Attitudes towards suicidal behavior in low and middle-income countries: a systematic review
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https://doi.org/10.29057/jbapr.v6i12.14377Keywords:
suicide, suicidal behaviors, attitudes, middle and low income, systematic reviewAbstract
Suicide is a multi-causal and complex phenomenon that affects thousands of people worldwide. One of the perspectives for its understanding is the analysis and understanding of attitudes toward suicide; these attitudes vary between countries and cultures, so it is required to contextualize them. The study's objective was to develop a systematic review of attitudes towards suicide in low- and middle-income countries due to increased suicides in these countries. The search engines were EBSCO, Google Scholar, PubMed, ScienceDirect, Scielo, Scopus, Taylor and Francis, and Wiley, following the PRISMA statement for developing systematic reviews. Results show that attitudes toward suicide are influenced by factors such as sex, age, profession, and religion; these play an essential role in behaviors, beliefs, and emotions toward suicide. The conclusion focuses on the importance of developing studies in low and middle-income countries and the generation of contextually and culturally adjusted evidence in developing intervention and prevention strategies.
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DISCUSSION
It is important to conduct research that provides information on suicidal behaviors in LAMIC since, according to epidemiological data, it is in these countries that the number of suicides is increasing (WHO, 2019). These studies would favor the development of contextual and culturally adjusted intervention and prevention protocols for the said population.
Attitudes towards suicide are a broad and complex object of study that encompasses beliefs, emotions, and behaviors (Ellis & McClintock, 1993) that people report towards suicide in general, the possibility of committing suicide themselves, the way they would react to people with such behaviors or whether they would justify suicide under certain conditions. The findings cannot be generalized based on this breadth of approach and the differences reported in the results in different contexts, ages, professions, and religions.
One limitation of the findings concerns the sampling. The samples were heterogeneous, with different characteristics such as university students, health professionals, general population, or community leaders. The most reported samples were health students or professionals who care people with suicidal behaviors. In these samples, both attitudes positive and negative were reported. Cultural, family, and religious aspects appear to influence negative attitudes. In this sense, it can be suggested that academic education does not modify the attitudes acquired early in life or that these professionals' academic training is not focused on providing information that allows modifying negative attitudes toward suicide.
In some studies, in which training in care for people with suicidal behaviors was implemented and in those in which workers had had experience with suicidal patients showed more positive attitudes and lower judgment, which agrees with what was observed by Mofidi et al. (2008) about having more positive attitudes based on having personal experiences with suicidal behaviors. Attitudes are not rigid and immutable, so it can be inferred that training and professionalization in care would modify negative attitudes toward people with suicide attempts (Bustamante, 2002; Cochran & Winfree, 2017).
Most of the studies used a quantitative approach, which allows the results to be compared, correlated, and contrasted and have valid and standardized instruments in the population to identify their attitudes towards suicide and consequently develop practical actions for vulnerable population groups. On the other hand, no longitudinal study was identified, so further research is still required concerning the stability or possibility of change in attitudes toward suicide.
Suicidal behaviors are diverse (Turecki et al., 2019); however, no information was found on whether attitudes towards different suicidal behaviors were different in the same sample for instance people might have positive attitudes toward ideation but negative attitudes toward attempted or suicide deaths.
Besides, negative attitude towards suicide does not guarantee that a person does not have suicidal behaviors, or having a positive attitude increases the risk of dying from this cause. For this reason, it is necessary to delve into the benefits or effects of having attitudes in favor or against suicide and use the knowledge on the subject for effective prevention and care.
It is also required to analyze attitudes towards suicide as a phenomenon of gradation, which is not necessarily dichotomic (positive or negative), but with a mixture of beliefs, emotions, and behaviors with different dimensions. A person can have a negative attitude towards the act by rejecting it. However, a favorable position to talk about suicidal ideation can lead to stability and mental health in those who think about or have tried to kill themselves.
The limitations of the systematic review were including only articles in English, which may exclude relevant studies published in other languages. The period established was limited to a decade, but this does not allow observing whether different results have been found on attitudes toward suicide over time. Finally, a detailed analysis of the results differentiating the socio-cultural characteristics of the countries is recommended because although they are all LAMIC, not only economic but social, cultural, and religious differences, among others, can modify attitudes towards suicide.
The study of suicidal behaviors is complex and multifactorial, so it is necessary to analyze attitudes in combination with another series of risk and protective factors, providing more comprehensive information on the implications that attitudes toward suicide may have.
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It is important to conduct research that provides information on suicidal behaviors in LAMIC since, according to epidemiological data, it is in these countries that the number of suicides is increasing (WHO, 2019). These studies would favor the development of contextual and culturally adjusted intervention and prevention protocols for the said population.
Attitudes towards suicide are a broad and complex object of study that encompasses beliefs, emotions, and behaviors (Ellis & McClintock, 1993) that people report towards suicide in general, the possibility of committing suicide themselves, the way they would react to people with such behaviors or whether they would justify suicide under certain conditions. The findings cannot be generalized based on this breadth of approach and the differences reported in the results in different contexts, ages, professions, and religions.
One limitation of the findings concerns the sampling. The samples were heterogeneous, with different characteristics such as university students, health professionals, general population, or community leaders. The most reported samples were health students or professionals who care people with suicidal behaviors. In these samples, both attitudes positive and negative were reported. Cultural, family, and religious aspects appear to influence negative attitudes. In this sense, it can be suggested that academic education does not modify the attitudes acquired early in life or that these professionals' academic training is not focused on providing information that allows modifying negative attitudes toward suicide.
In some studies, in which training in care for people with suicidal behaviors was implemented and in those in which workers had had experience with suicidal patients showed more positive attitudes and lower judgment, which agrees with what was observed by Mofidi et al. (2008) about having more positive attitudes based on having personal experiences with suicidal behaviors. Attitudes are not rigid and immutable, so it can be inferred that training and professionalization in care would modify negative attitudes toward people with suicide attempts (Bustamante, 2002; Cochran & Winfree, 2017).
Most of the studies used a quantitative approach, which allows the results to be compared, correlated, and contrasted and have valid and standardized instruments in the population to identify their attitudes towards suicide and consequently develop practical actions for vulnerable population groups. On the other hand, no longitudinal study was identified, so further research is still required concerning the stability or possibility of change in attitudes toward suicide.
Suicidal behaviors are diverse (Turecki et al., 2019); however, no information was found on whether attitudes towards different suicidal behaviors were different in the same sample for instance people might have positive attitudes toward ideation but negative attitudes toward attempted or suicide deaths.
Besides, negative attitude towards suicide does not guarantee that a person does not have suicidal behaviors, or having a positive attitude increases the risk of dying from this cause. For this reason, it is necessary to delve into the benefits or effects of having attitudes in favor or against suicide and use the knowledge on the subject for effective prevention and care.
It is also required to analyze attitudes towards suicide as a phenomenon of gradation, which is not necessarily dichotomic (positive or negative), but with a mixture of beliefs, emotions, and behaviors with different dimensions. A person can have a negative attitude towards the act by rejecting it. However, a favorable position to talk about suicidal ideation can lead to stability and mental health in those who think about or have tried to kill themselves.
The limitations of the systematic review were including only articles in English, which may exclude relevant studies published in other languages. The period established was limited to a decade, but this does not allow observing whether different results have been found on attitudes toward suicide over time. Finally, a detailed analysis of the results differentiating the socio-cultural characteristics of the countries is recommended because although they are all LAMIC, not only economic but social, cultural, and religious differences, among others, can modify attitudes towards suicide.
The study of suicidal behaviors is complex and multifactorial, so it is necessary to analyze attitudes in combination with another series of risk and protective factors, providing more comprehensive information on the implications that attitudes toward suicide may have.
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2025-01-05
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Valdés-García, K. P., Sánchez-Loyo, L. M., Padrós-Blázquez, F., & Nii‑Boye Quarshie, E. (2025). Attitudes towards suicidal behavior in low and middle-income countries: a systematic review. Journal of Basic and Applied Psychology Research , 6(12), 22–39. https://doi.org/10.29057/jbapr.v6i12.14377
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