Psychological Medicine

Original Article

Characteristics of attempted suicides seen in emergency-care settings of general hospitals in eight low- and middle-income countries

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 Department of Psychiatry, FCM – UNICAMP, Campinas, Brazil
a4 Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, People's Republic of China
a5 Estonian-Swedish Mental Health and Suicidology Institute, Estonian Center of Behavioral and Health Sciences, Tallinn, Estonia
a6 Department of Psychiatry, Voluntary Health Services & SNEHA, Kotturpuram, Chennai, India
a7 Tehran Psychiatric Institute, Mental Health Research Centre, Tehran, Islamic Republic of Iran
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 Department of Psychological Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
a10 Hanoi Medical University, Hanoi, Viet Nam
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
fleischmann a   [PubMed][Google Scholar] 
bertolote jm   [PubMed][Google Scholar] 
de leo d   [PubMed][Google Scholar] 
botega n   [PubMed][Google Scholar] 
phillips m   [PubMed][Google Scholar] 
sisask m   [PubMed][Google Scholar] 
vijayakumar l   [PubMed][Google Scholar] 
malakouti k   [PubMed][Google Scholar] 
schlebusch l   [PubMed][Google Scholar] 
de silva d   [PubMed][Google Scholar] 
tuong nguyen v   [PubMed][Google Scholar] 
wasserman d   [PubMed][Google Scholar] 


Background. The objective was to describe patients presenting themselves at emergency-care settings following a suicide attempt in eight culturally different sites [Campinas (Brazil), Chennai (India), Colombo (Sri Lanka), Durban (South Africa), Hanoi (Viet Nam), Karaj (Iran), Tallinn (Estonia), and Yuncheng, (China)].

Method. Subjects seen for suicide attempts, as identified by the medical staff in the emergency units of 18 collaborating hospitals were asked to participate in a 45-minute structured interview administered by trained health personnel after the patient was medically stable.

Results. Self-poisoning was the main method of attempting suicide in all eight sites. Self-poisoning by pesticides played a particularly important role in Yuncheng (71·6% females, 61·5% males), in Colombo (43·2% males, 19·6% females), and in Chennai (33·8% males, 23·8% females). The suicide attempt resulted in danger to life in the majority of patients in Yuncheng and in Chennai (over 65%). In four of the eight sites less than one-third of subjects received any type of referral for follow-up evaluation or care.

Conclusions. Action for the prevention of suicide attempts can be started immediately in the sites investigated by addressing the one most important method of attempted suicide, namely self-poisoning. Regulations for the access to drugs, medicaments, pesticides, and other toxic substances need to be improved and revised regulations must be implemented by integrating the efforts of different sectors, such as health, agriculture, education, and justice. The care of patients who attempt suicide needs to include routine psychiatric and psychosocial assessment and systematic referral to professional services after discharge.

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