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Most Suicidal Patients Receive No Treatment, Global Study Shows

Deborah Brauser

July 5, 2011 — Most people with suicidal intentions do not receive mental health treatment, in large part due to their attitudes toward help-seeking and not because of stigma or financial concerns, international research shows.

After examining data on more than 55,000 adults from 21 countries, investigators found that only about 40% of the total suicidal respondents had received any treatment at all.

"Clinicians, policy-makers, and healthcare planners should be aware of the significance of the degree of unmet need and the broad range of barriers that prevent suicidal people from seeking treatment," writes Ronny Bruffaerts, PhD, from the University Psychiatric Center at the Catholic University Leuven in Belgium and the University Hospital Gasthuisberg, and colleagues.

The researchers also note that suicide prevention strategies should become regionally tailored.

"Improving the receipt of treatment worldwide will have to take into account culture-specific factors that may influence the process of help-seeking [and] interventions may be needed to expand or reallocate treatment resources, especially in countries with lower access to treatment."

The study is published in the July issue of the British Journal of Psychiatry.

Ignoring Treatment

The researchers examined data from the population-based World Health Organization (WHO) World Mental Health (WMH) surveys on 55,302 participants older than 18 years from 6 continents, including North America, Africa, Asia, Australasia, Europe, and South America.

For this study, low-income countries included Colombia, India, Nigeria, China, and the Ukraine. Middle-income countries were Brazil, Bulgaria, Lebanon, Mexico, Romania, and South Africa. The 10 countries deemed high-income were Israel, Japan, New Zealand, Belgium, France, Germany, Italy, the Netherlands, Spain, and the United States.

All subjects underwent face-to-face interviews regarding sociodemographic information and any mental disorders, as well as suicidal behavior and healthcare use during the past year.

Results showed that only 39% of the suicidal respondents had received any sort of treatment for their emotional difficulties. Those who had actually attempted suicide were more likely to receive care than those with suicidal thoughts only (49% to 55% vs 34% to 42%, respectively).

In addition, 17% of the suicidal respondents from low-income countries sought treatment, whereas 28% of those in the middle-income and 56% of those in the high-income countries did so.

This treatment, for those with any suicidal behaviors, came most often from "any mental healthcare" (23%) and from general practitioners (21.8%), followed by nonhealthcare services (11%). For those who specified type of mental healthcare received, 15.1% reported seeing a psychiatrist and 14.9% reported seeing a nonpsychiatrist.

"Low perceived need was the most important reason for not seeking help (58%), followed by other attitudinal barriers, such as the wish to handle the problem alone (40%), and structural barriers, such as financial concerns (15%)," report the investigators, noting that stigma was reported as the main barrier to care by only 7%.

Finally, receipt of any type of care was significantly higher among those with a lifetime anxiety (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.4 – 2.5) or mood disorder (OR, 1.8; 95% CI, 1.3 – 2.4; P < .05 for both).

The odds of receiving any mental health treatment were significantly higher for those with higher education and income and for those who had never married. Significantly higher odds of receiving general health treatment were found for the participants who had lower educational levels and were married.

The researchers note that both primary care and nonhealthcare settings may serve as "important entry points into treatment" for this patient population.

"This suggests that general practitioners and other non–mental health providers may serve as gatekeepers for suicidal patients worldwide, guiding them towards evidence-based treatment in secondary care."

Tailored Interventions Needed

"These findings develop our understanding of help-seeking in suicidal crises, challenging the conventional wisdom that stigma and structural/financial constraints are the major barriers to accessing mental healthcare," Alexandra Pitman, MBBS, MRCPsych, and David P. J. Osborn, MRCPsych, PhD, both from the Department of Mental Health Sciences at University College London, United Kingdom, write in an accompanying editorial.

They note that those with more intense suicidality "were probably underrepresented" in this study sample. Still, most of the suicidal respondents felt that the services offered did not provide tangible benefits.

"If such attitudes constitute a genuine obstacle to the delivery of suicide prevention interventions, each nation must rethink its suicide strategy. Rather than pushing evidence-based interventions blindly, we must determine what individuals who are suicidal would find helpful and actually seek it out."

The editorialists recommend that future research is needed to "deliver an international evidence base" on the preferences of these people and to evaluate "tailored interventions for each clinical subgroup in a range of settings.

"Policy-makers will then have a more realistic chance of matching supply to need and demand in the marketing of suicide prevention services," they conclude.

The study was conducted in conjunction with the WHO WMH Survey Initiative. A full list of its funding sources is included in the original article, as are the disclosures listed by Dr. Bruffaerts. The other study authors and the editorialists have disclosed no relevant financial relationships.

Br J Psychiatry


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