Treatment of suicidal people around the world.
BACKGROUND
Suicide is a leading cause of death worldwide; however, little information is available about the treatment of suicidal people, or about barriers to treatment.


OBJECTIVE
To examine the receipt of mental health treatment and barriers to care among suicidal people around the world.


METHODS
Twenty-one nationally representative samples worldwide (n=55 302; age 18 years and over) from the World Health Organization's World Mental Health Surveys were interviewed regarding past-year suicidal behaviour and past-year healthcare use. Suicidal respondents who had not used services in the past year were asked why they had not sought care.


RESULTS
Two-fifths of the suicidal respondents had received treatment (from 17% in low-income countries to 56% in high-income countries), mostly from a general medical practitioner (22%), psychiatrist (15%) or non-psychiatrist (15%). Those who had actually attempted suicide were more likely to receive care. Low perceived need was the most important reason for not seeking help (58%), followed by attitudinal barriers such as the wish to handle the problem alone (40%) and structural barriers such as financial concerns (15%). Only 7% of respondents endorsed stigma as a reason for not seeking treatment.


CONCLUSIONS
Most people with suicide ideation, plans and attempts receive no treatment. This is a consistent and pervasive finding, especially in low-income countries. Improving the receipt of treatment worldwide will have to take into account culture-specific factors that may influence the process of help-seeking.
Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), University Hospitals Gasthuisberg, Leuven, Belgium. ronny.bruffaerts@med.kuleuven.be
Ronny
R
Bruffaerts
Koen
K
Demyttenaere
Irving
I
Hwang
Wai-Tat
WT
Chiu
Nancy
N
Sampson
Ronald C
RC
Kessler
Jordi
J
Alonso
Guilherme
G
Borges
Giovanni
G
de Girolamo
Ron
R
de Graaf
Silvia
S
Florescu
Oye
O
Gureje
Chiyi
C
Hu
Elie G
EG
Karam
Norito
N
Kawakami
Stanislav
S
Kostyuchenko
Viviane
V
Kovess-Masfety
Sing
S
Lee
Daphna
D
Levinson
Herber
H
Matschinger
Jose
J
Posada-Villa
Rajesh
R
Sagar
Kate M
KM
Scott
Dan J
DJ
Stein
Toma
T
Tomov
Maria Carmen
MC
Viana
Matthew K
MK
Nock
D003431:Cross-Cultural Comparison; D019049:Developed Countries / Q000706:statistics & numerical data; D003906:Developing Countries / Q000706:statistics & numerical data; D014943:Global Health; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006306:Health Surveys; D054625:Healthcare Disparities; D006801:Humans; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D014944:World Health Organization; D000092864:Suicide Prevention
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