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

Suicidal ideation and suicide attempts in eight low- and middle-income countries: a comparison of national surveys - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Search Log in Primary site navigation Search Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice BMC Psychiatry . 2026 May 29;26:435. doi: 10.1186/s12888-025-07005-w Suicidal ideation and suicide attempts in eight low- and middle-income countries: a comparison of national surveys David Villarreal-Zegarra 1, 6 , Sofía C Malaquias-Obregon 1 , Nikol Mayo-Puchoc 1 , Ali Al-kassab-Córdova 2, ✉ , Gloria Yantas-Alcantara 3 , Guillermo Almeida-Huanca 1 , Yscenia Paredes-Gonzales 3 , Jeff Huarcaya-Victoria 4 , G J Melendez-Torres 5 Author information Article notes Copyright and License information 1 Instituto Peruano de Orientación Psicológica, Lima, Peru 2 Centro de Excelencia en Estudios Económicos y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru 3 Digital Health Research Center, Lima, Peru 4 Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Filial Ica, Ica, Peru 5 Faculty of Health and Life Sciences, University of Exeter, Exeter, UK 6 IDEAS Research Group, Universidad Científica del Sur, Lima, Peru ✉ Corresponding author. Received 2024 Nov 22; Accepted 2025 May 19; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13220562  PMID: 42215896 Abstract 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. Supplementary Information The online version contains supplementary material available at 10.1186/s12888-025-07005-w. Keywords: Suicidal ideation, Suicidal attempt, Algeria, Azerbaijan, Eswatini, Guyana, Kiribati, Malawi, Tuvalu, Zambia Introduction Suicide is recognized as a sequential process culminating in a definitive outcome, rather than an isolated incident [ 1 ]. This process encompasses a spectrum of suicidal behaviours (SB). First, suicidal ideation (SI) emerges through thoughts about self-inflicted death. Then, detailed plans begin with methods of self-inflicted death. Third, there are several suicide attempts (SA) involving potentially self-injurious behaviour without a fatal outcome. However, in some cases, suicide occurs during the first attempt, highlighting the variability of suicide trajectories and the need to understand different risk patterns [ 2 , 3 ]. Statistically, suicide is a global health concern with more than 720,000 deaths worldwide every year [ 4 ]. An estimation indicates that suicide ranks as the 14 th leading cause of death [ 5 ]. Also, it was among the top 10 leading cause of death in Eastern Europe, High-income Asia Pacific, Australasia, Central Europe, and High-income North America in 2016 [ 6 ]. For every suicide, likely 20 other people are making a suicide attempt, and many more have serious thoughts of suicide [ 7 ]. To prevent this, build an epidemiological profile of SB is needed. By 2019, suicide was the fourth leading cause of death among 15 to 29-year-olds, and 77% of all suicides occur in low- middle- income countries (LMICs) [ 8 ]. However, LMICs are largely excluded of multi-country reports due to non-availability data [ 9 ]. Indeed, the Global Burden Disease report showed no increase in suicide deaths in LMICs by 2019, as 21 countries do not represent all regions [ 10 ]. LMICs face significant challenges in accurately documenting suicide-related outcomes due to inconsistent data collection methods and underreporting issues [ 11 ]. Due to the poverty, these settings have limited resources to prevent and intervene in SB. Thus, people from LMICs struggle with socioeconomic problems, limited mental health services, and welfare support [ 12 ]. Factors associated with SI, suicide plans, and SA have been extensively studied in high-income countries (HICs). These factors include sociodemographic characteristics, socioeconomic conditions, mental health disorders, and physical health issues. Sociodemographic factors may include younger age and female sex [ 13 – 15 ]; and the socioeconomic conditions risk factors of SB, could include living in poverty, unemployment, experiencing social, and racial inequalities [ 16 ]. Having psychosocial distress risk factors associated with SB may include depression, alcohol disorders [ 4 ], and exposure to physical or sexual violence in HICs [ 17 ]. Physical factors associated with SB may include chronic conditions, for example, cardiovascular disease, epilepsy, diabetes, hypercholesterolemia, and low blood pressure in LMICs [ 18 – 22 ]. Health risk behaviours include physical inactivity, early substance use, substance use disorders, and obesity in LMICs [ 23 – 25 ]. Despite this, a review highlighted increasing rates of suicidal ideation and attempts in LMIC, as well as a gap in prevention research, particularly among adolescents and young adults [ 26 ]. Given the high burden of suicide in LMICs and the lack of comprehensive data, it is essential to investigate the prevalence and determinants of SI and SA in these regions [ 10 ]. Additionally, the prevalence of associated factors changes according to geographical location, educational level, population growth, and age group distribution [ 6 , 17 , 27 ]. However, reports of that for SI, plans, and SA are under-reported or under-seen in LMICs because of the limitations in health systems and national information systems [ 28 ]. The aim of the present study was to assess prevalence and associate factors for SI and SA in eight countries of LMICs. Materials and methods Study design We conducted a cross-sectional study based on data from 2014 to 2017 obtained from the WHO STEPwise method for surveillance of risk factors for noncommunicable diseases (STEPS), which consists of a national household survey aimed at measuring risk factors that determine the main burden of non-communicable diseases; this follows three steps: a face-to-face interview (items on tobacco use, alcohol consumption, mental health, physical activity, and unhealthy eating), physical measurement (height and weight), and biochemical measurement (blood and urine analysis) [ 29 ]. We used the WHO NCD Microdata Repository to extract STEPS survey information from Azerbaijan 2017, Malawi 2017, Zambia 2017, Algeria 2016, Guyana 2016, Kiribati 2015, Tuvalu 2015, and Eswatini 2014 [ 30 ]. Setting As of June 11, 2022, 54 countries and territories in WHO regions had at least one STEPS dataset to request through the portal. The criteria to take into account were the periodicity and income level of these countries according to the World Bank; the former implies using the most current collection data since countries should repeat the survey approximately every 5 years according to WHO recommendation [ 29 ], while for the latter criterion, countries with low and middle-income levels were considered since the literature on IS and BS epidemiology evidences greater heterogeneity [ 11 ]. Furthermore, in an exclusionary manner, countries that completed the suicide ideation and attempt assessment modules were included; thus, Algeria, Azerbaijan, Eswatini, Guyana, Kiribati, Malawi, Tuvalu, and Zambia were selected. Their surveys were conducted between 2014 and 2017. They belong to Africa ( n = 4), Oceania ( n = 2), South America ( n = 1), and Europe-Asia ( n = 1). The most recent one was used for countries with more than one dataset available. Participants This study used STEPS data from Algeria, Azerbaijan, Eswatini, Guyana, Kiribati, Malawi, Tuvalu, and Zambia. Stratified cluster sampling was used in three stages. In the first stage, the primary sampling units were proportionally selected among the geographical areas of each country. In the second stage, secondary selection units (households) were selected using a simple random sampling method. In the third stage, tertiary selection units (individuals) were selected through simple random sampling. STEPS calculated the analysis weights by taking the inverse of each participant's probability of selection. These weights were adjusted for differences in the age and sex composition of the sample population compared to the target population. People between 15 and 69 years old with complete data on lifetime suicide attempts, SI, and covariates of interest were included. Participants with missing data or refusal to answer the main outcomes were excluded. This age group was considered as it was the only one available in the dataset. Measures Suicidal Ideation in last year In our study, suicidal ideation (SI) was conceptualized as the act of thinking about, contemplating, or planning to attempt suicide [ 31 ]. SI was assessed by the question"During the last 12 months, have you seriously considered attempting suicide?", with possible responses of"yes","no", or"prefer not to answer". Only positive responses were considered indicative of SI, while negative responses were interpreted as the absence of ideation. Subjects who chose not to answer were excluded from the analysis. Lifetime suicide attempt The variable lifetime suicide attempt considers any self-directed non-fatal behaviour with intent to harm and die, even if this behaviour is not evidenced by injury [ 31 ]. This was assessed using the single item"have you ever attempted suicide?". Affirmative responses were considered as having the outcome, whereas negative responses as not having the outcome. Participants who refused to answer the question were excluded. Covariates The sociodemographic variables evaluated in the study included: gender (female/male); age group (15 to 29, 30 to 44, 45 to 59, and 60 years or older); marital status (single, currently married, separated, divorced, widowed, and cohabiting); educational level (no formal education, less than primary school, end of primary school, end of middle school, end of high school or equivalent, high school, university, postgraduate degree, and Koranic school); and work activity (yes/no). In the case of Algeria, individuals enrolled in Koranic schools were not included due to the small number of participants ( n = 1). Other variables were tobacco and alcohol use and family history of suicidal behaviour using dichotomous items. These variables were based on an extensive literature review in which they were associated with SI or SA [ 14 , 32 , 33 ]. Statistical analysis The data analysis was conducted in Stata 16.0 (Stata Corporation, College Station, TX, USA). All analyses considered the STEPS complex sampling design. Absolute and weighted relative frequencies were used to describe the samples. Given that the outcomes were dichotomous and the cross-sectional study design, Poisson regression models were performed to estimate crude (cPR) and adjusted (aPR) prevalence ratios with their corresponding 95% confidence intervals (95% CI). Analyses were presented separately for each country and pooled for all countries. Models were adjusted for sex, age range, level education, current smoking, ever drank alcohol, vigorous activity at work, close family member attempted suicide, and SI. Owing to the multiple associations tested and the low prevalence of the outcome, a significance value of 0.01 was chosen. Results Sociodemographic characteristics and prevalence Our study surveyed a total of 27,786 individuals from eight countries; after applying the inclusion criteria, the sample was reduced to 26,926 (see Fig. 1 ). The characteristics of the participants before applying the inclusion criteria can be found in Supplementary Material 1 (Fig. 2 ). Fig. 1. Open in a new tab Flowchart of participants included by country Fig. 2. Open in a new tab Suicidal ideation and lifetime suicide attempt by country Most participants were female (60%, n = 16,155) and with a mean age of 39.5 years (SD = 14.1). The proportion of participants included in each country varied: Algeria (25.1%), Zambia (15.8%), Malawi (15.3%), Estonia (12.1%), Azerbaijan (10.1%), Guyana (9.7%), Kiribati (7.7%) and Tuvalu (4.2%). In addition, the pooled prevalence of suicidal ideation (SI) was 5.7%, while the pooled prevalence of lifetime SA was 1.9%. Sociodemographic characteristics and prevalence by country are shown in Table 1 . Table 1. Characteristics of included participants ( n = 26,926) Argelia ( n = 6767) Azerbaijan ( n = 2713) Eswatini ( n = 3270) Guyana ( n = 2616) Kiribati ( n = 2070) Malawi ( n = 4107) Tuvalu ( n = 1140) Zambia ( n = 4243) Pooled ( n = 26,926) n % n % n % n % n % n % n % n % n % Sex Men 2,992 44.2 1,089 40.1 1,134 34.7 1,040 39.8 942 45.5 1,455 35.4 521 45.7 1,598 37.7 10,771 40 Women 3,775 55.8 1,624 59.9 2,136 65.3 1,576 60.2 1,128 54.5 2,652 64.6 619 54.3 2,645 62.3 16,155 60 Age range 15–17 0 0 0 0 251 7.7 0 0 0 0 0 0 0 0 0 0 251 0.9 18–29 1,472 21.8 461 17.0 1,085 33.2 716 27.4 660 31.9 1,343 32.7 301 26.4 1,597 37.6 7,635 28.4 30–44 2,700 39.9 762 28.1 949 29.0 856 32.7 740 35.8 1,520 37 328 28.8 1,492 35.2 9,347 34.7 45–59 1,858 27.5 1,038 38.3 657 20.1 706 27.0 500 24.2 844 20.6 377 33.1 775 18.3 6,755 25.1 60–69 737 10.9 452 16.7 328 10.0 338 12.9 170 8.2 400 9.7 134 11.7 379 8.9 2,938 10.9 Level education Without formal education 1,052 15.5 17 0.6 341 10.4 57 2.2 54 2.6 573 14 8 0.7 418 9.9 2,520 9.36 Elementary school complete 2,679 39.6 73 2.7 1,511 46.2 1,374 52.5 747 36.1 2,449 60.8 520 45.6 2,120 50.0 11,523 42.8 High school complete 2,091 30.9 1,417 52.2 1,148 35.1 1,089 41.6 1,202 58.1 1,035 25.2 594 52.1 1,381 32.5 9,957 37.0 University education 945 14 1,206 44.5 270 8.3 96 3.7 67 3.2 0 0 18 1.6 324 7.6 2,926 10.9 Status civil Never married 1,676 24.8 349 12.9 1,474 45.1 766 29.3 314 15.2 407 9.9 217 19.0 922 21.7 6,125 22.8 Currently married 4,654 68.8 1,972 72.7 1,385 42.4 925 35.4 1,454 70.2 2,573 62.7 834 73.2 2,587 61.0 16,384 60.9 Separated 27 0.4 36 1.3 66 2.0 121 4.6 41 2 238 5.8 11 1.0 146 3.5 686 2.6 Divorced 177 2.6 53 2 21 0.6 75 2.9 35 1.7 252 6.1 24 2.1 256 6.0 893 3.3 Widowed 230 3.4 254 9.4 224 6.8 131 5 128 6.2 357 8.7 54 4.7 317 7.5 1,695 6.3 Missing 3 0 49 1.8 100 3.1 598 22.9 98 4.7 280 6.8 0 0 15 0.3 1,143 4.2 Current smoking Yes 943 13.9 530 19.5 189 5.8 337 12.9 950 45.9 354 8.6 391 34.3 469 11.0 4,163 15.5 No 5,824 86.1 2,183 80.5 3,081 94.2 2,279 87.1 1,120 54.1 3,753 91.4 749 65.7 3,774 89.0 22,763 84.5 Ever drank alcohol Yes 550 8.1 726 26.8 818 25.0 1,752 67.0 581 28.1 1,033 25.1 275 24.1 1,379 32.5 7,114 26.4 No 6,217 91.9 1,987 73.2 2,452 75.0 864 33.0 1,489 71.9 3,074 74.9 865 75.9 2,864 67.5 19,812 73.6 Drank alcohol in past 12 months Yes 187 2.8 482 17.8 541 16.5 1,339 51.2 343 16.6 714 17.4 239 21.0 1,035 24.4 4,880 18.1 No 363 5.4 244 9 277 8.5 413 15.8 238 11.5 319 7.8 36 3.1 344 8.1 2,234 8.3 Missing 6,217 91.9 1,987 73.2 2,452 75.0 864 33.0 1,489 71.9 3,074 74.8 865 75.9 2,864 67.5 19,812 73.6 Vigorous activity at work Yes 1,384 20.5 307 11.3 1,223 37.4 600 22.9 498 24.1 3,491 85 390 34.2 2,724 64.2 10,617 394 No 5,383 79.6 2,406 88.7 2,047 62.6 2,016 77.1 1,572 75.9 616 15 750 65.8 1,519 35.8 16,309 60.6 Suicidal ideation Yes 206 3 37 1.4 307 9.4 116 4.4 182 8.8 304 7.4 54 4.7 342 8.1 1,548 5.7 No 6,561 97 2,676 98.6 2,963 90.6 2,500 95.6 1,888 91.2 3,803 92.6 1,086 95.3 3,901 91.9 25,378 94.3 Lifetime suicide attempt Yes 59 0.9 24 0.9 115 3.5 81 3.1 99 4.8 36 0.9 12 1.0 98 2.3 524 1.9 No 6,708 99.1 2,689 99.1 3,155 96.5 2,535 96.9 1,971 95.2 4,071 99.1 1,128 99.0 4,145 97.7 26,402 98.1 Close family member attempted suicide Yes 92 1.4 20 0.7 341 10.4 274 10.5 162 7.8 166 4.0 69 6.1 450 10.6 1,574 5.8 No 6,675 98.6 2,693 99.3 2,929 89.6 2,342 89.5 1,908 92.2 3,941 96 1,071 93.9 3,793 89.4 25,352 94.2 Missing 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Close family member died from suicide Yes 38 0.6 11 0.4 247 7.5 252 9.6 126 6.1 94 2.3 56 4.9 251 5.9 1,075 4 No 6,725 99.4 9 0.3 3,022 92.4 2,358 90.1 1,942 93.8 72 1.7 1,084 95.1 199 4.7 15,411 57.2 Missing 4 0 2,693 99.3 1 0.1 6 0.2 2 0.1 3,941 96.0 0 0 3,793 89.4 10,440 38.8 Open in a new tab All analyses considered the complex sampling weighting factor by country Characteristics of people with suicidal ideation and attempted suicide The pooled proportion of people who had SI and sought professional help for their suicidal thoughts was 24.8% and depending on the country of origin ranged from 14.7% to 31.2%. In addition, the pooled proportion of people who committed a SA and sought medical treatment for that attempt was 23.2% and depending on the country of origin ranged from 0% to 37.7%. The characteristics of SA are shown in Table 2 . Table 2. Specific characteristics of people with suicidal ideation, suicide attempt and those who sought help Argelia Azerbaijan Estawani Guyana Kiribati Malawi Tavalu Zambia Pooled n % n % n % n % n % n % n % n % n % Sought help for suicidal ideation a Yes 31 14.7 8 19.5 89 28.7 25 21.2 41 22.2 96 31.2 27 47.37 74 21.33 391 24.8 No 178 84.4 33 80.5 221 71.3 93 78.8 144 77.8 207 67.2 27 47.37 271 78.10 1,174 74.5 Missing 2 1.0 0 0.0 0 0.0 0 0.0 0 0.0 5 1.6 3 5.26 2 0.58 12 0.8 Suicide attempt in the last year b Yes 23 38.3 9 30.0 58 50.4 26 30.6 69 68.3 21 58.3 7 58.33 45 45.45 258 48.0 No 37 61.7 19 63.3 57 49.6 59 69.4 32 31.7 15 41.7 4 33.33 54 54.55 277 51.5 Missing 0 0.0 2 6.7 0 0.0 0 0.0 0 0.0 0 0.0 1 8.33 0 0.0 3 0.6 Main method used in last suicide attempt b Cutting instrument 8 13.3 5 16.7 5 4.4 11 12.9 2 2.0 1 2.8 2 16.67 14 14.1 48 8.9 Medication 23 38.3 2 6.7 17 14.8 20 23.5 12 11.9 7 19.4 1 8.33 19 19.2 101 18.8 Other substance 4 6.7 0 0.0 4 3.5 5 5.9 70 69.3 0 0.0 0 0.0 3 3.0 86 16.0 Poisons or pesticides 2 3.3 3 10.0 48 41.7 18 21.2 3 3 8 22.2 0 0.0 19 19.2 101 18.8 Other pesticides 3 5 1 3.3 1 0.9 6 7.1 2 2.0 0 0.0 0 0.0 5 5.1 18 3.4 Gaseous pesticides 1 1.7 0 0.0 2 1.7 0 0.0 6 5.9 1 2.8 0 0.0 19 19.2 29 5.4 Other 13 21.7 8 26.7 32 27.8 21 24.7 0 0.0 14 38.9 8 66.67 2 2.0 98 18.2 Missing 6 10 11 36.7 6 5.2 4 4.7 6 5.9 5 13.9 1 8.33 18 18.2 57 10.6 Sought medical care for last suicide attempt b Yes 20 33.3 11 36.7 30 26.1 32 37.7 6 5.9 4 11.1 0 0.0 22 22.22 125 23.2 No 38 63.3 17 56.7 85 73.9 52 61.2 94 93.1 30 83.3 12 100.0 77 77.78 405 75.3 Missing 2 3.3 2 6.7 0 0.0 1 1.2 1 1.0 2 5.6 0 0.0 0 0 8 1.5 Admitted to hospital overnight due to last attempt c Yes 12 20.0 7 23.3 13 11.3 24 28.2 1 0.99 2 5.5 0 0.0 14 14.14 73 13.6 No 8 13.3 4 13.3 17 14.8 61 71.8 5 4.95 2 5.6 0 0.0 8 8.08 105 19.5 Missing 40 66.7 19 63.3 85 73.9 0 0.0 95 94.1 32 88.9 12 100.0 77 77.78 360 66.9 Open in a new tab All analyses considered the complex sampling weighting factor a The denominator is persons with suicidal ideation (see Table 1 ) b The denominator is persons with suicide attempts (see Table 1 ) c The denominator is people who sought help due to the suicide attempt (see Table 2 ) Associated factors to suicidal ideation and suicide attempt In the pooled analysis, female participants were slightly more likely to have SI compared to males (aPR = 1.04, 95% CI: 1.03–1.05), and participants aged 45–59 years (aPR = 0.97, 95% CI: 0.97–0.98) and 60–69 years (aPR = 0.97, 95% CI: 0.96–0.98) were slightly less likely to have SI compared to adolescents aged 15–17 years. In addition, active smoking (aPR = 1.02, 95% CI: 1.01–1.03) and having a close relative who attempted suicide were associated with a higher likelihood of SI (aPR = 1.07, 95% CI: 1.06–1.09). Table 3 shows the factors associated with SI by country. Table 3. Factors associated with suicidal ideation ( n = 26,926) Argelia ( n = 6767) Azerbaijan ( n = 2713) Eswatini ( n = 3270) Guyana ( n = 2616) Kiribati ( n = 2070) Malawi ( n = 4107) Tuvalu ( n = 1140) Zambia ( n = 4243) Pooled ( n = 26,926) aPR (95% CI) a aPR (95% CI) a aPR (95% CI) a aPR (95% CI) a aPR (95% CI) a aPR (95% CI) a aPR (95% CI) a aPR (95% CI) a aPR (95%CI) a Sex Men (ref) 1 1 1 1 1 1 1 1 1 Women 1.03 [1.01–1.04] 1.01 [1.00–1.02] 1.06 [1.04–1.08] 1.03 [ 1 .02–1.05] 1.06 [1.03–1.09] 1.03 [1.01–1.05] 1.02 [1.00–1.05] 1.05 [1.04–1.07] 1.04 [1.03–1.05] Age range 15–17 - - 0.96 [0.93–0.99] - - - - - 0.98 [0.95–1.01] 18–29 (ref) 1 1 1 1 1 1 1 1 1 30–44 1.00 [0.98–1.01] 0.99 [0.98–1.01] 1.00 [0.97–1.02] 0.98 [0.96–1.00] 0.99 [0.96–1.02] 1.01 [0.99–1.03] 0.97 [0.93–1.01] 1.00 [0.98–1.01] 0.98 [0.98–1.00] 45–59 0.99 [0.97–1.00] 0.99 [0.97–1.00] 0.97 [0.94–0.99] 0.96 [0.94–0.98] 0.96 [0.93–0.99] 1.01 [0.99–1.03] 0.96 [0.93–0.98] 0.98 [0.96–1.00] 0.97 [0.97–0.98] 60–69 0.99 [0.96–1.01] 0.98 [0.97–1.00] 0.95 [0. 92 –0.99] 0.96 [0.94–0.99] 0.94 [0.91–0.98] 1.00 [0.98–1.03] 0.96 [0.92–1.00] 0.98 [0.95–1.00] 0.97 [0.96–0.98] Level education Without formal education (ref) 1 1 1 1 1 1 1 1 1 Elementary school complete 1.01 [0.99–1.03] 1.00 [0.89–1.13] 0.97 [0.94–1.00] 1.03 [1.00–1.07] 0.98 [0.91–1.06] 1.04 [1.02–1.06] 1.06 [1.03–1.09] 0.99 [0.96–1.02] 1.00 [0.99–1.01] High school complete 1.00 [0.98–1.02] 0.95 [0.86–1.06] 0.96 [0.93–1.00] 1.04 [1.00–1.07] 0.96 [0.89–1.03] 1.03 [1.00–1.05] 1.03 [1.00–1.06] 0.99 [0.96–1.02] 0.99 [0.98–1.00] University education 0.99 [0.97–1.01] 0.95 [0.85–1.06] 0.92 [0.88–0.96] 1.01 [0.97–1.06] 0.93 [0.85–1.02] - 1.01 [0.97–1.04] 0.94 [0.91–0.98] 0.97 [0.96–0.98] Current smoking No (ref) 1 1 1 1 1 1 1 1 1 Yes 1.01 [1.00–1.02] 1.00 [0.99–1.01] 1.03 [0.99–1.08] 1.04 [1.01–1.07] 1.01 [0.99–1.04] 1.00 [0.97–1.03] 1.01 [0.98–1.04] 1.05 [1.02–1.08 ] 1.02 [1.01–1.03] Ever drank alcohol No (ref) 1 1 1 1 1 1 1 1 1 Yes 1.03 [1.00–1.05] 1.01 [0.99–1.02] 1.05 [1.02–1.07] 0.99 [0.97–1.01] 1.05 [1.02–1.08] 1.02 [1.00–1.05] 1.02 [0.99–1.05] 1.05 [1.03–1.08] 1.03 [1.02–1.04] Vigorous activity at work No (ref) 1 1 1 1 1 1 1 1 1 Yes 1.00 [0.99–1.02] 1.00 [0.99–1.02] 1.02 [1.00–1.04] 1.00 [0.98–1.01] 1.07 [1.04–1.10] 0.99 [0.97–1.01] 1.03 [1.00–1.05] 0.97 [0.95–0.99] 1.01 [1.01–1.02] Close family member attempted suicide No (ref) 1 1 1 1 1 1 1 1 1 Yes 1 .10 [1.06–1.15] 1.03 [0.94–1.13] 1.06 [1.02–1.09] 1.04 [1.01–1.08] 1.15 [1.09–1.21] 1.07 [1.02–1.12] 1.13 [1.02–1.25] 1.06 [1.03–1.09] 1.07 [1.06–1.09] Open in a new tab All analyses considered the complex sampling weighting factor. Values in bold are significant ( p < 0.01). Only participants who were not missing in the variables of interest were included (Sex, Age range, Level education, Current smoking, Ever drank alcohol, Vigorous activity at work, Close family member attempted suicide, Suicidal Ideation, and Suicide attempt in lifetime) a The model was adjusted by Sex, Age range, Level education, Current smoking, Ever drank alcohol, Vigorous activity at work, Close family member attempted suicide Regarding lifetime suicide attempt, participants with SI had 21% higher probability of having a SA in pooled analysis (aPR = 1.21, 95% CI: 1.18–1.22). Other factors associated that increased the probability of a SA in participants from pooled analysis were active smoking (aPR = 1.01, 95% CI: 1.01–1.02), and having at least one close relative with a SA (aPR = 1.02, 95% CI: 1.01–1.03). Table 4 shows the factors associated with SA by country. Table 4. Factors associated with lifetime suicide attempt ( n = 26,926) Argelia ( n = 6767) Azerbaijan ( n = 2713) Eswatini ( n = 3270) Guyana ( n = 2616) Kiribati ( n = 2070) Malawi ( n = 4107) Tuvalu ( n = 1140) Zambia (n = 4243) Pooled ( n = 26,926) aPR (95% CI) a aPR (95% CI) a aPR (95% CI) a aPR (95% CI) a aPR (95% CI) a aPR (95% CI) a aPR (95% CI) a aPR (95% CI) a aPR (95% CI) a Sex Men (ref) 1 1 1 1 1 1 1 1 1 Women 1.01 [1.00–1.01] 1.01 [1.00–1.01] 1.01 [1.00–1.02] 1.03 [1.01–1.04] 1.01 [0.99–1.03] 1.00 [1.00–1.01] 1.00 [0.99–1.01] 1.00 [0.99–1.01] 1.01 [1.00–1.01] Age range 15–17 - - 1.00 [0.98–1.02] - - - - - 1.01 [0.99–1.02] 18–29 (ref) 1 1 1 1 1 1 1 1 1 30–44 1.00 [1.00–1.01] 1.00 [0.99–1.01] 1.00 [0.99–1.02] 0.98 [0.96–1.00] 0.99 [0.97–1.01] 1.00 [0.99–1.01] 1.00 [0.98–1.01] 0.99 [0.98–1.00] 1.00 [0.99–1.02] 45–59 1.00 [0.995–1.00] 1.00 [0.99–1.01] 1.00 [0.98–1.02] 0.99 [0.98–1.01] 0.99 [0.97–1.01] 1.00 [0.99–1.01] 1.00 [0.98–1.01] 0.99 [0.98–1.00] 1.00 [0.99–1.00] 60–69 1.00 [0.99–1.00] 1.00 [0.99–1.01] 0.99 [0.97–1.01] 0.99 [0.97–1.01] 0.98 [0.96–1.00] 1.00 [0.99–1.02] 0.99 [0.98–1.00] 0.99 [0.98–1.00] 0.99 [0.98–1.00] Level education Without formal education (ref) 1 1 1 1 1 1 1 1 1 Elementary school complete 1.00 [1.00–1.01] 1.02 [0.97–1.07] 1.00 [0.98–1.02] 1.01 [0.99–1.04] 1.02 [0.98–1.07] 1.00 [0.99–1.01] 1.00 [0.99–1.00] 1.00 [0.99–1.01] 1.00 [0.99–1.01] High school complete 1.00 [0.99–1.00] 1.03 [0.99–1.07] 0.99 [0.97–1.02] 1.01 [0.99–1.04] 1.01 [0.97–1.06] 1.00 [0.99–1.01] 1.00 [0.99–1.01] 1.01 [0.99–1.02] 1.00 [0.99–1.01] University education 0.99 [0.99–1.00] 1.02 [0.98–1.07] 0.99 [0.96–1.02] 1.01 [0.98–1.05] 1.06 [1.00–1.12] - 1.00 [0.99–1.00] 1.00 [0.98–1.02] 0.99 [0.99–1.00] Current smoking No (ref) 1 1 1 1 1 1 1 1 1 Yes 1.00 [1.00–1.01] 1.00 [1.00–1.01] 0.98 [0.96–1.01] 1.03 [1.01–1.06] 1.01 [0.99–1.02] 1.00 [0.99–1.01] 1.01 [1.00–1.02] 1.01 [1.00–1.03] 1.01 [1.01–1.02] Ever drank alcohol No (ref) 1 1 1 1 1 1 1 1 1 Yes 1.01 [1.00–1.02] 1.00 [1.00–1.01] 1.02 [1.00–1.04] 1.01 [0.99–1.02] 1.01 [0.99–1.03] 1.00 [1.00–1.01] 1.01 [0.99–1.03] 1.01 [1.00–1.02] 1.01 [1.01–1.02] Vigorous activity at work No (ref) 1 1 1 1 1 1 1 1 1 Yes 1.00 [1.00–1.00] 1.00 [0.99–1.01] 1.00 [0.98–1.01] 1.02 [1.00–1.03] 0.99 [0.97–1.01] 1.00 [0.99–1.01] 1.00 [0.99–1.01] 1.00 [0.99–1.01] 0.99 [0.99–1.00] Close family member attempted suicide No (ref) 1 1 1 1 1 1 1 1 1 Yes 1.06 [1.00–1.12] 1.03 [0.97–1.08] 1.00 [0.98–1.03] 1.04 [1.01–1.07] 1.04 [1.00–1.08] 1.00 [0.98–1.02] 1.01 [0.97–1.05] 1.01 [0.99–1.02] 1.02 [1.01–1.03] Suicidal Ideation No (ref) 1 1 1 1 1 1 1 1 1 Yes 1.17 [1.13–1.22] 1.37 [1.23–1.53] 1.20 [1.15–1.25] 1.25 [1.17–1.33] 1.44 [1.37–1.51] 1.09 [1.06–1.13] 1.18 [1.1–1.26] 1.19 [1.15–1.23] 1.21 [1.18–1.22] Open in a new tab All analyses considered the complex sampling weighting factor. Values in bold are significant ( p < 0.01). Only participants who were not missing in the variables of interest were included (Sex, Age range, Level education, Current smoking, Ever drank alcohol, Vigorous activity at work, Close family member attempted suicide, Suicidal Ideation, and Suicide attempt in lifetime) a The model was adjusted by Sex, Age range, Level education, Current smoking, Ever drank alcohol, Vigorous activity at work, Close family member attempted suicide, and Suicidal Ideation Discussion Prevalence The 12-month prevalence of SI in our pooled analysis was 5.7% (range: 1.4%–9.4%), which is comparable to previous cross-sectional studies conducted in 17 countries using population-based samples (range: 3.1%–12.4%) [ 34 ] and in studies focused exclusively on LMICs, where the range was 3.5%–11.1% [ 28 ]. However, our estimate was higher than that reported in another study involving ten LMICs (2.1%). Similarly, the pooled lifetime prevalence of suicide attempts (1.9%; range: 0.9%–4.8%) aligns with figures reported in countries such as Nigeria (1.0%) [ 35 ], South Africa (2.9%) [ 36 ], Bhutan (0.7%) [ 14 ], Ethiopia (3.7%), India (0.4%), and Nepal (0.7%) [ 28 ]. The similarities observed may be explained by the present study conducted in countries facing similar economic challenges. However, it is important to note that SI and SA were assessed based on the self-perception of the respondents rather than within a primary healthcare context. Possibly, the prevalence of psychiatric disorders by each country, access to lethal means, and incidence of non-suicidal self-injuries partially explain the difference in the prevalences of SI and suicide attempt in these countries [ 37 ]. In addition, other factors can explain these differences, such as political, social, cultural and economic factors [ 38 ]. Such as Malawi and Zambia have been exposed to gender-based, political, and racial violence, and have limited access to health services due to mismanagement of funds [ 39 ], and in Eswatini, pro-democracy and anti-police brutality rallies resulted in a harsh crackdown on human rights [ 39 ]. It is worth noting that other studies have reported slightly different findings. For example, a meta-analysis conducted among students in predominantly Muslim countries identified a higher one-year prevalence of suicidal ideation compared to our study (13.4%; 95% CI: 11.1%–16.1%) [ 40 ]. It was found that the main methods used in the most recent SA were pesticide poisoning and drug overdose (both 18.8%). This partially aligns with findings from countries such as Argentina [ 41 ], where only one method was typically used in SA, with drug use being the most common, followed by sharp objects as the second predominant method. However, the pattern differs in cases of completed suicides. In countries like Mexico [ 42 ], violent methods (e.g., hanging, firearms, and jumping from heights) are more prevalent, while pesticide use remains more common in rural areas of LMICs. According to live fife, knowledge of the most commonly use methods of suicide in countries could help to implement suicide prevention strategies to reduce access to the means of suicide (i.e., raising public awareness, engage government sectors in the regulation of pesticides) [ 43 ]. In addition, of respondents who reported past 12-month SI, 24.8% has sought for professional help, and among those reported a SA in the last year, 48% sough medical care, results were lower than globally community adults samples (ranging from 34 to 42% and 49% to 55% respectively) [ 44 ]. Associated factors Regarding sociodemographic variables, the risk was found to be nearly identical between men and women for SI and SA (aPR = 1.04 [1.03–1.05] and 1.01 [1.00–1.01], respectively). These findings contrast with previous studies conducted in both LMICs [ 45 ] and some HIC [ 46 – 49 ]. This discrepancy may be attributed to the limitations of the current evidence, which is affected by high heterogeneity and wide, imprecise prediction intervals. Moreover, most primary studies examining sex as a risk factor have been conducted in high-income countries [ 50 , 51 ], potentially introducing bias, given that approximately 75% of suicide attempts occur in LMICs [ 4 ], particularly among specific subgroups such as young people. Our results also showed that the middle-aged and 65 years and older group experienced a higher SI than other groups. Although certain studies corroborate these outcomes [ 47 , 52 ], they diverge from other cross-sectional studies that have reported elevated rates among young adults [ 34 , 46 , 53 ]. Reasons for the cross-sectional variation in older adult suicide rates between countries could be due to cultural factors, genetic factors, prevalence of mental illness in the elderly (i.e., depression), life expectancy, socioeconomic status [ 54 , 55 ]. In addition, consistent with other study [ 56 ], our findings showed that those with university education have more likely to have SI and SA. Reasons could be to the academic stress, financial pressure, lack of employment, and fear of poor academic performance among university students, and stigma related to mental health [ 56 – 58 ]. Furthermore, the study reported that current smoking and alcohol problems increased the rates of suicidal ideation, and suicide attempts. These results are aligns with other studies [ 14 ]. The World Organization Health estimates that both smoking and alcohol use disorders significantly contributes to suicide [ 4 , 59 ]. Both drinking alcohol and cigarette smoking is associated with a risk of developing behavioral disorders, mental health problems, physical health problems, which could lead to suicide-related behaviors [ 59 – 61 ]. In addition, the family history (having a relative attempted suicide) was reported as risk factor of SI and SA. The event of suicide among the family can have a great impact between them, both in suicide survivors and the relatives of someone who has died by suicide. They often experience stigma linked to the event, loss intimacy, financial crisis, feeling guilty or blame between members, and may receive inadequate social support [ 62 – 65 ]. Although the previous findings were significant, their association was relatively weak. However, the relationship between IS and SA shows a more robust association, with people with IS being 21% more likely to have attempted suicide at some point in their lives. This finding is consistent with the sequential model of suicidal behavior, which suggests a progressive process that begins with suicidal ideation, continues with planning, progresses to self-harm, and culminates in a suicide attempt. It should be noted that suicidal ideation does not necessarily lead to a suicide attempt, as factors such as personality traits, resilience, psychopathological characteristics, and socio-demographic factors influence the outcome [ 66 ]. Limitations and strengths The study findings should be interpreted considering its methodological limitations. First, given the cross-sectional study design, associations can be drawn but causality cannot be determined. Also, some variables could exhibit reverse causality, such as ever drank alcohol and current smoking. Second, females were the predominant sex of the respondents, which could lead to an overrepresentation of them and may not reflect the entire population of the countries under study. Third, the outcome variables were measured through retrospective self-reports, which might arise social desirability bias due to their stigmatizing nature. Although such statistics might be underestimated [ 67 ], well-trained pollsters collected information with standardized questionnaires. Further studies assessing SI and suicide attempts with standardized validated tools in the post-pandemic stage are required. Fourth, as this study was based on secondary data analysis, it would be favourable to assess other non-included variables such as mental illnesses, drugs use, family environment, emotional problems, and psychological trauma. Fifth, the data used were collected in different years; this temporal discrepancy makes it difficult to compare between countries, since socioeconomic, political and environmental conditions can vary considerably. Sixth, information on smoking and alcohol consumption impeded to determine if they are the result of a medical diagnosis. In spite of these limitations, this is the first multi-country study assessing SI and lifetime suicide attempt among eight LMICs from different continents. Also, sampling errors were adjusted through sample weights. Seventh, suicidal ideation and suicidal behaviors were assessed over two different periods (within the past year and over the lifetime, respectively). Therefore, the temporal discrepancy in this assessment may introduce bias when interpreting the results. Finally, we excluded missing data from the analysis, which reduced the sample size and could affect the representativeness of the results; for that, findings should be interpreted cautiously. Implications for public health LMICs experience poor access to healthcare services, particularly over mental health services provision [ 68 ]. Also, most of these countries have high rates of poverty, violence and inequality [ 69 , 70 ], and poor rates of mental health literacy [ 71 ], among other issues that threatens mental health. These problems have led to LMICs accounting for more than 75% of suicides worldwide [ 4 ]. Given the specific and unique socio-cultural and environmental factors in LMICs, tailored interventions are required to avert suicide targeting vulnerable groups. It is of paramount importance to recognize these differential determinants and develop comprehensive strategies [ 72 ]. Owing to the multidimensional nature of this phenomena, these public health strategies should cover political, financial, social, cultural, science, engineering, educational, religion, and legal areas [ 73 ]. Importantly, countries, such as Malawi and Guyana, should decriminalize suicide as it hampers help-seeking and tracking, and stigmatizes suicide [ 74 ]. Government suicide prevention programmes prioritising screening, timely reference, access to psychotherapeutic and psychopharmacological interventions, and ensuring an appropriate follow-up are urgently needed. In addition, they should limit access to methods of suicide. Conclusions SI and suicide attempts are two major public health concerns in LMICs, but mental healthcare seems to be neglected. Similar characteristics were associated to SI and lifetime suicide attempts in the eight countries under analysis. The strongest association with SI was having a close family member that attempted suicide. Similarly, the strongest association to lifetime suicide attempt was having SI. Improving mental health in LMICs requires multisectoral interventions that are individualised and tailored to the characteristics of each country. Supplementary Information Supplementary Material 1. (29.6KB, docx) Acknowledgements The authors thank the World Health Organization team for collecting the data and making it open access. Authors’ contributions DVZ and SCMO conceptualized the study and developed the methodology. DVZ conducted the formal analysis, supervised the project, and contributed to writing the original draft. SCMO, NMP, AAC, and GYA contributed to the methodology, software implementation, formal analysis, investigation, and writing the original draft. NMP and SCMO curated the data and prepared the visualizations. GAH and YPG contributed to the investigation and writing the original draft. JHV and GJMT validated the findings, provided critical review, editing, and supervised the project. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Data availability The data are open access on request to the World Health Organization team ( https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/steps ). Declarations Ethics approval and consent to participate The data used in our study are publicly available. It does not use personal identifiers (anonymous) and therefore do not pose an ethical risk to participants. Each country was responsible for collecting and managing the STEPS data, and the World Health Organization provided technical support to the implementing agencies in each country. Each implementing agency in each country obtained consent from participants to collect the information needed for the survey. WHO requested the STEPS databases, and the principal investigator agreed to (1) acknowledge the source of the data. (2) Inform WHO of any planned publication before publication. (3) Offer co-authorship of any report or publication using the survey results to the survey coordinator. (4) Use the data only for non-commercial, non-profit public health purposes. In addition, only authorized personnel had access to the database. Consent to collect information was obtained from each adult (18 years and over). In the case of minors (17 years and under), the consent form was read to a parent or legal guardian to allow for the assessment of the minor. There were two consent forms for participants to sign. One is for STEP 1 and 2 and the other is for STEP 3. All signed forms will be kept on file at WHO's Centre for Public Health and Reform. This study did not require approval from an ethics committee as it involved a secondary data analysis of the publicly available WHO STEPS database. The authors had no contact with the study participants, and the accessed data were anonymized, posing no ethical risk for evaluation. Our study adhered to international research ethics standards outlined in the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Footnotes Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. Van Heeringen K, Hawton K, G. Williams JM. Pathways to Suicide: An Integrative Approach. In: The International Handbook of Suicide and Attempted Suicide. Chichester: John Wiley & Sons, Ltd; 2000. p. 223–34. 2. Ministerio de Sanidad, Política Social e Igualdad. Guía de Práctica Clínica de Prevención y Tratamiento de la Conducta Suicida. Santiago de Compostela: Consellería de Sanidad de la Xunta de Galicia; 2012. 3. World Health Organization. Preventing suicide: a global imperative. Geneva: World Health Organization; 2014. [ Google Scholar ] 4. World Health Organization. Suicide. 2025. https://www.who.int/news-room/fact-sheets/detail/suicide . Accessed 10 Apr 2025. 5. GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Lond Engl. 2018;392:1736–88. [ DOI ] [ PMC free article ] [ PubMed ] 6. Naghavi M, Burden G, of Disease Self-Harm Collaborators. Global, regional, and national burden of suicide mortality,. to 2016: systematic analysis for the Global Burden of Disease Study 2016. BMJ. 1990;2019(364):l94. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 7. World Health Organization. World Suicide Prevention Day 2022. World Health Organization. 2023. https://www.who.int/campaigns/world-suicide-prevention-day/2022 . Accessed 19 Feb 2024. 8. World Health Organization. Suicide worldwide in 2019: Global health estimates. Geneva: World Health Organization; 2021. 9. Knipe D, John A, Padmanathan P, Eyles E, Dekel D, Higgins JPT, et al. Suicide and self-harm in low- and middle- income countries during the COVID-19 pandemic: A systematic review. PLOS Glob Public Health. 2022;2:e0000282. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 10. Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Data Resources. 2024. https://ghdx.healthdata.org/gbd-2019 . Accessed 3 Apr 2024. 11. Lovero KL, Dos Santos PF, Come AX, Wainberg ML, Oquendo MA. Suicide in Global Mental Health. Curr Psychiatry Rep. 2023;25:255–62. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 12. Cash R, Patel V. Has COVID-19 subverted global health? The Lancet. 2020;395:1687–8. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 13. Canetto SS, Sakinofsky I. The gender paradox in suicide. Suicide Life Threat Behav. 1998;28:1–23. [ PubMed ] [ Google Scholar ] 14. Dendup T, Zhao Y, Dorji T, Phuntsho S. Risk factors associated with suicidal ideation and suicide attempts in Bhutan: An analysis of the 2014 Bhutan STEPS Survey data. PLoS ONE. 2020;15:e0225888. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 15. World Health Organization. Suicide in the world: global health estimates. Geneva: World Health Organization; 2019. 16. Meda N, Miola A, Slongo I, Zordan MA, Sambataro F. The impact of macroeconomic factors on suicide in 175 countries over 27 years. Suicide Life Threat Behav. 2022;52:49–58. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 17. Turecki G, Brent DA, Gunnell D, O’Connor RC, Oquendo MA, Pirkis J, et al. Suicide and suicide risk. Nat Rev Dis Primer. 2019;5:74. [ DOI ] [ PubMed ] [ Google Scholar ] 18. Cheah YK, Azahadi M, Phang SN, Abd Manaf NH. Sociodemographic, lifestyle and health determinants of suicidal behaviour in Malaysia. Psychiatry Res. 2018;261:319–24. [ DOI ] [ PubMed ] [ Google Scholar ] 19. Elamoshy R, Bird Y, Thorpe LU, Moraros J. Examining the association between diabetes, depressive symptoms, and suicidal ideation among Aboriginal Canadian peoples living off-reserve: a cross-sectional, population-based study. Diabetes Metab Syndr Obes. 2018;11:767–80. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 20. Joung K, Cho S. Association of low blood pressure with suicidal ideation: a cross-sectional study of 10,708 adults with normal or low blood pressure in Korea. BMC Public Health. 2018;18:200. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 21. Moazzami K, Dolmatova EV, Feurdean M. Suicidal ideation among adults with cardiovascular disease: The National Health and Nutrition Examination Survey. Gen Hosp Psychiatry. 2018;51:5–9. [ DOI ] [ PubMed ] [ Google Scholar ] 22. Scott KM, Hwang I, Chiu W-T, Kessler RC, Sampson NA, Angermeyer M, et al. Chronic Physical Conditions and Their Association With First Onset of Suicidal Behavior in the World Mental Health Surveys. Psychosom Med. 2010;72:712. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 23. Henriksen CA, Mather AA, Mackenzie CS, Bienvenu OJ, Sareen J. Longitudinal Associations of Obesity With Affective Disorders and Suicidality in the Baltimore Epidemiologic Catchment Area Follow-up Study. J Nerv Ment Dis. 2014;202:379. [ DOI ] [ PubMed ] [ Google Scholar ] 24. Uddin R, Burton NW, Maple M, Khan SR, Tremblay MS, Khan A. Low physical activity and high sedentary behaviour are associated with adolescents’ suicidal vulnerability: Evidence from 52 low- and middle-income countries. Acta Paediatr. 2020;109:1252–9. [ DOI ] [ PubMed ] [ Google Scholar ] 25. Vancampfort D, Stubbs B, Mugisha J, Firth J, Van Damme T, Smith L, et al. Leisure-time sedentary behavior and suicide attempt among 126,392 adolescents in 43 countries. J Affect Disord. 2019;250:346–53. [ DOI ] [ PubMed ] [ Google Scholar ] 26. Doty B, Bass J, Ryan T, Zhang A, Wilcox H. Systematic review of suicide prevention studies with data on youth and young adults living in low-income and middle-income countries. BMJ Open. 2022;12:e055000. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 27. Yip PSF, Zheng Y, Wong C. Demographic and epidemiological decomposition analysis of global changes in suicide rates and numbers over the period 1990–2019. Inj Prev J Int Soc Child Adolesc Inj Prev. 2022;28:117–24. [ DOI ] [ PubMed ] [ Google Scholar ] 28. Jordans M, Rathod S, Fekadu A, Medhin G, Kigozi F, Kohrt B, et al. Suicidal ideation and behaviour among community and health care seeking populations in five low- and middle-income countries: a cross-sectional study. Epidemiol Psychiatr Sci. 2018;27:393–402. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 29. World Health Organization. WHO STEPS Surveillance Manual: STEPwise approach to NCD risk factor surveillance (STEPS). Geneva: World Health Organization; 2017. [ Google Scholar ] 30. World Health Organization. NCD Microdata Repository. 2024. https://extranet.who.int/ncdsmicrodata/index.php/catalog/?page=1&ps=15 . Accessed 3 Apr 2024. 31. Klonsky ED, May AM, Saffer BY. Suicide, Suicide Attempts, and Suicidal Ideation. Annu Rev Clin Psychol. 2016;12:307–30. [ DOI ] [ PubMed ] [ Google Scholar ] 32. Inder KJ, Handley TE, Johnston A, Weaver N, Coleman C, Lewin TJ, et al. Determinants of suicidal ideation and suicide attempts: parallel cross-sectional analyses examining geographical location. BMC Psychiatry. 2014;14:208. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 33. Liu X, Huang J, Yu NX, Li Q, Zhu T. Mediation Effect of Suicide-Related Social Media Use Behaviors on the Association Between Suicidal Ideation and Suicide Attempt: Cross-Sectional Questionnaire Study. J Med Internet Res. 2020;22:e14940. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 34. Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Suicide and suicidal behavior. Epidemiol Rev. 2008;30:133–54. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 35. Gureje O, Kola L, Uwakwe R, Udofia O, Wakil A, Afolabi E. The profile and risks of suicidal behaviours in the Nigerian Survey of Mental Health and Well-Being. Psychol Med. 2007;37:821–30. [ DOI ] [ PubMed ] [ Google Scholar ] 36. Joe S, Stein DJ, Seedat S, Herman A, Williams DR. Non-fatal suicidal behavior among South Africans : results from the South Africa Stress and Health Study. Soc Psychiatry Psychiatr Epidemiol. 2008;43:454–61. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 37. Klonsky ED, Dixon-Luinenburg T, May AM. The critical distinction between suicidal ideation and suicide attempts. World Psychiatry Off J World Psychiatr Assoc WPA. 2021;20:439–41. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 38. Stack S. Contributing factors to suicide: Political, social, cultural and economic. Prev Med. 2021;152(Pt 1): 106498. [ DOI ] [ PubMed ] [ Google Scholar ] 39. Amnesty International. Amnesty International Report 2021/22: The state of the world’s human rights. United Kingdom: British Library; 2022. 40. Arafat SMY, Baminiwatta A, Menon V, Singh R, Varadharajan N, Guhathakurta S, et al. Prevalence of suicidal behaviour among students living in Muslim-majority countries: systematic review and meta-analysis. BJPsych Open. 2023;9:e67. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 41. Steinmetz LCL. Perfil de métodos en intentos de suicidio: tendencias e implicancias para la prevención. Jujuy, noroeste de Argentina. Ciencias Psicológicas. 2019;13(2):197–208. 42. Machorro MS y, Moreno DLC. Suicidio: epidemiología, clínica, manejo y prevención. Neurol Neurocir Psiquiatr. 2024;52:11–20. 43. Health M, Use S. LIVE LIFE: An implementation guide for suicide prevention in countries. Geneva: World Health Organization; 2021. [ Google Scholar ] 44. Bruffaerts R, Demyttenaere K, Hwang I, Chiu W-T, Sampson N, Kessler RC, et al. Treatment of suicidal people around the world. Br J Psychiatry J Ment Sci. 2011;199:64–70 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 45. Borges G, Nock MK, Haro Abad JM, Hwang I, Sampson NA, Alonso J, et al. Twelve-month prevalence of and risk factors for suicide attempts in the World Health Organization World Mental Health Surveys. J Clin Psychiatry. 2010;71:1617–28. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 46. Bromet EJ, Havenaar JM, Tintle N, Kostyuchenko S, Kotov R, Gluzman S. Suicide ideation, plans and attempts in Ukraine: findings from the Ukraine World Mental Health Survey. Psychol Med. 2007;37:807–19. [ DOI ] [ PubMed ] [ Google Scholar ] 47. Cabello M, Miret M, Ayuso-Mateos JL, Caballero FF, Chatterji S, Tobiasz-Adamczyk B, et al. Cross-national prevalence and factors associated with suicide ideation and attempts in older and young-and-middle age people. Aging Ment Health. 2019;24:1533–42. [ DOI ] [ PubMed ] [ Google Scholar ] 48. Wang N, Yan X, Imm K, Xu T, Li S, Gawronska J, et al. Racial and ethnic disparities in prevalence and correlates of depressive symptoms and suicidal ideation among adults in the United States, 2017–2020 pre-pandemic. J Affect Disord. 2024;345:272–83. [ DOI ] [ PubMed ] [ Google Scholar ] 49. Richardson C, Robb KA, McManus S, O’Connor RC. Psychosocial factors that distinguish between men and women who have suicidal thoughts and attempt suicide: findings from a national probability sample of adults. Psychol Med. 2023;53:3133–41. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 50. Renaud J, MacNeil SL, Vijayakumar L, Spodenkiewicz M, Daniels S, Brent DA, et al. Suicidal ideation and behavior in youth in low- and middle-income countries: A brief review of risk factors and implications for prevention. Front Psychiatry. 2022;13:1044354. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 51. Favril L, Yu R, Geddes JR, Fazel S. Individual-level risk factors for suicide mortality in the general population: an umbrella review. Lancet Public Health. 2023;8:e868–77. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 52. Biswas T, Scott JG, Munir K, Renzaho AMN, Rawal LB, Baxter J, et al. Global variation in the prevalence of suicidal ideation, anxiety and their correlates among adolescents: A population based study of 82 countries. EClinicalMedicine. 2020;24: 100395. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 53. Lawrence HR, Burke TA, Sheehan AE, Pastro B, Levin RY, Walsh RFL, et al. Prevalence and correlates of suicidal ideation and suicide attempts in preadolescent children: A US population-based study. Transl Psychiatry. 2021;11:1–10. [ DOI ] [ PMC free article ] [ PubMed ] 54. Shah A. The relationship between suicide rates and age: an analysis of multinational data from the World Health Organization. Int Psychogeriatr. 2007;19:1141–52. [ DOI ] [ PubMed ] [ Google Scholar ] 55. Shah A, Padayatchi M, Das K. The relationship between elderly suicide rates and elderly dependency ratios: a cross-national study using data from the WHO data bank. Int Psychogeriatr. 2008;20:596–604. [ DOI ] [ PubMed ] [ Google Scholar ] 56. Garg S, Kharb A, Bansal K. What covariates drive medical students to the brink of suicidal ideation, plan, and attempt? A double-centric cross-sectional study in a resource-constrained rural setting in North India. Indian J Psychiatry. 2023;65:431–42. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 57. Ajibola AO, Agunbiade OM. Suicide Ideation and Its Correlates Among University Undergraduates in South Western Nigeria. Community Health Equity Res Policy. 2022;43:45–58. [ DOI ] [ PubMed ] [ Google Scholar ] 58. Seo C, Di Carlo C, Dong SX, Fournier K, Haykal K-A. Risk factors for suicidal ideation and suicide attempt among medical students: A meta-analysis. PLoS ONE. 2021;16:e0261785. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 59. World Health Organization. Alcohol. 2022. https://www.who.int/news-room/fact-sheets/detail/alcohol . Accessed 2 Apr 2024. 60. Green M, Turner S, Sareen J. Smoking and suicide: biological and social evidence and causal mechanisms. J Epidemiol Community Health. 2017;71:839–40. [ DOI ] [ PubMed ] [ Google Scholar ] 61. Harrison R, Munafò MR, Davey Smith G, Wootton RE. Examining the effect of smoking on suicidal ideation and attempts: triangulation of epidemiological approaches. Br J Psychiatry J Ment Sci. 2020;217:701–7. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 62. Ara M, Uddin M, Kabir M. The causes of suicide and Impact of society in Bangladesh. Int Res J Soc Sci. 2016;5:25–35. [ Google Scholar ] 63. Pitman A, Osborn D, King M, Erlangsen A. Effects of suicide bereavement on mental health and suicide risk. Lancet Psychiatry. 2014;1:86–94. [ DOI ] [ PubMed ] [ Google Scholar ] 64. Sveen C-A, Walby FA. Suicide survivors’ mental health and grief reactions: a systematic review of controlled studies. Suicide Life Threat Behav. 2008;38:13–29. [ DOI ] [ PubMed ] [ Google Scholar ] 65. Tsukahara T, Arai H, Kamijo T, Kobayashi Y, Washizuka S, Arito H, et al. The Relationship between Attitudes toward Suicide and Family History of Suicide in Nagano Prefecture, Japan. Int J Environ Res Public Health. 2016;13:623. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 66. Lewitzka U, Spirling S, Ritter D, Smolka M, Goodday S, Bauer M, et al. Suicidal Ideation vs. Suicide Attempts: Clinical and Psychosocial Profile Differences Among Depressed Patients: A Study on Personality Traits, Psychopathological Variables, and Sociodemographic Factors in 228 Patients. J Nerv Ment Dis. 2017;205:361–71. [ DOI ] [ PubMed ] 67. Tøllefsen IM, Hem E, Ekeberg Ø. The reliability of suicide statistics: a systematic review. BMC Psychiatry. 2012;12:9. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 68. Rathod S, Pinninti N, Irfan M, Gorczynski P, Rathod P, Gega L, et al. Mental Health Service Provision in Low- and Middle-Income Countries. Health Serv Insights. 2017;10:1178632917694350. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 69. Hanandita W, Tampubolon G. Does poverty reduce mental health? An instrumental variable analysis. Soc Sci Med. 1982;2014(113):59–67. [ DOI ] [ PubMed ] [ Google Scholar ] 70. Ribeiro WS, Andreoli SB, Ferri CP, Prince M, Mari JJ. Exposure to violence and mental health problems in low and middle-income countries: a literature review. Rev Bras Psiquiatr Sao Paulo Braz. 1999;2009(31 Suppl 2):S49-57. [ DOI ] [ PubMed ] [ Google Scholar ] 71. Ganasen KA, Parker S, Hugo CJ, Stein DJ, Emsley RA, Seedat S. Mental health literacy: focus on developing countries. Afr J Psychiatry. 2008;11:23–8. [ DOI ] [ PubMed ] [ Google Scholar ] 72. Vijayakumar L, Ray S, Fernandes TN, Pathare S. A descriptive mapping review of suicide in vulnerable populations in low and middle countries. Asia-Pac Psychiatry Off J Pac Rim Coll Psychiatr. 2021;13:e12472. [ DOI ] [ PubMed ] [ Google Scholar ] 73. Jacob KS. Suicide prevention in low- and middle-income countries: part perceptions, partial solutions. Br J Psychiatry J Ment Sci. 2017;211:264–5. [ DOI ] [ PubMed ] [ Google Scholar ] 74. Ochuku BK, Johnson NE, Osborn TL, Wasanga CM, Ndetei DM. Centering decriminalization of suicide in low - and middle - income countries on effective suicide prevention strategies. Front Psychiatry. 2022;13:1034206. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Supplementary Materials Supplementary Material 1. (29.6KB, docx) Data Availability Statement The data are open access on request to the World Health Organization team ( https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/steps ). Articles from BMC Psychiatry are provided here courtesy of BMC ACTIONS View on publisher site PDF (994.7 KB) Cite Collections Permalink RESOURCES Similar articles Cited by other articles Links to NCBI Databases Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top

Related documents

• Suicide Re Attempts in Young Adults After First Suicide Attempt : Socio-demographic, Clinical and Biological Correlates#807590
• Identifying important predictors of adolescent suicide ideation, planning, and attempt in low- and middle-income countries.#659744
• Non-suicidal self-injury and other key predictors of suicide deaths among children and adolescents in England: a population-based case-control study.#1107509
• Psychosocial factors of deliberate self-harm in Afghanistan: a hospital based, matched case-control study#135238
• Among key social determinants, connection associated with lowest odds of non-suicidal self-injury and suicidal ideation among Australian youth.#312726