Suicidology Needs a More Inclusive Approach for Low and Middle‐Income Countries

ABSTRACT

Background and Aims

Suicide is a global challenge. About three‐quarters of suicides happen in low‐ and middle‐income countries (LMICs). There are disparities in research and publication opportunities between countries based on income category. We aimed to discuss the disparities in research and publication on suicide between high‐income countries and LMICs.

Methods

We made a search in Scopus with the term “suicide” in early February 2025 and noted the number of publications and publishing journals.

Results

Along with suicidology journals, mental health journals are publishing research on suicide. There are no open access journals indexed in PubMed, Scopus, and PsycINFO which have no concerns about limited space. The leading three journals with good indexing follow a subscription/hybrid model with limited space that has results in the exclusion of papers of authors from LMICs.

Conclusions

Immediate attention is warranted to ensure that research on suicidal behavior from LMICs be solicited and published in journals currently available in the major indexing services. An open access journal focused on suicidal behavior without page limitations and with minimal or zero cost would be very useful.

Suicide is a global public health challenge that ends more than 720,000 lives in a year, being the third major cause of death among 15–29 years of age. About three‐quarters of suicides occur in low‐ and middle‐income countries (LMICs) [1]. Suicide among adolescents is also major burden in LMICs as about 90% of the global adolescents live here [2]. Despite the recent increase of research and theories of suicidal behavior, the world is struggling to prevent suicide effectively due to its complex nature and variations in risk factors across countries and cultures. Additionally, poor quality data is a major concern for suicide prevention in LMICs [1].

A quick search of the term “suicide*” in Scopus identified 197,219 documents on suicide in early February 2025. The number of articles was 827 till 1980, 1444 till 1990, 2576 till 2000, 4861 till 2010, 9241 till 2020, and 11,904 till 2024 indicating an exponential growth in publications on suicide. Research studying articles on suicide in the Web of Science and Scopus revealed that, during the last 30 years, there was a more than twofold increase in the number of articles on suicide [3, 4]. The studies also noted that two‐thirds of the articles were published by researchers in only 15 countries, roughly 30% of the papers were published in the USA, and 85% of the papers were published by researchers in high‐income countries (HICs) [4]. Although we searched in Scopus (a single database) with a single search term, a similar outcome is expected while searching the other databases like Embase, Web of Science, and PsycINFO. Additionally, there are many studies published in journals without having a Scopus indexation, which come more often from LMICs than HICs. This scarcity of indexed journals in LMICs could be attributed to the lack of adequately trained human resources, inadequate funds, language barrier, substandard research culture, and perhaps, combination of several aspects [5].

The Scopus search also revealed that the Journal of Affective Disorders, Suicide and Life‐Threatening Behavior (SLTB), Crisis, Psychiatry Research, Frontiers in Psychiatry, the American Journal of Psychiatry, the Archives of Suicide Research (ASR), the Journal of Clinical Psychiatry, the British Journal of Psychiatry, and the Lancet to be the leading journals in the field of suicidology. This indicates that, along with the leading suicidology journals, mental health journals are publishing research on suicide. Astraud, et al. (2021) found that psychiatry (46.4%), psychology (26.6%), neurosciences (18%), public health (8.1%), and general internal medicine (7%) were the leading subject headings under which articles on suicide were published [2].

There are several journals which focus on suicide: Crisis, ASR, SLTB, Suicidology Online (which now appears to be defunct), Journal of Suicide Prevention (JSP), Journal of Suicidology, South East Asian Journal of Suicide Prevention (SEAJSP) and Suicide Studies. Additionally, Omega (Journal of Death and Dying), Death Studies, and Mortality cover suicide. Among the journals, SLTB, Crisis, ASR are indexed in PubMed, Scopus, and PsycINFO; JSP, Journal of Suicidology, and SEAJSP do not have well‐accepted indexation and regular issues. SLTB, Crisis, and ASR are published on a subscription/hybrid model with a limited number of articles due to the space limitation. One assessment found that the three journals had published an average of 10.7 papers per issue (ASR‐11.6, Crisis‐9.5, SLTB‐12.3) during the last two decades (2004–24). Six volumes of each journal were selected and every alternate issue of the volumes was scrutinized. Currently, Crisis and SLTB publish six issues in a year and ASR publishes four issues in a year. These estimates indicate that specialized journals with good indexing publish a small number of papers in comparison to the total number of publications. There are no open access journals indexed in PubMed, Scopus, and PsycINFO on suicidology which have no concerns about limited space.

Suicide is an extremely complex phenomenon with overlaps in multiple domains influenced by multiple socio‐cultural factors. LMICs incur the major burden with minimal research output. The global burden cannot be reduced without considering the LMICs. There are lots of challenges for researchers working in LMICs, and the quality of papers from these regions is typically lower than that of those from HICs [5]. Since the major journals publishing articles on suicidal behavior demand high‐quality papers, they frequently reject research from LMICs. Additionally, LMICs face enormous challenges in the field of suicide and suicide prevention as a result of limited resources, support, and trained researchers (who often emigrate to HICs). This affects academic hiring, tenure, and promotion, which often rely on publications to the top‐ranked journals.

There are several major conclusions. First, there is a significantly low research input from LMICs on suicide despite the high suicide burden in those countries. Second, the specialized suicide journals publish a limited number of papers, and there is no open‐access journal with good indexing with a specific focus on suicide. As they look for high‐quality papers, because of space constraints, articles from LMICs are being rejected by the leading suicide‐oriented journals. Third, psychiatry and psychology journals are the leading avenues for suicide articles, even though suicide and suicide prevention have been emphasized as a public health issue [6].

To address these challenges, immediate attention is warranted to ensure that publications on suicidal behavior from LMICs and in journals not currently covered by the major indexing services like PubMed, Scopus, and PsycINFO be indexed in the future. An open‐access journal focused on suicidal behavior without page limitations and with minimal or zero cost would be very useful. Research for Life (R4L) could be a potential source of support as it is helping authors from LMICs in all other open‐access journals based on the income category of the country. For example, we can consider model following by the already viable journals like Global Mental Health and Health Science Reports, and Sage Open. Having opportunities to publish in high‐quality journals would also increase the quality of suicide data for LMICs, which is a fundamental challenge in suicide prevention. International organizations such as the World Psychiatric Association (WPA), suicide prevention associations such as the International Academy of Suicide Research, the International Association for Suicide Prevention, American Association of Suicidology, and journal publishers should come forward to address the problem [7]. The World Psychiatric Association has made some efforts in this regard, and these efforts need to be encouraged. Well‐reputed publishers should consider the challenges for researchers of LMICs as well as for potential solutions, as the industry is shifting to an open access model. The overall focus needs to be redirected to public health instead of mental health for suicide prevention. Without focusing on and encouraging research into suicidal behavior in the LMICs, the result will be a global failure in preventing suicide as there is a persistently high burden of suicide in LMICs and, paradoxically, an extremely low contribution to global suicide research.

Author Contributions

S. M. Yasir Arafat: conceptualization, writing – original draft, writing – review and editing. David Lester: writing – review and editing, writing – original draft.

Ethics Statement

We did not collect any data from human participants. We assessed already published articles. We did not seek any formal approval from any institutional review board.

Conflicts of Interest

Arafat, S.M. Yasir is an Editorial Board member of Health Science Reports and a coauthor of this article. To minimize bias, they were excluded from all editorial decision‐making related to the acceptance of this article for publication.

Transparency Statement

The lead author, S. M. Yasir Arafat, affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Data Availability Statement

The authors have nothing to report.