title: Suicide attempts, plans, and ideation in culturally diverse sites: the WHO SUPRE-MISS community survey.
abstract: BACKGROUND
  The objectives were to assess thoughts about suicide, plans to commit suicide and suicide attempts in the community, to investigate the use of health services following a suicide attempt, and to describe basic socio-cultural indices of the community.
  
  
  METHODS
  The community survey was one component of the larger WHO multisite intervention study on suicidal behaviours (SUPRE-MISS). In each site, it aimed at randomly selecting and interviewing at least 500 subjects of the general population living in the catchment area of the emergency department where the intervention component of the study was conducted. Communities of eight SUPRE-MISS sites (in Brazil, China, Estonia, India, Iran, South Africa, Sri Lanka, and Viet Nam) participated plus two additional sites from Australia and Sweden conducting similar surveys.
  
  
  RESULTS
  Suicide attempts (0.4-4.2%), plans (1.1-15.6%), and ideation (2.6-25.4%) varied by a factor of 10-14 across sites, but remained mostly within the ranges of previously published data. Depending on the site, the ratios between attempts, plans, and thoughts of suicide differed substantially. Medical attention following a suicide attempt varied between 22% and 88% of the attempts.
  
  
  CONCLUSIONS
  The idea of the suicidal process as a continuous and smooth evolution from thoughts to plans and attempts of suicide needs to be further investigated as it seems to be dependent on the cultural setting. There are indications, that the burden of undetected attempted suicide is high in different cultures; an improved response from the health sector on how to identify and support these individuals is needed.
authors.affiliation: Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland. bertolotej@who.int
authors.forename: José M
authors.initials: JM
authors.lastname: Bertolote
authors.forename: Alexandra
authors.initials: A
authors.lastname: Fleischmann
authors.forename: Diego
authors.initials: D
authors.lastname: De Leo
authors.forename: Jafar
authors.initials: J
authors.lastname: Bolhari
authors.forename: Neury
authors.initials: N
authors.lastname: Botega
authors.forename: Damani
authors.initials: D
authors.lastname: De Silva
authors.forename: Huong
authors.initials: H
authors.lastname: Tran Thi Thanh
authors.forename: Michael
authors.initials: M
authors.lastname: Phillips
authors.forename: Lourens
authors.initials: L
authors.lastname: Schlebusch
authors.forename: Airi
authors.initials: A
authors.lastname: Värnik
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Vijayakumar
authors.forename: Danuta
authors.initials: D
authors.lastname: Wasserman
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D001938:Brazil / Q000453:epidemiology; D002681:China / Q000453:epidemiology; D003431:Cross-Cultural Comparison; D004957:Estonia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007492:Iran / Q000453:epidemiology; D008297:Male; D013019:South Africa / Q000453:epidemiology; D013188:Sri Lanka / Q000453:epidemiology; D013406:Suicide, Attempted / Q000208:ethnology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D013850:Thinking; D014744:Vietnam / Q000453:epidemiology