Suicide attempts, plans, and ideation in culturally diverse sites: the WHO SUPRE-MISS community survey.
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.
Bertolote
José M
JM
Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland. bertolotej@who.int
Fleischmann
Alexandra
A
De Leo
Diego
D
Bolhari
Jafar
J
Botega
Neury
N
De Silva
Damani
D
Tran Thi Thanh
Huong
H
Phillips
Michael
M
Schlebusch
Lourens
L
Värnik
Airi
A
Vijayakumar
Lakshmi
L
Wasserman
Danuta
D
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