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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Public Health 1/2015

Association of socio-economic position and suicide/attempted suicide in low and middle income countries in South and South-East Asia – a systematic review

BMC Public Health > Ausgabe 1/2015
Duleeka W. Knipe, Robert Carroll, Kyla H. Thomas, Anna Pease, David Gunnell, Chris Metcalfe
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12889-015-2301-5) contains supplementary material, which is available to authorized users.

Competing interests

Authors declare that they have no competing interests.

Authors’ contributions

DK conceived the study and conducted the literature search. DK and AP screened the abstracts with assistance from Galit Geulayov. DK and KT screened the full text with assistance from CM and DG. DK and RC were responsible for data extraction. DK analysed the data and wrote the paper with contributions from all authors. All authors have approved the final draft of the manuscript.

Authors’ information

Not applicable.



Forty percent of the world’s suicide deaths occur in low and middle income countries (LAMIC) in Asia. There is a recognition that social factors, such as socioeconomic position (SEP), play an important role in determining suicidal risk in high income countries, but less is known about the association in LAMIC.


The objective of this systematic review was to synthesise existing evidence of the association between SEP and attempted suicide/suicide risk in LAMIC countries in South and South East Asia. Web of Science, MEDLINE, MEDLINE in Process, EMBASE, PsycINFO, and article reference lists/forward citations were searched for eligible studies. Epidemiological studies reporting on the association of individual SEP with suicide and attempted suicide were included. Study quality was assessed using an adapted rating tool and a narrative synthesis was conducted.


Thirty-one studies from nine countries were identified; 31 different measures of SEP were reported, with education being the most frequently recorded. Most studies suggest that lower levels of SEP are associated with an increased risk of suicide/attempted suicide, though findings are not always consistent between and within countries. Over half of the studies included in this review were of moderate/low quality. The SEP risk factors with the most consistent association across studies were asset based measures (e.g. composite measures); education; measures of financial difficulty and subjective measures of financial circumstance. Several studies show a greater than threefold increased risk in lower SEP groups with the largest and most consistent association with subjective measures of financial circumstance.


The current evidence suggests that lower SEP increases the likelihood of suicide/attempted suicide in LAMIC in South and South East Asia. However, the findings are severely limited by study quality; larger better quality studies are therefore needed.

Systematic review registration

PROSPERO 2014:CRD42014006521
Additional file 1: Supplementary methods. Description of data: Detailed description of search strategy used, additional methods and adapted quality rating scales used. (DOC 112 kb)
Additional file 2: Supplementary results. Description of data: Detailed quality rating results; description of questions used to derive composite scores; results of marital status and religion; and summary of measures across studies. (DOCX 74 kb)
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