title: 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.
abstract: Suicidal behaviours are one of the most important contributors to the global burden of disease among women, but little is known about prevalence and modifiable risk factors in low and middle income countries. We use data from the WHO multi-country study on women's health and domestic violence against women to examine the prevalence of suicidal thoughts and attempts, and relationships between suicide attempts and mental health status, child sexual abuse, partner violence and other variables. Population representative cross-sectional household surveys were conducted from 2000-2003 in 13 provincial (more rural) and city (urban) sites in Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia, Thailand and Tanzania. 20967 women aged 15-49 years participated. Prevalence of lifetime suicide attempts, lifetime suicidal thoughts, and suicidal thoughts in the past four weeks were calculated, and multivariate logistic regression models were fit to examine factors associated with suicide attempts in each site. Prevalence of lifetime suicide attempts ranged from 0.8% (Tanzania) to 12.0% (Peru city); lifetime thoughts of suicide from 7.2% (Tanzania province) to 29.0% (Peru province), and thoughts in the past four weeks from 1.9% (Serbia) to 13.6% (Peru province). 25-50% of women with suicidal thoughts in the past four weeks had also visited a health worker in that time. The most consistent risk factors for suicide attempts after adjusting for probable common mental health disorders were: intimate partner violence, non-partner physical violence, ever being divorced, separated or widowed, childhood sexual abuse and having a mother who had experienced intimate partner violence. Mental health policies and services must recognise the consistent relationship between violence and suicidality in women in low and middle income countries. Training health sector workers to recognize and respond to the consequences of violence may substantially reduce the health burden associated with suicidal behaviour.
authors.affiliation: London School of Hygiene & Tropical Medicine (LSHTM), Public Health and Policy, 36 Gordon Square, London WC1H 0DP, United Kingdom. karen.devries@lshtm.ac.uk
authors.forename: Karen
authors.initials: K
authors.lastname: Devries
authors.forename: Charlotte
authors.initials: C
authors.lastname: Watts
authors.forename: Mieko
authors.initials: M
authors.lastname: Yoshihama
authors.forename: Ligia
authors.initials: L
authors.lastname: Kiss
authors.forename: Lilia Blima
authors.initials: LB
authors.lastname: Schraiber
authors.forename: Negussie
authors.initials: N
authors.lastname: Deyessa
authors.forename: Lori
authors.initials: L
authors.lastname: Heise
authors.forename: Julia
authors.initials: J
authors.lastname: Durand
authors.forename: Jessie
authors.initials: J
authors.lastname: Mbwambo
authors.forename: Henrica
authors.initials: H
authors.lastname: Jansen
authors.forename: Yemane
authors.initials: Y
authors.lastname: Berhane
authors.forename: Mary
authors.initials: M
authors.lastname: Ellsberg
authors.forename: Claudia
authors.initials: C
authors.lastname: Garcia-Moreno
mesh_terms: D000293:Adolescent; D000328:Adult; D054523:Adult Survivors of Child Abuse; D003430:Cross-Sectional Studies; D003906:Developing Countries; D017579:Domestic Violence / Q000523:psychology*; D005260:Female; D006801:Humans; D038622:Internationality; D013406:Suicide, Attempted / Q000639:trends*; D014944:World Health Organization; D055815:Young Adult