhang Y, Wang L, Ji H, Zhou M. Risk factors for suicide in China: a national case-control psychological autopsy study. Lancet. 2002;360(9347):1728–36. Epub 2002/12/14. doi: 10.1016/S0140-6736(02)11681-3 12480425.

10. Vijayakumar L, Rajkumar S. Are risk factors for suicide universal? A case-control study in India. Acta Psychiatr Scand. 1999;99(6):407–11. doi: 10.1111/j.1600-0447.1999.tb00985.x 10408261.

11. Ahmed HU, Hossain MD, Aftab A, Soron TR, Alam MT, Chowdhury MWA, et al. Suicide and depression in the World Health Organization South-East Asia Region: A systematic review. WHO South East Asia J Public Health. 2017;6(1):60–6. Epub 2017/06/10. doi: 10.4103/2224-3151.206167 28597861.

12. World Bank. Country and Lending Groups [27/02/2018]. Available from: http://data.worldbank.org/about/country-and-lending-groups. [cited 2018 February 27].

13. Spitzer R, Williams J, Gibbon M, First M. Structured Clinical Interview for DSM-III-R. Washington DC: American Psychiatric Press; 1990.

14. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Systematic Reviews. 2016;5(1):210. doi: 10.1186/s13643-016-0384-4 27919275

15. Tong Y, Phillips MR, Yin Y. Prevalence of psychiatric diagnoses in individuals who die by suicide or attempt suicide in China based on independent structured diagnostic interviews with different informants. J Psychiatr Res. 2018;98:30–8. Epub 2017/12/24. doi: 10.1016/j.jpsychires.2017.12.003 29274530.

16. Reza AS, Feroz AHM, Islam SN, Karim MN, Rabbani MG, Shah Alam M, et al. Risk Factors of Suicide and Para Suicide in Rural Bangladesh. Bangladesh J Medicine. 2014;14(2):7. Epub 2014-08-04. doi: 10.3329/jom.v14i2.19653

17. Zarghami M, Khalilian A. Deliberate self-burning in Mazandaran, Iran. Burns. 2002;28(2):115–9. Epub 2002/03/20. doi: 10.1016/s0305-4179(01)00092-4 11900933.

18. Paholpak P, Rangseekajee P, Arunpongpaisal S, Piyavhatkul N, Thepsuthammarat K, Paholpak S. Characteristics and burden of hospitalization because of intentional self-harm: Thai national, hospital-based data for 2010. J Med Assoc Thai. 2012;95 Suppl 7:S156–62. Epub 2012/11/08. 23130448.

19. Wells G, Shea B, O'Connell D, Peterson J, Welch W, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [6 May 2014]. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. [cited 2014 May 6].

20. Nyaga VN, Arbyn M, Aerts M. Metaprop: a Stata command to perform meta-analysis of binomial data. Arch Public Health. 2014;72(1):39. Epub 2014/01/01. doi: 10.1186/2049-3258-72-39 25810908; PubMed Central PMCID: PMC4373114.

21. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88. Epub 1986/09/01. 3802833.

22. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. Epub 2003/09/06. doi: 10.1136/bmj.327.7414.557 12958120; PubMed Central PMCID: PMC192859.

23. World Bank. DataBank 2017 [updated 16/10/2018]. Available from: http://databank.worldbank.org/data/reports.aspx?source=2&series=SP.POP.TOTL&country=. [cited 2018 October 16].

24. Wilson DA, Wormald PJ. Battery acid—an agent of attempted suicide in black South Africans. S Afr Med J. 1995;85(6):529–31. Epub 1995/06/01. 7652636.

25. Lari AR, Joghataei MT, Adli YR, Zadeh YA, Alaghehbandan R. Epidemiology of suicide by burns in the province of Isfahan, Iran. J Burn Care Res. 2007;28(2):307–11. Epub 2007/03/14. doi: 10.1097/BCR.0B013E318031A27F 17351450.

26. Seghatoleslam T, Farzaneh E, Rezaee O, Sajadfar F, Mehrpour O. Factors Related to Suicide Attempts by Poisoning in Iranian Children. Indian Journal of Forensic Medicine & Toxicology. 2013;7(1):129–32.

27. Toudehskchuie GR, Fereidoon M. What Can Influence Iranian Suicide Attempters to Go Through the Process of Non-Fatal Suicide Act Once Again? A Preliminary Report. Community Ment Health J. 2016;52(5):597–608. Epub 2016/03/21. doi: 10.1007/s10597-015-9958-1 26995684.

28. Rajapakse T, Griffiths KM, Christensen H, Cotton S. A comparison of non-fatal self-poisoning among males and females, in Sri Lanka. BMC Psychiatry. 2014;14:221. doi: 10.1186/s12888-014-0221-z PubMed Central PMCID: PMC4149235. 25103532

29. Caribe AC, Nunez R, Montal D, Ribeiro L, Sarmento S, Quarantini LC, et al. Religiosity as a protective factor in suicidal behavior: a case-control study. J Nerv Ment Dis. 2012;200(10):863–7. Epub 2012/10/06. doi: 10.1097/NMD.0b013e31826b6d05 23037509.

30. Tuan NV, Dalman C, Thiem NV, Nghi TV, Allebeck P. Suicide attempts by poisoning in Hanoi, Vietnam: methods used, mental problems, and history of mental health care. Arch Suicide Res. 2009;13(4):368–77. Epub 2009/10/09. doi: 10.1080/13811110903266657 19813114.

31. Bilginer C, Cop E, Goker Z, Hekim O, Sekmen E, Uneri O. Overview of young people attempting suicide by drug overdose and prevention and protection services. Dusunen Adam The Journal of Psychiatry and Neurological Sciences. 2017;30:243–50.

32. van der Hoek W, Konradsen F. Risk factors for acute pesticide poisoning in Sri Lanka. Trop Med Int Health. 2005;10(6):589–96. doi: 10.1111/j.1365-3156.2005.01416.x 15941423.

33. Haddad S.Y., Haddadin K.J., Abu-Samen M., Wreikat M.W., A.I. H. Suicide attempted by burning: A three-year study. Annals of Burns and Fire Disasters. 1998;6(4):1–4.

34. Ahmadi A, Mohammadi R, Schwebel DC, Yeganeh N, Hassanzadeh M, Bazargan-Hejazi S. Psychiatric disorders (Axis I and Axis II) and self-immolation: a case-control study from Iran. J Forensic Sci. 2010;55(2):447–50. Epub 2010/01/15. doi: 10.1111/j.1556-4029.2009.01268.x 20070465.

35. Galgali RB, Rao S, Ashok MV, Appaya P, Srinivasan K. Psychiatric diagnosis of self poisoning cases: a general hospital study. Indian J Psychiatry. 1998;40(3):254–9. Epub 1998/07/01. 21494481; PubMed Central PMCID: PMC2966600.

36. Farzaneh E, Mehrpour O, Alfred S, Moghaddam HH, Behnoush B, Seghatoleslam T. Self-poisoning suicide attempts among students in Tehran, Iran. Psychiatr Danub. 2010;22(1):34–8. Epub 2010/03/23. 20305588.

37. Khelil MB, Zgarni A, Zaafrane M, Chkribane Y, Gharbaoui M, Harzallah H, et al. Suicide by self-immolation in Tunisia: A 10 year study (2005–2014). Burns. 2016;42(7):1593–9. Epub 2016/05/24. doi: 10.1016/j.burns.2016.04.019 27211362.

38. Abbas MJ, Alhemiary N, Razaq EA, Naosh S, Appleby L. The Iraqi national study of suicide: Report on suicide data in Iraq in 2015 and 2016. J Affect Disord. 2018;229:56–62. Epub 2018/01/08. doi: 10.1016/j.jad.2017.12.037 29306693.

39. Abeyasinghe R, Gunnell D. Psychological autopsy study of suicide in three rural and semi-rural districts of Sri Lanka. Soc Psychiatry Psychiatr Epidemiol. 2008;43(4):280–5. doi: 10.1007/s00127-008-0307-3 18253684

40. Ali NH, Zainun KA, Bahar N, Haniff J, Hamid AM, Bujang MA, et al. Pattern of suicides in 2009: data from the National Suicide Registry Malaysia. Asia Pacific Psychiatry. 2014;6(2):217–25. Epub 2013/07/17. doi: 10.1111/j.1758-5872.2012.00227.x 23857761.

41. Altindag A, Ozkan M, Oto R. Suicide in Batman, southeastern Turkey. Suicide Life Threat Behav. 2005;35(4):478–82. 16184698.

42. Bhise MC, Behere PB. Risk Factors for Farmers' Suicides in Central Rural India: Matched Case-control Psychological Autopsy Study. Indian J Psychol Med. 2016;38(6):560–6. Epub 2016/12/30. doi: 10.4103/0253-7176.194905 28031593; PubMed Central PMCID: PMC5178041.

43. Hagaman AK, Khadka S, Lohani S, Kohrt B. Suicide in Nepal: a modified psychological autopsy investigation from randomly selected police cases between 2013 and 2015. Soc Psychiatry Psychiatr Epidemiol. 2017;52(12):1483–94. Epub 2017/09/01. doi: 10.1007/s00127-017-1433-6 28856382; PubMed Central PMCID: PMC5705471.

44. Hayati AN, Salina AA, Abdullah AA, Eusni RT, Mansar AH. The pattern of completed suicides seen in Kuala Lumpur General Hospital 1999. Med J Malaysia. 2004;59(2):190–8. Epub 2004/11/24. 15559169.

45. Jia CX, Wang LL, Xu AQ, Dai AY, Qin P. Physical illness and suicide risk in rural residents of contemporary China: a psychological autopsy case-control study. Crisis. 2014;35(5):330–7. Epub 2014/09/06. doi: 10.1027/0227-5910/a000271 25189111.

46. Khan FA, Anand B, Devi MG, Murthy KK. Psychological autopsy of suicide-a cross-sectional study. Indian J Psychiatry. 2005;47(2):73–8. Epub 2005/04/01. doi: 10.4103/0019-5545.55935 20711285; PubMed Central PMCID: PMC2918303.

47. Khan MM, Mahmud S, Karim MS, Zaman M, Prince M. Case-control study of suicide in Karachi, Pakistan. Br J Psychiatry. 2008;193(5):402–5. http://dx.doi.org/10.1192/bjp.bp.107.042069. doi: 10.1192/bjp.bp.107.042069 18978322

48. Kurihara T, Kato M, Reverger R, Tirta IGR. Risk factors for suicide in Bali: a psychological autopsy study. BMC Public Health. 2009;9:327. doi: 10.1186/1471-2458-9-327 19740419; PubMed Central PMCID: PMC2754455.

49. Maksuti P, Kola V, Simaku A. Epidemiological overview on pattern of suicide in the district of Tirana in Albania, over the period 2001–2010. Int J Neuropsychopharmacol. 2012;1:229. 71592750.

50. Manoranjitham S, Rajkumar A, Thangadurai P, Prasad J, Jayakaran R, Jacob K. Risk factors for suicide in rural South India. Br J Psychiatry. 2010;196(1):26–30. doi: 10.1192/bjp.bp.108.063347 20044655

51. Palacio-Acosta C, Garcia-Valencia J, Diago-Garcia J, Zapata C, Ortiz-Tobon J, Lopez-Calle G, et al. Characteristics of people committing suicide in Medellin, Colombia. Revista de Salud Publica. 2005;7(3):243–53. 16396414.

52. Samaraweera S, Sumathipala A, Siribaddana S, Sivayogan S, Bhugra D. Prevalence of suicidal ideation in Sri Lanka. Crisis. 2010;31(1):30–5. Epub 2010/03/04. doi: 10.1027/0227-5910/a000010 20197255.

53. Taktak S, Uzun I, Balcioglu I. Gender differences in completed suicides in Istanbul, Turkey. J Affect Disord. 2013;145(3):394–9. doi: 10.1016/j.jad.2012.05.055 22854097.

54. Tong Y, Phillips MR, Conner KR. DSM-IV Axis II personality disorders and suicide and attempted suicide in China. Br J Psychiatry. 2016;209(4):319–26. Epub 2015/11/21. doi: 10.1192/bjp.bp.114.151076 26585099; PubMed Central PMCID: PMC6173803.

55. Yang GH, Phillips MR, Zhou MG, Wang LJ, Zhang YP, Xu D. Understanding the unique characteristics of suicide in China: national psychological autopsy study. Biomed Environ Sci. 2005;18(6):379–89. Epub 2006/03/21. 16544520.

56. Zhang Y, Conner KR, Phillips MR. Alcohol use disorders and acute alcohol use preceding suicide in China. Addict Behav. 2010;35(2):152–6. doi: 10.1016/j.addbeh.2009.09.020 19850415

57. Phillips MR, Shen Q, Liu X, Pritzker S, Streiner D, Conner K, et al. Assessing depressive symptoms in persons who die of suicide in mainland China. J Affect Disord. 2007;98(1):73–82. doi: 10.1016/j.jad.2006.07.020 16945424.

58. Tong Y, Phillips MR. Cohort-specific risk of suicide for different mental disorders in China. Br J Psychiatry. 2010;196(6):467–73. Epub 2010/06/02. doi: 10.1192/bjp.bp.109.070409 20513857.

59. Du C-J, Li X-Y, Zhang Y-P. Comparison of the characteristics of completed suicide in people with and without mental disorders older than 55 and with no serious physical illnesses. [Chinese]. Chinese Mental Health Journal. 2008;22(6):397–400.

60. Zhang Y, Li X, Wang L, Zhao Y, Meng M, Zhang F, et al. National case-control study of suicide and accidental death Chinese Mental Health Journal. 2004;18:861–4.

61. Phillips MR, Yang G. Suicide and Attempted Suicide—China, 1990–2002. Morbidity and Mortality Weekly Report. 2004;53(22):481–4. 15190245

62. Li XY, Phillips MR, Zhang YP, Xu D, Yang GH. Risk factors for suicide in China's youth: a case-control study. Psychol Med. 2008;38(3):397–406. doi: 10.1017/S0033291707001407 17825127.

63. Zhang J, Conwell Y, Zhou L, Jiang C. Culture, risk factors and suicide in rural China: a psychological autopsy case control study. Acta Psychiatr Scand. 2004;110(6):430–7. Epub 2004/11/04. doi: 10.1111/j.1600-0447.2004.00388.x 15521827; PubMed Central PMCID: PMC2730492.

64. Zhang J, Zhou L. A case control study of suicides in China with and without mental disorder. Crisis. 2009;30(2):68–72. doi: 10.1027/0227-5910.30.2.68 19525164

65. Zhang J, Xiao SY, Zhou LA. Mental Disorders and Suicide Among Young Rural Chinese: A Case-Control Psychological Autopsy Study. Am J Psychiatry. 2010;167(7):773–81. doi: 10.1176/appi.ajp.2010.09101476 20395398

66. Sun L, Zhang J. Characteristics of chinese rural young suicides: Who did not have a strong intent to die. Compr Psychiatry. 2015;57:73–8. doi: 10.1016/j.comppsych.2014.11.019 25497170

67. Lin L, Zhang J, Zhou L, Jiang C. The relationship between impulsivity and suicide among rural youths aged 15–35 years: A case-control psychological autopsy study. Psychol Health Med. 2016;21(3):330–7. doi: 10.1080/13548506.2015.1051555 26110614

68. Zhang J, Li Z. Characteristics of Chinese rural young suicides by pesticides. Int J Soc Psychiatry. 2013;59(7):655–62. doi: 10.1177/0020764012450995 22751613.

69. Jia C-X, Zhang J. Global functioning and suicide among Chinese rural population aged 15–34 years: A psychological autopsy case-control study. J Forensic Sci. 2012;57(2):391–7. doi: 10.1111/j.1556-4029.2011.01978.x 22150171

70. Lin L, Zhang J. Impulsivity, mental disorder, and suicide in rural China. Arch Suicide Res. 2017;21(1):73–82. doi: 10.1080/13811118.2015.1004478 25764273

71. Li Z, Zhang J. Coping skills, mental disorders, and suicide among rural youths in China. J Nerv Ment Dis. 2012;200(10):885–90. doi: 10.1097/NMD.0b013e31826b6ecc 22986278.

72. Zhang J, Wieczorek W, Conwell Y, Tu XM, Wu BY, Xiao S, et al. Characteristics of young rural Chinese suicides: a psychological autopsy study. Psychol Med. 2010;40(4):581–9. doi: 10.1017/S0033291709990808 19656428; PubMed Central PMCID: PMC2996472.

73. Kong Y, Zhang J. Access to farming pesticides and risk for suicide in Chinese rural young people. Psychiatry Res. 2010;179(2):217–21. Epub 2010/05/21. doi: 10.1016/j.psychres.2009.12.005 20483175; PubMed Central PMCID: PMC2925062.

74. Lyu J, Zhang J. Characteristics of schizophrenia suicides compared with suicides by other diagnosed psychiatric disorders and those without a psychiatric disorder. Schizophr Res. 2014;155(1):59–65.

75. Sun L, Zhang J, Liu X. Insomnia symptom, mental disorder and suicide: A case-control study in Chinese rural youths. Sleep Biol Rhythms. 2015;13(2):181–8. doi: 10.1111/sbr.12105 25914606.

76. Zhang J, Li Z. Suicide means used by Chinese rural youths: A comparison between those with and without mental disorders. J Nerv Ment Dis. 2011;199(6):410–5. doi: 10.1097/NMD.0b013e31821d3ac7 21629021

77. Zhang J, Li Z. The association between depression and suicide when hopelessness is controlled for. Compr Psychiatry. 2013;54(7):790–6. doi: 10.1016/j.comppsych.2013.03.004 23602028

78. Zhang J, Li ZY, Xiao SY, Zhou L, Jia CX, Pan GW. Mental disorder and suicide among youths in rural China: a case control study based on consecutive samples from Hunan, Liaoning and Shandong provinces. [Chinese]. Chung Hua Liu Hsing Ping Hsueh Tsa Chih Chinese Journal of Epidemiology. 2012;33(6):588–92. 22883266.

79. Zhang J, Wieczorek WF, Conwell Y, Tu XM. Psychological strains and youth suicide in rural China. Soc Sci Med. 2011;72(12):2003–10. doi: 10.1016/j.socscimed.2011.03.048 51454798.

80. Zhou R, Zhang J, Qiu H-M. Identification of mental disorders in rural youth suicides. [Chinese]. Chinese Mental Health Journal. 2014;28(4):248–52.

81. Zhou XM, Jia SH. Suicidal communication signifies suicidal intent in Chinese completed suicides. Soc Psychiatry Psychiatr Epidemiol. 2012;47(11):1845–54. doi: 10.1007/s00127-012-0488-7 22366911.

82. Aghanwa H. The determinants of attempted suicide in a general hospital setting in Fiji Islands: a gender-specific study. Gen Hosp Psychiatry. 2004;26(1):63–9. 14757305.

83. Aghanwa HS. The characteristics of suicide attempters admitted to the main general hospital in Fiji Islands. J Psychosom Res. 2000;49(6):439–45. Epub 2001/02/22. doi: 10.1016/s0022-3999(00)00193-8 11182438.

84. Atay IM, Eren I, Gundogar D. The prevalence of death ideation and attempted suicide and the associated risk factors in Isparta, Turkey. Turkish Journal of Psychiatry. 2012;23(2):89–98. 22648871

85. Ayehu M, Solomon T, Lemma K. Socio-demographic characteristics, clinical profile and prevalence of existing mental illness among suicide attempters attending emergency services at two hospitals in Hawassa city, South Ethiopia: A cross-sectional study. Int J Ment Health Syst. 2017;11(32). 615548282.

86. Bansal PD, Barman R. Psychiatric morbidity and the socio-demographic determinants of deliberate self harm. Journal of Clinical and Diagnostic Research. 2011;5(3):601–4.

87. Bansal P, Gupta A, Kumar R. The Psychopathology and the Sociodemographic Determinants of Attempted Suicide Patients. Journal of Clinical and Diagnostic Research. 2011;5(5):917–20.

88. Barrimi M, Zaidi K, Hlal H, Kettani N, Khelafa S, Rammouz I, et al. Violent suicide attempts in the general hospital of Fez (Morocco): Evaluation and management in liaison psychiatry. Prospective study over a period of 6 months. [French]. L'Evolution Psychiatrique. 2014;79(4):619–28.

89. Batinic B, Djeric-Jeremic M, Opacic G, editors. Analysis of sociodemographics, diagnostic characteristics and suicide attempt method of hospitalized suicide attempters. European Psychiatry. Conference: 20th European Congress of Psychiatry, EPA; 2012 2012-1-1.

90. Bhattacharjee S, Bhattacharya A, Thakurta RG, Ray P, Singh OP, Sen S. Putative effect of alcohol on suicide attempters: an evaluative study in a tertiary medical college. Indian J Psychol Med. 2012;34(4):371–5. Epub 2013/06/01. doi: 10.4103/0253-7176.108224 23723547; PubMed Central PMCID: PMC3662136.

91. Bi B, Tong J, Liu L, Wei S, Li H, Hou J, et al. Comparison of patients with and without mental disorders treated for suicide attempts in the emergency departments of four general hospitals in Shenyang, China. Gen Hosp Psychiatry. 2010;32(5):549–55. doi: 10.1016/j.genhosppsych.2010.06.003 20851276.

92. Borges G, Nock MK, Medina-Mora ME, Hwang I, Kessler RC. Psychiatric disorders, comorbidity, and suicidality in Mexico. J Affect Disord. 2010;124(1–2):98–107. Epub 2009/11/21. doi: 10.1016/j.jad.2009.10.022 19926141; PubMed Central PMCID: PMC2875312.

93. Chandrasekaran R, Gnanaselane J. Correlates of suicidal intent in attempted suicide. Hong Kong Journal of Psychiatry. 2005;15:118–21.

94. Chandrasekaran R, Gnanaseelan J, Sahai A, Swaminathan RP, Perme B. Psychiatric and personality disorders in survivors following their first suicide attempt. Indian J Psychiatry. 2003;45(2):45–8. Epub 2003/04/01. 21206833; PubMed Central PMCID: PMC2952146.

95. Chatterjee S, Kadam M. Study of psychiatric comorbidity and psychosocial stress factors in patients attempting suicide. Indian J Psychiatry. 2015;1:S78. 71769122.

96. Cherif L, Ayedi H, Sahnoun F, Walha A, Moalla Y, Rekik N, et al. Psychopathology of suicide attempts among adolescents. [French]. Neuropsychiatr Enfance Adolesc. 2012;60(6):454–60. 51964348.

97. Cosar B, Kocal N, Arikan Z, Isik E. Suicide attempts among Turkish psychiatric patients. Can J Psychiatry. 1997;42(10):1072–5. Epub 1998/02/20. doi: 10.1177/070674379704201009 9469240.

98. De Silva HJ, Kasturiaratchi N, Seneviratne SL, Senaratne DC, Molagoda A, Ellawala NS. Suicide in Sri Lanka: points to ponder. Ceylon Med J. 2000;45(1):17–24. Epub 2000/09/28. 11006615.

99. Diehl A, Laranjeira R. Suicide attempts and substance use in an emergency room sample. J Bras Psiquiatr. 2009;58(2):86–91. 355189362.

100. Fresan A, Gonzalez-Castro TB, Peralta-Jimenez Y, Juarez-Rojop I, Pool-Garcia S, Velazquez-Sanchez MP, et al. Gender differences in socio-demographic, clinical characteristics and psychiatric diagnosis in/of suicide attempters in a Mexican population. Acta Neuropsychiatrica. 2015;27(3):182–8. doi: 10.1017/neu.2015.6 25686910

101. Gao T, Xiang YT, Zhang H, Gao J, Kong Y, Hu Y, et al. Prevalence and Correlates of Suicidal Behaviors among College Students in Northeastern China: a Cross-Sectional Study. Psychiatr Q. 2017:1–12. doi: 10.1007/s11126-016-9428-0 618892032.

102. Ghaleiha A, Afzali S, Bazyar M, Khorsand F, Torabian S. Characteristics of hospitalized patients following suicide attempt in hamadan district, iran. Oman Med J. 2012;27(4):304–9. doi: 10.5001/omj.2012.75 23071883; PubMed Central PMCID: PMC3464740.

103. Gomes FA, O'Brien B, Nakano AM. Attempted suicide in reproductive age women. Health Care Women Int. 2009;30(8):707–19. doi: 10.1080/07399330903018385 19575322.

104. Grau AG, Sanchez AC, Mendez NR, Ramirez GB. Suicide attempts and related risk factors in Cartagena, Colombia. [Spanish]. Acta Psiquiatr Psicol Am Lat. 2013;59(4):240–52.

105. Grover S, Sarkar S, Bhalla A, Chakrabarti S, Avasthi A. Religious coping among self-harm attempters brought to emergency setting in India. Asian J Psychiatr. 2016;23:78–86. doi: 10.1016/j.ajp.2016.07.009 27969084

106. Haider S, Mahato AK. Socio-demographic and clinical characteristics of patients who attempt suicide: A hospitalbased study from eastern India. East Asian Archives of Psychiatry. 2016;26(3):98–103. 27703097.

107. Ibiloglu AO, Atli A, Demir S, Gunes M, Kaya MC, Bulut M, et al. The investigation of factors related to suicide attempts in Southeastern Turkey. Neuropsychiatr Dis Treat. 2016;12:407–16. doi: 10.2147/NDT.S97471 26966362

108. Jain V, Singh H, Gupta SC, Kumar S. A study of hopelessness, suicidal intent and depression in cases of attempted suicide. Indian J Psychiatry. 1999;41(2):122–30. Epub 1999/04/01. 21455374; PubMed Central PMCID: PMC2962835.

109. Jiang C, Li X, Phillips MR, Xu Y. Matched case-control study of medically serious attempted suicides in rural China. Shanghai Arch Psychiatry. 2013;25(1):22–31. Epub 2013/02/01. doi: 10.3969/j.issn.1002-0829.2013.01.006 24991129; PubMed Central PMCID: PMC4054523.

110. Kar N. Profile of risk factors associated with suicide attempts: A study from Orissa, India. Indian J Psychiatry. 2010;52(1):48–56. Epub 2010/02/23. doi: 10.4103/0019-5545.58895 20174518; PubMed Central PMCID: PMC2824981.

111. Khan MM, Reza H. Gender differences in nonfatal suicidal behavior in Pakistan: significance of sociocultural factors. Suicide Life Threat Behav. 1998;28(1):62–8. Epub 1998/04/29. 9560167.

112. Khazaei HE, Parvizifard A. Demographic characteristics and mental state evalusation of attempted suicide victims in Tabriz in 2001 [Persian]. Journal of Kermanshah University of Medical Sciences. 2003;7(3):42–51.

113. Kinyanda E, Hjelmeland H, Musisi S. Deliberate self-harm as seen in Kampala, Uganda—a case-control study. Soc Psychiatry Psychiatr Epidemiol. 2004;39(4):318–25. Epub 2004/04/16. doi: 10.1007/s00127-004-0748-2 15085335.

114. Kulkarni RR, Rao KN, Begum S. Comorbidity of psychiatric and personality disorders in first suicide attempters: a case-control study. Asian J Psychiatr. 2013;6(5):410–6. Epub 2013/09/10. doi: 10.1016/j.ajp.2013.05.004 24011689.

115. Kulkarni RR, Nagaraja Rao K, Begum S. Clinical profile of first suicide attempters in a general hospital. Indian J Psychiatry. 2013;55:S56. 70991163.

116. Rao KN, Kulkarni RR, Begum S. Comorbidity of psychiatric and personality disorders in first suicide attempters. Indian J Psychol Med. 2013;35(1):75–9. Epub 2013/07/09. doi: 10.4103/0253-7176.112210 23833346; PubMed Central PMCID: PMC3701364.

117. Kumar PN. Age and gender related analysis of psychosocial factors in attempted suicide. Indian J Psychiatry. 1998;40(4):338–45. 21494498; PubMed Central PMCID: PMC2966685.

118. Kumar CTS, Mohan R, Ranjith G, Chandrasekaran R. Gender differences in medically serious suicide attempts: a study from south India. Psychiatry Res. 2006;144(1):79–86. Epub 2006/08/22. doi: 10.1016/j.psychres.2005.11.012 16919336.

119. Kumar PNS, Anish PK, George B. Risk factors for suicide in elderly in comparison to younger age groups. Indian J Psychiatry. 2015;57(3):249–54. doi: 10.4103/0019-5545.166614 26600577.

120. Latha KS, Bhat SM, D'Souza P. Suicide attempters in a general hospital unit in India: their socio-demographic and clinical profile—emphasis on cross-cultural aspects. Acta Psychiatr Scand. 1996;94(1):26–30. Epub 1996/07/01. doi: 10.1111/j.1600-0447.1996.tb09820.x 8841673.

121. Liu Y, Zhang J. The Impact of Negative Life Events on Attempted Suicide in Rural China. J Nerv Ment Dis. 2018;206(3):187–94. Epub 2017/08/18. doi: 10.1097/NMD.0000000000000727 28816918; PubMed Central PMCID: PMC5812834.

122. Liu BP, Wang XT, Jia CX. Suicide attempters with high and low suicide intent: Different populations in rural China. Psychiatry Res. 2017;251:176–81. doi: 10.1016/j.psychres.2017.01.096 28213187.

123. Liu YY, Wang XT, Qiu HM, Xu AQ, Jia CX. Functional and dysfunctional impulsivity and attempted suicide in rural China: A paired case-control study. Psychiatry Res. 2017;253:22–7. doi: 10.1016/j.psychres.2017.03.025 28319788.

124. Ma C, Fang M. Psychological factors and clinical features of attempted suicides. [Chinese]. Chinese Mental Health Journal. 1999;13(2):110–2.

125. Maselko J, Patel V. Why women attempt suicide: the role of mental illness and social disadvantage in a community cohort study in India. J Epidemiol Community Health. 2008;62(9):817–22. doi: 10.1136/jech.2007.069351 18701733

126. Mechri A, Mrad A, Ajmi F, Zaafrane F, Khiari G, Nouira S, et al. Repeat suicide attempts: characteristics of repeaters versus first-time attempters admitted in the emergency of a tunisian general hospital. [French]. L'Encephale: Revue de psychiatrie clinique biologique et therapeutique. 2005;31(1):65–71.

127. Mohammadi MR, Ghanizadeh A, Rahgozart M, Noorbala AA, Malekafzali H, Davidian H, et al. Suicidal attempt and psychiatric disorders in Iran. Suicide Life Threat Behav. 2005;35(3):309–16. Epub 2005/09/15. 16156491.

128. Moosa MYH, Jeenah FY, Vorster M. Repeat non-fatal suicidal behaviour at Johannesburg Hospital. S Afr J Psychiatr. 2005;11(3):84–8. 43116147.

129. Mugisha J, Muyinda H, Malamba S, K, a E. Major depressive disorder seven years after the conflict in northern Uganda: Burden, risk factors and impact on outcomes (The Wayo-Nero Study). BMC Psychiatry. 2015;15:48. doi: 10.1186/s12888-015-0423-z 25881310

130. Muralidhara Yadiyal B, Aruna G. Psychopathology among suicide attempters: A cross-sectional study. Indian Journal of Forensic Medicine and Toxicology. 2011;5(1):5–8. 361592989.

131. Naidoo S, Schlebusch L. Sociodemographic and clinical profiles of suicidal patients requiring admission to hospitals south of Durban. South African Family Practice. 2013;55(4):373–9.

132. Narang RL, Mishra BP, Nitesh M. Attempted suicide in ludhiana. Indian J Psychiatry. 2000;42(1):83–7. Epub 2000/01/01. 21407914; PubMed Central PMCID: PMC2957009.

133. Ndosi NK, Waziri MC. The nature of parasuicide in Dar es Salaam, Tanzania. Soc Sci Med. 1997;44(1):55–61.

134. Ozdel O, Varma G, Atesci FC, Oguzhanoglu NK, Karadag F, Amuk T. Characteristics of suicidal behavior in a Turkish sample. Crisis. 2009;30(2):90–3. Epub 2009/06/16. doi: 10.1027/0227-5910.30.2.90 19525168.

135. Pandey A, Singh H, Dalai P, Tripathi A, Dutt K, Sinha P. Psychiatric Morbidity in Suicide attempters attending University Hospital of North India. Delhi Psychiatry Journal. 2013;16(1):128–33.

136. Parkar SR, Dawani V, Weiss MG. Clinical diagnostic and sociocultural dimensions of deliberate self-harm in Mumbai, India. Suicide Life Threat Behav. 2006;36(2):223–38. doi: 10.1521/suli.2006.36.2.223 16704326.

137. Parkar SR, Dawani V, Weiss MG. Gender, suicide, and the sociocultural context of deliberate self-harm in an urban general hospital in Mumbai, India. Cult Med Psychiatry. 2008;32(4):492–515. doi: 10.1007/s11013-008-9109-z 18807157

138. Pearson V, Phillips MR, He F, Ji H. Attempted Suicide among Young Rural Women in the People's Republic of China: Possibilities for Prevention. Suicide Life Threat Behav. 2002;32(4):359–69. doi: 10.1521/suli.32.4.359.22345 12501961

139. Pérez-Olmos I, Rodríguez-Sandoval E, Dussán-Buitrago M, Ayala-Aguilera J. Psychiatric and social characterisation of suicide attempts treated at a children's clinic, 2003–2005 [Spanish]. Rev Salud Pública. 2007;9:230–40. 17962841

140. Qusar MS, Morshed NM, Azad MAK, Kader MA, Shams SF, Ahmed MF, et al. Psychiatric Morbidity Among Suicide Attempters Who Needed ICU Intervention. Bangabandhu Sheikh Mujib Medical University Journal. 2010;2(2):5. Epub 2010-04-09. doi: 10.3329/bsmmuj.v2i2.4761

141. Read GFH. Trends in an adolescent and young adult parasuicide population presenting at a psychiatric emergency unit: a descriptive study. Int J Adolesc Med Health. 1997;9(4):249–70. doi: 10.1515/ijamh.1997.9.4.249 22912243.

142. Rezaie L, Khazaie H, Soleimani A, Schwebel DC. Is self-immolation a distinct method for suicide? A comparison of Iranian patients attempting suicide by self-immolation and by poisoning. Burns. 2011;37(1):159–63. Epub 2010/08/17. doi: 10.1016/j.burns.2010.07.003 20708844.

143. Risal A, Sharma PP. Psychiatric manifestations of patients admitted for intentional self harm in a tertiary care hospital. Indian J Psychiatry. 2011;1:S61. 70733147.

144. Santos SA, Lovisi G, Legay L, Abelha L. Prevalence of mental disorders associated with suicide attempts treated at an emergency hospital in Rio de Janeiro, Brazil [Portuguese]. Cad Saude Publica. 2009;25(9):2064–74. doi: 10.1590/s0102-311x2009000900020 19750393.

145. Sathish S, Kishan P, Sanjay Kumar ND, Sharma S. Psychiatric morbidity in suicide attempters. Indian J Psychiatry. 2016;58:S80.

146. Shakeri J, Farnia V, Abdoli N, Akrami MR, Arman F, Shakeri H. The risk of repetition of attempted suicide among Iranian women with psychiatric disorders as quantified by the suicide behaviors questionnaire. Oman Med J. 2015;30(3):173–80. doi: 10.5001/omj.2015.38 26171123.

147. Sharma RC. Attempted suicide in himachal pradesh. Indian J Psychiatry. 1998;40(1):50–4. Epub 1998/01/01. 21494443; PubMed Central PMCID: PMC2964818.

148. Sheikholeslami H, Kani C, Ziaee A. Attempted suicide among Iranian population. Suicide Life Threat Behav. 2008;38(4):456–66. Epub 2008/08/30. doi: 10.1521/suli.2008.38.4.456 18724794.

149. Simsek Z, Demir C, Er G, Munir KM. Evaluation of attempted suicide in emergency departments in Sanliurfa province, southeastern Turkey. Journal of Public Health (Germany). 2013;21(4):325–31. 52549227.

150. Srivastava MK, Sahoo RN, Ghotekar LH, Dutta S, Danabalan M, Dutta TK, et al. Risk factors associated with attempted suicide: a case control study. Indian J Psychiatry. 2004;46(1):33–8. 21206774; PubMed Central PMCID: PMC2912675.

151. Sun L, Zhang J. Gender differences among medically serious suicide attempters aged 15–54 years in rural China. Psychiatry Res. 2017;252:57–62. doi: 10.1016/j.psychres.2017.02.042 28249203

152. Zhang J, Liu Y, Sun L. Life satisfaction and degree of suicide intent: A test of the strain theory of suicide. Compr Psychiatry. 2017;74:1–8. doi: 10.1016/j.comppsych.2016.12.002 28040550

153. Thalagala N, Fernando D. Attempted suicides in kurunegala district: circumstances and risk factors. Journal of the College of Community Physicians of Sri Lanka. 2003;8:38–45.

154. Thanh HT, Jiang GX, Van TN, Minh DP, Rosling H, Wasserman D. Attempted suicide in Hanoi, Vietnam. Soc Psychiatry Psychiatr Epidemiol. 2005;40(1):64–71. doi: 10.1007/s00127-005-0849-6 15624077.

155. Trabelsi I, Maamri A, Bahrini L, Moula O, Zalila H. Clinical and environmental features associated with Tunisian patients who committed a suicide attempt. Eur Psychiatry. 2015;1:1816. 71932137.

156. Unni KE, Rotti SB, Chandrasekaran R. An exploratory study of the motivation in suicide attempters. Indian J Psychiatry. 1995;37(4):169–75. Epub 1995/10/01. 21743744; PubMed Central PMCID: PMC2972431.

157. Vasquez-Rojas R, Quijano-Serrano M. When a Suicide Attempt is Kid's Stuff [Spanish]. Rev Colomb Psiquiatr. 2013;43 Suppl 1:36–46. Epub 2013/01/01. doi: 10.1016/j.rcp.2013.11.004 26574112.

158. Vishnuvardhan G, Saddichha S. Psychiatric comorbidity and gender differences among suicide attempters in Bangalore, India. Gen Hosp Psychiatry. 2012;34(4):410–4. doi: 10.1016/j.genhosppsych.2012.03.017 22542051

159. Wang W, Ding L, Wen C, Liao Z, Wu S. Attempters suicide in people aged 18 and older in Xiamen City [Chinese]. Chinese Mental Health Journal. 2012;26:332–6.

160. Wei S, Yan H, Chen W, Liu L, Bi B, Li H, et al. Gender-specific differences among patients treated for suicide attempts in the emergency departments of four general hospitals in Shenyang, China. Gen Hosp Psychiatry. 2013;35(1):54–8. doi: 10.1016/j.genhosppsych.2012.10.007 23200697

161. Wei S, Liu L, Bi B, Li H, Hou J, Chen W, et al. Comparison of impulsive and nonimpulsive suicide attempt patients treated in the emergency departments of four general hospitals in Shenyang, China. Gen Hosp Psychiatry. 2013;35(2):186–91. doi: 10.1016/j.genhosppsych.2012.10.015 23260336.

162. Xiao C-L, Li X-Y, Zhang Y-P, Phillips MR. Characteristics of suicide attempters who ingested pesticides and those who used other methods. [Chinese]. Chinese Mental Health Journal. 2011;25(2):128–33.

163. Li X, Phillips MR, Cohen A. Indepth interviews with 244 female suicide attempters and their associates in northern China: understanding the process and causes of the attempt. Crisis. 2012;33(2):66–72. doi: 10.1027/0227-5910/a000108 21945843.

164. Li X, Xu Y, Wang Y, Yang R, Zhang C, Ji H, et al. Characteristics of serious suicide attempts treated in general hospitals. [Chinese]. Chinese Mental Health Journal. 2002;16(10):681–4.

165. Li X, Yang R, Zhang C. A case-control study on attempted suicide. [Chinese]. Chung Hua Liu Hsing Ping Hsueh Tsa Chih Chinese Journal of Epidemiology. 2001;22(4):281–3. 11718067.

166. Li X, Phillips MR, Wang Y, Yang R, Zhang C, Ji H, et al. The comparison of impulsive and non-impulsive attempted suicide [Chinese]. Chinese Journal of Mental and Nervous Diseases. 2003;29(27–31).

167. Cui S, Yang R, He F, Zheng Y. Case-control analysis and follow-up study on risk factors of suicide attempt in a rural population in Shandong Province. [Chinese]. Wei Sheng Yan Jiu. 2003;32(6):562–4. Epub 2004/02/18. 14963904.

168. Eddleston M, Phillips MR. Self poisoning with pesticides. BMJ. 2004;328(7430):42–4. Epub 2004/01/03. doi: 10.1136/bmj.328.7430.42 14703547; PubMed Central PMCID: PMC313909.

169. Marecek J. Young Women's Suicide in Sri Lanka: Cultural, Ecological, and Psychological Factors. Asian Journal of Counselling. 2006;13(1):63–92.

170. Phillips MR. Rethinking the role of mental illness in suicide. Am J Psychiatry. 2010;167(7):731–3. Epub 2010/07/03. doi: 10.1176/appi.ajp.2010.10040589 20595422.

171. Mishara BL, Weisstub DN. The legal status of suicide: A global review. Int J Law Psychiatry. 2016;44:54–74. Epub 2015/09/17. doi: 10.1016/j.ijlp.2015.08.032 26375452.

172. Chan KP, Hung SF, Yip PS. Suicide in response to changing societies. Child Adolesc Psychiatr Clin N Am. 2001;10(4):777–95. Epub 2001/10/09. 11588803.

173. Gunnell D, Knipe D, Chang S-S, Pearson M, Konradsen F, Lee WJ, et al. Prevention of suicide with regulations aimed at restricting access to highly hazardous pesticides: a systematic review of the international evidence. Lancet Global Health. 2017. doi: 10.1016/S2214-109X(17)30299-1

174. Iemmi V, Bantjes J, Coast E, Channer K, Leone T, McDaid D, et al. Suicide and poverty in low-income and middle-income countries: a systematic review. Lancet Psychiatry. 2016;3(8):774–83. doi: 10.1016/S2215-0366(16)30066-9 27475770.

175. Knipe DW, Carroll R, Thomas KH, Pease A, Gunnell D, Metcalfe C. Association of socio-economic position and suicide/attempted suicide in low and middle income countries in South and South-East Asia—a systematic review. BMC Public Health. 2015;15(1):1055. doi: 10.1186/s12889-015-2301-5 26472204; PubMed Central PMCID: PMC4608117.

176. Devries K, Watts C, Yoshihama M, Kiss L, Schraiber LB, Deyessa N, et al. Violence against women is strongly associated with suicide attempts: Evidence from the WHO multi-country study on women's health and domestic violence against women. Soc Sci Med. 2011;73(1):79–86. doi: 10.1016/j.socscimed.2011.05.006 21676510.

177. Barnes MC, Haase AM, Bard AM, Donovan JL, Davies R, Dursley S, et al. HOPE: Help fOr People with money, employment, benefit or housing problems: study protocol for a randomised controlled trial. Pilot Feasibility Stud. 2017;3:44. Epub 2017/10/19. doi: 10.1186/s40814-017-0179-y 29043091; PubMed Central PMCID: PMC5629806.

178. Chen YY, Wu KC, Yousuf S, Yip PS. Suicide in Asia: opportunities and challenges. Epidemiol Rev. 2012;34(1):129–44. Epub 2011/12/14. doi: 10.1093/epirev/mxr025 22158651.

179. Patel V, Ramasundarahettige C, Vijayakumar L, Thakur JS, Gajalakshmi V, Gururaj G, et al. Suicide mortality in India: a nationally representative survey. Lancet. 2012;379(9834):2343–51. Epub 2012/06/26. doi: 10.1016/S0140-6736(12)60606-0 22726517.

180. Abramsky T, Devries K, Kiss L, Nakuti J, Kyegombe N, Starmann E, et al. Findings from the SASA! Study: a cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduce HIV risk in Kampala, Uganda. BMC Med. 2014;12:122. Epub 2014/09/25. doi: 10.1186/s12916-014-0122-5 25248996; PubMed Central PMCID: PMC4243194.

181. Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, et al. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA. 2004;291(21):2581–90. Epub 2004/06/03. doi: 10.1001/jama.291.21.2581 15173149.

182. Bruckner TA, Scheffler RM, Shen G, Yoon J, Chisholm D, Morris J, et al. The mental health workforce gap in low- and middle-income countries: a needs-based approach. Bull World Health Organ. 2011;89(3):184–94. Epub 2011/03/08. doi: 10.2471/BLT.10.082784 21379414; PubMed Central PMCID: PMC3044251.

183. Nadkarni A, Weobong B, Weiss HA, McCambridge J, Bhat B, Katti B, et al. Counselling for Alcohol Problems (CAP), a lay counsellor-delivered brief psychological treatment for harmful drinking in men, in primary care in India: a randomised controlled trial. Lancet. 2017;389(10065):186–95. Epub 2016/12/19. doi: 10.1016/S0140-6736(16)31590-2 27988144; PubMed Central PMCID: PMC5236065.

184. Patel V, Weobong B, Weiss HA, Anand A, Bhat B, Katti B, et al. The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: a randomised controlled trial. Lancet. 2017;389(10065):176–85. doi: 10.1016/S0140-6736(16)31589-6 27988143; PubMed Central PMCID: PMC5236064.