Substance use and suicidal ideation and behaviour in low- and middle-income countries: a systematic review

Abstract

BackgroundUnderstanding relationships between substance use and suicidal ideation and behaviour (SIB) has important public health implications for suicide prevention in low- and middle-income countries (LMICs), where 75% of suicides occur. This systematic review explored the associations between substance use and SIB in LMICs.MethodsWe searched five databases using a combination of keywords for substance use, SIB and LMICs to identify English-written quantitative studies published between January 2006 and February 2016. Data were extracted to provide an overview of what is known about the topic, highlight gaps in the literature, and explore the implications of current knowledge for suicide prevention. Studies included in the review were assessed for methodological quality using the Scottish Intercollegiate Guidelines Network checklist.ResultsAnalysis of included studies (N = 108) demonstrated a consistent positive association between substance use and SIB across all substances (i.e. alcohol, tobacco, cannabis, illicit drugs, non-medical use of prescription drugs), all substance use dimensions (i.e. intoxication, use, and pathological use) and all SIB dimensions (i.e. suicidal ideation, non-fatal suicidal behaviour, and suicide). Most of the available research evidence comes from upper-middle-income countries, only 22% comes from lower-middle-income and low-income countries. Most studies focused on alcohol and tobacco, while neglecting substances such as cannabis, opioids, sedatives, stimulants, misuse of prescription medication, inhalants, and hallucinogens. Most of the studies employed a cross-sectional design, were conducted within a risk-factor paradigm, and provided little information about the potential interaction between variables.ConclusionsPublic health suicide prevention policy and research in LMICs should take account of the fact that: substance use is a potentially modifiable risk factor; assessment and management of substance use is integral to the care of at-risk patients; reducing consumption and hazardous use of substances in LMICs is important for suicide prevention; and research needs to be expanded to include more theory driven research that focuses on all substance use dimensions and SIB dimensions, while employing more sophisticated statistical methods.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5425-6) contains supplementary material, which is available to authorized users.

Suicide among people treated for drug use disorders: a Danish national record-linkage study

“…The prevalence of psychiatric care among those who did not commit suicide were 1461 (1.1%) in the control group versus 4619 (18.6%) in patients treated for DUD. Figure 2 shows the Nelson-Aalen cumulative incidence of suicide for all four groups (i.e., [1] people with a history of treatment for DUD without psychiatric history, [2] people with a history of treatment for DUD with psychiatric history, [3] people with no history of treatment for alcohol or DUD without psychiatric history, and [4] people with no history of treatment for alcohol or DUD with psychiatric history.…”

“…Several meta-analytic studies have reported an association between substance use, including alcohol and illicit drug use on the one hand, and suicidal ideation, suicide attempts, and suicide death on the other [3,4]. A recent meta-analysis found that in case-control psychological autopsy studies, the presence of a drug use disorder (DUD) was associated with a 7-fold increase in suicide [5].…”

Lifestyle Interventions and Prevention of Suicide

“…Bowden et al ( 97 ) in a large cohort study of 2,803,457 residents of Wales, UK, highlighted the relationship between emergency alcohol-related hospital admission and the increased risk of suicide. A recent systematic review of 108 studies explored the associations between substance use and suicide risk in low- and middle-income countries ( 98 ) demonstrated an association between alcohol use, intoxication and pathological use of alcohol, tobacco, cannabis, illicit drugs and non-medical use of prescription drugs and suicide risk. Furthermore, Choi et al ( 99 ) examined blood alcohol concentration (BAC) among suicide decedents aged 50 years or older.…”

Suicide ideation, attempt, and determinants among medical students Northwest Ethiopia: an institution-based cross-sectional study

“…Even though suicidal behavior has a high prevalence among medical students, most available research evidence comes from developed countries, and little attention is paid to lower-middle-income and lower-income countries [26]. To the best of our knowledge, there has been no published study on suicide ideation, attempt, and associated factors among medical students in Ethiopia.…”