More research needed on poverty and suicide
Understanding socio-economic causes crucial to effective prevention
GLOBALLY, 800 000 people die by suicide each year with the number expected to rise to 1.53 million by 2020. It is estimated 75 percent of suicides occur in low and middle- income countries (LMICs), where rates of poverty are high and medical resources are scarce.
This problem prompted researchers from the Psychology Department at Stellenbosch University and the Department of Psychiatry at UCT to join forces with researchers from the London School of Economics and Political Science to investigate the links between poverty and suicide.
As part of this study, we systematically reviewed all published studies on links between poverty and suicide in LMICs.
Our research, which was published in Lancet Psychiatry, found there 37 studies had been conducted in LMICs exploring the association between economic poverty and suicidal ideation and behaviour.
This highlights the lack of research on this topic.
We found that at the individual level there is consistent evidence to support a positive association between poverty and suicide risk.
In particular, suicidal ideations and behaviours are associated with low economic status, diminished wealth and unemployment.
Less evidence was found on the association between suicidal ideations and behaviours and relative poverty, financial problems, debt and being the recipient of welfare support.
There is no evidence of links between absolute poverty and suicidal ideations and behaviours in LMICs.
At the country level we could not find enough evidence to draw any firm conclusions.
We found some evidence of associations between suicidal ideations and behaviours and both chronic poverty and acute economic events, such as crop failure.
No evidence was found of an association with economic crisis and national-level inequalities.
It is important for suicide prevention to understand the relationship between poverty and suicidal behaviour, especially in LMICs where rates of poverty and suicide are high and where the impact of suicidal behaviour is substantial. Suicide is not only a human tragedy for those bereaved by the death of a loved one, it also has economic and social costs.
In high income countries the mean costs per suicide has been estimated to range from $400 000 to $4.3 million.
Little is known about the economic costs of suicides in LMICs, even though LMICs account for the majority of the top 10 suicide rates worldwide.
Rates of attempted suicide are significantly higher than suicide rates; it is estimated that for every completed suicide there are approximately 20 non-fatal attempts.
For every suicide attempt an estimated 10 people experience thoughts of killing themselves.
While it is well established psychiatric factors contribute to suicide, there is growing evidence that socio-economic factors, such as poverty, financial crisis, indebtedness and unemployment are also associated with suicide risk.
In high income countries, suicide has been associated with economic inequalities and economic shocks.
Interestingly, suicide rates seem to increase in response to sudden recessions and rapid economic booms.
The impact of unemployment on suicide in high income countries has been extensively investigated in the wake of recent global economic crises.
In Australia, rates of suicide increased along with unemployment rates following the 20062008 economic crisis.
Similar patterns were reported in Japan, South Korea and Hong Kong following the 1997-1998 Asian economic crisis.
The strength of the association between poverty and suicide also depends on a variety of socio-demographic, geographic, and cultural factors.
Following the recent economic crises, materially deprived men in rural Portugal were more vulnerable to suicide than the general population.
However, the impact of the economic recession in Portugal, compared with other European countries, was buffered by strong family networks in the country.
This demonstrates how cultural factors can mediate the relationship between poverty and suicide.
Similarly, social welfare safety nets in Nordic countries were protective against suicides in the wake of economic uncertainty following the collapse of the Soviet Union.
While much is known about the links between poverty and suicide in high income countries, comparatively little is known about this relationship in LMICs, which is home to the world’s poor and economically vulnerable.
There are good reasons why we need to have a better understanding of the links between poverty and suicide in LMICs.
Without this understanding, we are reliant on psychiatric and medical interventions to deal with this issue.
Typically, suicide prevention programmes focus on population-wide interventions aimed at recognising risk and promoting access to psychiatric care, without giving attention to the socio-economic determinants of suicide, such as poverty.
This strategy is likely to be ineffective and difficult to implement in LMICs where there is typically a dearth of mental health services; there are less than 0.5 psychiatrists per 100 000 people in LMICs, compared to 6.6 per 100 000 in other parts of the world.
Our research highlights the need for more investigation into the relationship between suicidality and poverty.
Suicidal thoughts and behaviours are a multi-dimensional phenomenon that results from a complex interaction between personal characteristics and situational, socio-cultural and economic factors.
The studies we examined only focused on economic poverty and did not consider other dimensions of poverty (such as education, health and food insecurity) and people’s subjective experience of living in poverty.
In order to understand how poverty is related to suicidal ideations and behaviours, we will need to explore the association with non-economic poverty, cultural contexts and people’s subjective experience of living in poverty.
This review was an important milestone, but there is still much work to be done in this field.
SUICIDAL IDEATIONS AND BEHAVIOURS ARE ASSOCIATED WITH LOW ECONOMIC STATUS, DIMINISHED WEALTH AND UNEMPLOYMENT
Dr Jason Bantjes is a senior lecturer in the Department of Psychology at Stellenbosch University. Valentina Iemmi is a research fellow in the Personal Social Services Research Unit at the London School of Economics and Political Science.