Surveillance for self-harm: an urgent need in low-income and middle-income countries
Abstract
Low-income and middle-income countries (LMICs) account for around 75% of the estimated 800 000 annual deaths by suicide globally. There is an imperative to obtain better self-harm (both fatal and non-fatal) data from LMICs to inform prevention strategies and the allocation of scarce resources. Hospital-based self-harm surveillance systems are recommended by WHO as a crucial source of epidemiological data. Such systems have additional value in LMICs, where the prevalence, methods of, and risk factors for self-harm can vary from those in high-income countries. In The Lancet Psychiatry, the excellent paper by Duleeka Knipe and colleagues shows the importance of a hospital-based self-harm surveillance system in a rural area of Sri Lanka. This paper provides estimates of the risk of repeat self-harm (3·1%, 95% CI 2·4–3·9) and suicide (0·6%, 0·4–1·1) in individuals within 12 months of presentation to hospital after a previous self-harm episode. These results contrast with a systematic review and meta-analysis by Carroll and colleagues, which was predominantly based on research from HICs and reported a substantially higher risk of repeat non-fatal (16·3%, 95% CI 15·1–17·7) and fatal (1·6%, 1·2–2·4) selfharm at 12 months, and that the risk of repeat non-fatal self-harm was considerably lower across the few studies in Asia (10·0%, 7·3–13·6). Consequently, the authors posit that repeat self-harm might be lower in LMICs than in HICs. If this is true, why? Possible explanations are…
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