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Home arrow Language & Literature arrow The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health

Global Mental Health Perspectives on Suicide

The perspectives of burden and need for equity underpinning Global Mental Health (GMH) (Patel 2014) establish the imperative and legitimacy for suicide in LMICs to be prioritised.


Burden is defined as the sum total of the consequence of a condition (WHO 2004). The Disability Adjusted Life Year (DALY) is the metric that is used by the WHO to measure the burden caused by 235 different health conditions. The DALY combines the number of years of life lived at less than full health with the number of years of life lost premature, providing a combined measure of mortality and disability. Figures from the Global Burden of Disease 2010 study indicate a total of 36.2 million (26.5—44.3 million) DALYs attributed to suicide in 2010, with estimates suggesting that mental and substance use disorders were responsible for 22.5 million (14.8—29.8 million) of these DALYs, that is, 62% of the burden caused by suicide (Ferrari et al. 2014). Importantly, data on suicide particularly from LMICs lack reliability owing to significant differences in registration between countries and values and social pressures which affect people’s reporting behaviour (Adinkrah 2012; Hawton and van Heeringen 2009). Thus one could speculate that suicide mortality and morbidity in LMICs may actually be higher than documented.

LMICs bear a substantially larger share of the mortality burden associated with suicide than HICs (Bertolote and Fleischmann 2002; WHO 2014). Consistent with the fact that the vast majority of the global population live in LMICs, the recent WHO publication stated that 75.5% of suicides occur in LMICs (WHO 2014). China and India account for approximately 30% and 20%, respectively, of global suicide mortality (Phillips et al. 2002; Kumar et al. 2013). In China, a study of a six-year (2004—2010) trend of injury death found suicide to be the second leading cause of injury death and more significantly, the biggest cause of rural female mortality (Zhang et al. 2014). Evidence from South Africa has shown that suicide accounts for one-tenth of all unnatural deaths there (South Africa National Injury Mortality Surveillance System, 2004, cited in Mugisha et al. 2011). Ovuga (2005) also reported a high suicide rate of 16.7 per 100, 000 persons in Northern Uganda. A WHO suicide mortality database study has demonstrated that Belarus, Hungary and Latvia, all in the LMIC category, were listed among the ten countries with the highest suicide mortality rate (Varnik 2012). Belarus, for example, had a male suicide rate as high as 48.7 per 100, 000 persons (Varnik 2012). With estimates for suicide deaths, given by the WHO, to be approximately 1.53 million for the year 2020 (Bertolote and Fleischmann 2002), it has been projected that the greatest mortality burden will be felt in LMICs (Gad El Hak et al. 2009). This projection together with the foregoing evidence on the burden of suicide is alarming and provides a compelling reason for suicide in LMICs to be considered as an issue of concern.

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