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Only a Minority of Persons Who Are Suicidal Receive Treatment

Leslie Citrome, MD, MPH

Bruffaerts R, Demyttenaere K, Hwang I, et al
Br J Psychiatry. 2011;199:64-70

Study Summary

This is a report on mental health treatment and potential barriers to care among suicidal adults around the world. Six continents, including Africa (Nigeria and South Africa), Asia (India, Israel, Japan, Lebanon, and China [Beijing, Shanghai, and Shenzhen]), Australasia (New Zealand), Europe (Belgium, Bulgaria, France, Germany, Italy, The Netherlands, Romania, Spain, and the Ukraine) and North and South America (Brazil, Colombia, Mexico, and the United States), contributed 21 nationally representative samples worldwide from the World Health Organization's World Mental Health Surveys. The total sample size was 109,381, and analyses in this report were based on 55,302 persons where additional information was collected.

Participants were interviewed regarding past-year suicidal behavior and past-year healthcare use. The number of individuals reporting only suicide ideation was 1161, suicide plan 448, unplanned suicide attempt 119, planned suicide attempt 282, or any suicidal behavior 2010. Suicidal respondents who had not used services in the past year were asked why they had not sought care. Two fifths of the suicidal respondents had received treatment (from 17% in low-income countries to 56% in high-income countries), mostly from a general medical practitioner (22%), psychiatrist (15%), or nonpsychiatrist (15%). Those who had actually attempted suicide were more likely to receive care. Low perceived need was the most important reason for not seeking help (58%), followed by attitudinal barriers such as the wish to handle the problem alone (40%), and structural barriers such as financial concerns (15%). Only 7% of respondents endorsed stigma as a reason for not seeking treatment.

Viewpoint

Suicide is a leading cause of death. The authors concluded that most people with suicide ideation, plans, and attempts receive no treatment and that this is a consistent and pervasive finding, especially in low-income countries. Some important limitations include that the nonresponders in population surveys are likely to have higher rates of mental disorders than respondents, so that any calculation of incidence of suicidal behavior would be an underestimate.