Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom.
Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom.
PLoS Med. 2019 Oct 9;16(10):e1002905. doi: 10.1371/journal.pmed.1002905. eCollection 2019 Oct.
Psychiatric disorders are reported to be present in 80% to 90% of suicide deaths in high-income countries (HIC), but this association is less clear in low- and middle-income countries (LMIC). There has been no previous systematic review of this issue in LMIC. The current study aims to estimate the prevalence of psychiatric morbidity in individuals with suicidal behaviour in LMIC.
PubMed, PsycINFO, and EMBASE searches were conducted to identify quantitative research papers (any language) between 1990 and 2018 from LMIC that reported on the prevalence of psychiatric morbidity in suicidal behaviour. We used meta-analytic techniques to generate pooled estimates for any psychiatric disorder and specific diagnosis based on International classification of disease (ICD-10) criteria. A total of 112 studies (154 papers) from 26 LMIC (India: 25%, China: 15%, and other LMIC: 60%) were identified, including 18 non-English articles. They included 30,030 individuals with nonfatal suicidal behaviour and 4,996 individuals who had died by suicide. Of the 15 studies (5 LMIC) that scored highly on our quality assessment, prevalence estimates for psychiatric disorders ranged between 30% and 80% in suicide deaths and between 3% and 86% in those who engaged in nonfatal suicidal behaviour. There was substantial heterogeneity between study estimates. Fifty-eight percent (95% CI 46%-71%) of those who died by suicide and 45% (95% CI 30%-61%) of those who engaged in nonfatal suicidal behaviour had a psychiatric disorder. The most prevalent disorder in both fatal and nonfatal suicidal behaviour was mood disorder (25% and 21%, respectively). Schizophrenia and related disorders were identified in 8% (4%-12%) of those who died by suicide and 7% (3%-11%) of those who engaged in nonfatal suicidal behaviour. In nonfatal suicidal behaviour, anxiety disorders, and substance misuse were identified in 19% (1%-36%) and 11% (7%-16%) of individuals, respectively. This systematic review was limited by the low number of high-quality studies and restricting our searches to databases that mainly indexed English language journals.
Our findings suggest a possible lower prevalence of psychiatric disorders in suicidal behaviour in LMIC. We found very few high-quality studies and high levels of heterogeneity in pooled estimates of psychiatric disorder, which could reflect differing study methods or real differences. There is a clear need for more robust evidence in order for LMIC to strike the right balance between community-based and mental health focussed interventions.
据报道，在高收入国家（HIC），80%至 90%的自杀死亡与精神障碍有关，但在中低收入国家（LMIC），这种关联不太明确。以前没有对这一问题进行过系统的综述。本研究旨在评估 LMIC 中自杀行为者的精神疾病发病率。
对 1990 年至 2018 年期间来自 LMIC 的定量研究论文（任何语言）进行了 PubMed、PsycINFO 和 EMBASE 搜索，这些论文报告了自杀行为中精神疾病发病率。我们使用荟萃分析技术，根据国际疾病分类（ICD-10）标准，生成任何精神障碍和特定诊断的汇总估计值。从 26 个 LMIC 中确定了 112 项研究（154 篇论文）（印度：25%，中国：15%，其他 LMIC：60%），其中包括 18 篇非英文文章。它们包括 30030 名非致命性自杀行为者和 4996 名自杀死亡者。在我们的质量评估中，15 项研究（5 项来自 LMIC）得分较高，精神障碍的发病率在自杀死亡者中为 30%至 80%，在非致命性自杀行为者中为 3%至 86%。研究估计之间存在很大的异质性。58%（95%CI 46%-71%）的自杀死亡者和 45%（95%CI 30%-61%）的非致命性自杀行为者患有精神障碍。在致命和非致命自杀行为中最常见的障碍是心境障碍（分别为 25%和 21%）。在自杀死亡者中，精神分裂症和相关障碍占 8%（4%-12%），在非致命性自杀行为者中占 7%（3%-11%）。在非致命性自杀行为中，焦虑障碍和物质使用障碍分别占 19%（1%-36%）和 11%（7%-16%）。本系统评价受到高质量研究数量较少以及将检索范围仅限于主要索引英文期刊的数据库的限制。
我们的研究结果表明，在 LMIC 中，自杀行为中精神疾病的发病率可能较低。我们发现很少有高质量的研究，并且精神障碍的汇总估计值存在高度异质性，这可能反映了不同的研究方法或真实的差异。为了使 LMIC 在以社区为基础的干预和以心理健康为重点的干预之间取得适当的平衡，显然需要更有力的证据。
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