Substance use and suicidal ideation and behaviour in low- and middle-income countries : a systematic review
Date
2018-04-24
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: Understanding 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.
Methods: We 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.
Results: Analysis 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, nonfatal
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.
Conclusions: Public 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.
Description
CITATION: Breet, E., Goldstone, D. & Bantjes, J. 2018. Substance use and suicidal ideation and behaviour in low- and middle-income countries : a systematic review. BMC Public Health, 18:549, doi:10.1186/s12889-018-5425-6.
The original publication is available at https://bmcpublichealth.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund.
The original publication is available at https://bmcpublichealth.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund.
Keywords
Substance abuse, Suicidal behavior, Suicide -- Prevention
Citation
Breet, E., Goldstone, D. & Bantjes, J. 2018. Substance use and suicidal ideation and behaviour in low- and middle-income countries : a systematic review. BMC Public Health, 18:549, doi:10.1186/s12889-018-5425-6