Psychological Medicine

Original Article

Suicide attempts, plans, and ideation in culturally diverse sites: the WHO SUPRE-MISS community survey

a1 Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
a2 Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Queensland, Australia
a3 Tehran Psychiatric Institute, Mental Health Research Centre, Tehran, Islamic Republic of Iran
a4 Department of Psychiatry, FCM – UNICAMP, Campinas, Brazil
a5 Department of Psychological Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
a6 Hanoi Medical University, Dong Da, Hanoi, Viet Nam
a7 Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, People's Republic of China
a8 Department of Behavioural Medicine, School of Family and Public Health Medicine, Faculty of Health Sciences, Nelson R. Mandela School of Medicine, University of KwaZulu–Natal, Durban, South Africa
a9 Estonian–Swedish Mental Health and Suicidology Institute, Estonian Center of Behavioral and Health Sciences, Tallinn, Estonia
a10 Department of Psychiatry, Voluntary Health Services & SNEHA, Kotturpuram, Chennai, India
a11 National and Stockholm County Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Public Health Sciences, Karolinska Institute and Swedish National Institute of Psychosocial Medicine, Stockholm, Sweden

Article author query
bertolote jm   [PubMed][Google Scholar] 
fleischmann a   [PubMed][Google Scholar] 
de leo d   [PubMed][Google Scholar] 
bolhari j   [PubMed][Google Scholar] 
botega n   [PubMed][Google Scholar] 
de silva d   [PubMed][Google Scholar] 
thi thanh ht   [PubMed][Google Scholar] 
phillips m   [PubMed][Google Scholar] 
schlebusch l   [PubMed][Google Scholar] 
varnik a   [PubMed][Google Scholar] 
vijayakumar l   [PubMed][Google Scholar] 
wasserman d   [PubMed][Google Scholar] 


Background. The objectives were to assess thoughts about suicide, plans to commit suicide and suicide attempts in the community, to investigate the use of health services following a suicide attempt, and to describe basic socio-cultural indices of the community.

Method. The community survey was one component of the larger WHO multisite intervention study on suicidal behaviours (SUPRE-MISS). In each site, it aimed at randomly selecting and interviewing at least 500 subjects of the general population living in the catchment area of the emergency department where the intervention component of the study was conducted. Communities of eight SUPRE-MISS sites (in Brazil, China, Estonia, India, Iran, South Africa, Sri Lanka, and Viet Nam) participated plus two additional sites from Australia and Sweden conducting similar surveys.

Results. Suicide attempts (0·4–4·2%), plans (1·1–15·6%), and ideation (2·6–25·4%) varied by a factor of 10–14 across sites, but remained mostly within the ranges of previously published data. Depending on the site, the ratios between attempts, plans, and thoughts of suicide differed substantially. Medical attention following a suicide attempt varied between 22% and 88% of the attempts.

Conclusions. The idea of the suicidal process as a continuous and smooth evolution from thoughts to plans and attempts of suicide needs to be further investigated as it seems to be dependent on the cultural setting. There are indications, that the burden of undetected attempted suicide is high in different cultures; an improved response from the health sector on how to identify and support these individuals is needed.

c1 Department of Mental Health and Substance Abuse, World Health Organization, CH-1211, Geneva 27, Switzerland. (Email: