Abstract:
Suicidal behaviours are one of the most important contributors to the global burden of disease among
women, but little is known about prevalence and modifiable risk factors in low and middle income
countries. We use data from the WHO multi-country study on women’s health and domestic violence
against women to examine the prevalence of suicidal thoughts and attempts, and relationships between
suicide attempts and mental health status, child sexual abuse, partner violence and other variables.
Population representative cross-sectional household surveys were conducted from 2000e2003 in 13
provincial (more rural) and city (urban) sites in Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia,
Thailand and Tanzania. 20967 women aged 15e49 years participated. Prevalence of lifetime suicide
attempts, lifetime suicidal thoughts, and suicidal thoughts in the past four weeks were calculated, and
multivariate logistic regression models were fit to examine factors associated with suicide attempts in
each site. Prevalence of lifetime suicide attempts ranged from 0.8% (Tanzania) to 12.0% (Peru city);
lifetime thoughts of suicide from 7.2% (Tanzania province) to 29.0% (Peru province), and thoughts in the
past four weeks from 1.9% (Serbia) to 13.6% (Peru province). 25e50% of women with suicidal thoughts in
the past four weeks had also visited a health worker in that time. The most consistent risk factors for
suicide attempts after adjusting for probable common mental health disorders were: intimate partner
violence, non-partner physical violence, ever being divorced, separated or widowed, childhood sexual
abuse and having a mother who had experienced intimate partner violence. Mental health policies and
services must recognise the consistent relationship between violence and suicidality in women in low
and middle income countries. Training health sector workers to recognize and respond to the consequences
of violence may substantially reduce the health burden associated with suicidal behaviour.
