title: Suicidal ideation and behaviour among community and health care seeking populations in five low- and middle-income countries: a cross-sectional study.
abstract: AimsSuicidal behaviour is an under-reported and hidden cause of death in most low- and middle-income countries (LMIC) due to lack of national systematic reporting for cause-specific mortality, high levels of stigma and religious or cultural sanctions. The lack of information on non-fatal suicidal behaviour (ideation, plans and attempts) in LMIC is a major barrier to design and implementation of prevention strategies. This study aims to determine the prevalence of non-fatal suicidal behaviour within community- and health facility-based populations in LMIC.
  
  
  
  Twelve-month prevalence of suicidal ideation, plans and attempts were established through community samples (n = 6689) and primary care attendees (n = 6470) from districts in Ethiopia, Uganda, South Africa, India and Nepal using the Composite International Diagnostic Interview suicidality module. Participants were also screened for depression and alcohol use disorder.
  
  
  
  We found that one out of ten persons (10.3%) presenting at primary care facilities reported suicidal ideation within the past year, and 1 out of 45 (2.2%) reported attempting suicide in the same period. The range of suicidal ideation was 3.5-11.1% in community samples and 5.0-14.8% in health facility samples. A higher proportion of facility attendees reported suicidal ideation than community residents (10.3 and 8.1%, respectively). Adults in the South African facilities were most likely to endorse suicidal ideation (14.8%), planning (9.5%) and attempts (7.4%). Risk profiles associated with suicidal behaviour (i.e. being female, younger age, current mental disorders and lower educational and economic status) were highly consistent across countries.
  
  
  
  The high prevalence of suicidal ideation in primary care points towards important opportunities to implement suicide risk reduction initiatives. Evidence-supported strategies including screening and treatment of depression in primary care can be implemented through the World Health Organization's mental health Global Action Programme suicide prevention and depression treatment guidelines. Suicidal ideation and behaviours in the community sample will require detection strategies to identify at risks persons not presenting to health facilities.
authors.affiliation: Research and Development Department,HealthNet TPO-Amsterdam,Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Jordans
authors.affiliation: Department of Population Health,London School of Hygiene and Tropical Medicine,London,UK.
authors.forename: S
authors.initials: S
authors.lastname: Rathod
authors.affiliation: Department of Psychiatry,School of Medicine, College of Health Sciences, Addis Ababa University,Addis Ababa,Ethiopia.
authors.forename: A
authors.initials: A
authors.lastname: Fekadu
authors.affiliation: Aklilu Lemma Institute of Pathobiology,Addis Ababa University,Addis Ababa,Ethiopia.
authors.forename: G
authors.initials: G
authors.lastname: Medhin
authors.affiliation: Butabika National Referral and Teaching Mental Hospital,Makerere University,Kampala,Uganda.
authors.forename: F
authors.initials: F
authors.lastname: Kigozi
authors.affiliation: Duke Global Health Institute,Duke University,Durham,USA.
authors.forename: B
authors.initials: B
authors.lastname: Kohrt
authors.affiliation: Transcultural Psychosocial Organization (TPO),Kathmandu,Nepal.
authors.forename: N
authors.initials: N
authors.lastname: Luitel
authors.affiliation: Centre for Rural Health,School of Nursing and Public Health,University of KwaZulu-Natal,Durban,South Africa.
authors.forename: I
authors.initials: I
authors.lastname: Petersen
authors.affiliation: Centre for the Control of Chronic Conditions, Public Health Foundation of India,New Delhi,India;Sangath,India.
authors.forename: R
authors.initials: R
authors.lastname: Shidhaye
authors.affiliation: Butabika National Referral and Teaching Mental Hospital,Makerere University,Kampala,Uganda.
authors.forename: J
authors.initials: J
authors.lastname: Ssebunnya
authors.affiliation: Center for Global Mental Health,London School of Hygiene and Tropical Medicine,London,UK.
authors.forename: V
authors.initials: V
authors.lastname: Patel
authors.affiliation: Department of Psychiatry and Mental Health,Alan J Flisher Centre for Public Mental Health,University of Cape Town,Cape Town,South Africa.
authors.forename: C
authors.initials: C
authors.lastname: Lund
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D006306:Health Surveys; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D012959:Socioeconomic Factors; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*
keywords: Low- and middle-income countries; suicidal behaviour; suicidal ideation