Skip to main content
. 2021 Oct 1;17:100283. doi: 10.1016/j.lanwpc.2021.100283

Table 3.

Important findings and information regarding suicide attempts and non-fatal suicidal behaviour in the Pacific Islands

Author(s), year NFSB rates and/or prevalence Risk groups/ risk factors NFSB methods Other important information Limitations Quality
Aghanwa, 2000 [35] An annual suicide attempt rate 34.8 per 100,000 in 1999 (39 SA cases over the study period). Adolescent and young adults, mostly students, not being married. The predominant method was medical drug overdose (46.2%). There were significant differences by marital status (suicide attempters were most frequently never married). There were significant differences by employment status (most suicide attempters were students, while most of the other patients were unemployed persons). Over one year, a small number of consecutive patients, control/comparison group was "other psychiatric patients." 13 (Medium)
Aghanwa, 2001 [36] An annual rate of deliberate self-poisoning (DSP) 25.9 per 100,000 (68 suicide attempts; the subjects of the specific study were 58 DSP cases over the study period). NR Drug overdose (n=31), poison-ingestion (n=27). Younger age, female gender, higher rate of psychopathology and low rate of recent alcohol abuse are associated more with drug overdose than poison ingestion in suicidal attempts. Consecutive patients with DSP and small numbers, no control/comparison group. 15 (Medium)
Aghanwa, 2004 [5] NR NR Although males used violent methods such as hanging and wounding, more females used poisoning methods, the difference in methods was not significant. The mean age of female (M=22.99) suicide attempters was significantly lower than that of their male counterparts (M=25.15).
Alcohol misuse was significantly higher in males (42.5%) than females (10.2%). The motive for the act being a ‘desire to die’ was significantly higher in males (90%) than females (54.6%).
Did not report prevalence or rates, no control/comparison group. In total 134 patients, six were excluded due to leaving the hospital before psychiatric intervention or dying as a result of complications arising from the index attempts. 16 (Medium)
Amadeo et al., 2015 [34] n = 21, 21% in TAU, n = 24, 26.7% in BIC. NR NR There was no statistical difference in the frequency of suicidal behaviour (suicides or repeated NFSB). The limited sample size and timeframe of the investigation made it difficult to obtain a statistically detectable difference in suicidal behaviours. Due to limited funding, only 200 people participated. 14 (Medium)
Amadeo et al., 2016 [23] The mean rate of non-fatal suicidal behaviour (NFSB) presenting at ED is 79.4 per 100,000 in 2008-2010. Females (2.13:1), those aged 25-34 years, followed by 15-24 years (however, the prevalence of NFSB by age groups was highest for 15-24, followed by 25-34); divorced/separated; single; unemployed (highest rates). The predominant method was drug intoxication (X60-X64, 63.8%). The most frequent precipitating factor to the episode was relationship problems (68.6%). A more correct estimate of the annual number of NFSB for all French Polynesia would be a crude rate of 98 per 100,000. Records suicide method (first method up to three methods) and triggers/events related to episode. Some cases were not monitored due to the temporary unavailability of staff. No control group and population census data were available only for a limited number of variables. 18 (High)
De Leo et al., 2013 [24] NR as differing years. Youth (median age of NFSB <28 in all 4 PI countries); females (gender ratios of 0.7 in Fiji and 0.5 in French Polynesia). Most frequent method of NFSB - Fiji: chemicals/poisons M: 71.4% F: 58.4%; Tonga: hanging M: 100% F: 50% (only 19 persons); Vanuatu: analgesics M: 80% F: 40% (only 10 persons); French Polynesia: psychotropic drugs M:31.7%, F:38.6%. Only the first presentation to the healthcare facility was included. The description was specific to persons, not events. Low numbers for Tonga (19) and Vanuatu (10); likely to be underestimated also in Fiji as information from a psychiatric hospital. 16 (Medium)
Devries et al., 2011 [56] 3.3% of the Samoan national sample of women (n=1,640; aged 15-49 years) reported ever attempting suicide. Childhood sexual abuse, probable mental illness, non-partner physical violence, non-partner sexual violence, intimate partner violence. NR A survey was completed interview-style, and authors acknowledged that country or site-specific (vs global) models might have allowed for a more nuanced understanding of culturally specific risk/protective factors. Cross-sectional, question about suicide attempts was asked from those who reported lifetime suicidal ideation. 17 (High)
Henson et al., 2012 [38] 153 (2.7%) out of 5581 cases were referred for a suicide attempt. Indo-Fijian, male, younger age, single or de facto, and secondary or tertiary education (compared to other hospitalised patients). The most common method of attempted suicide was intentional self-poisoning (78.4%). An additional 10.5% of the total group
attempted suicide by hanging, strangulation and suffocation.
NA The comparison/control group was limited to other hospitalised patients who were referred for services. 17 (High)
Herman et al., 2016 [46] Non-fatal self-harm was present in 60 hospitalisations (13.3% for the year), of which 13 (4.4%) were Indigenous Fijians, and 45 (28.1%) were Indian-Fijians. Men and women of Indian ethnicity. NR The majority of non-fatal injuries were from poisoning in Fijians of Indian ethnicity (however not clear whether these were intentional self-poisoning). Case series with one year of data. 15 (Medium)
Kushal et al., 2021 [20] SA prevalence split by gender for each Pacific Island. The highest for boys was Samoa at 58.9%, and the lowest was French Polynesia at 5.3%. The highest for girls was Samoa at 47.9%, and the lowest was Niue at 6.7%. For most Islands, the prevalence of SA between boys and girls was reasonably equivocal however, there was some country-level variation. NA; further analyses were reported in aggregate. NR Analyses restricted to adolescents aged 12-15 years. Cross-sectional, reliance on self-report, could not control for important variables such as previous SA, depression etc. 18 (High)
Liu et al., 2018 [19] Prevalence of SA in Islands combined: 31.2% for boys, 26.8% for girls, and 28.6% total (the difference between genders was significant, and the total prevalence was highest for this region compared to other global regions). The prevalence of SA for each Island was only provided for Samoa 61.2%, the Solomon Islands 33.6%, and Kiribati 31.5%, which incidentally were the top three highest out of all 40 countries reported on this study. NR; further analyses were for combined sample rather than Pacific Islands specifically however, food insecurity, bullying and loneliness were risk factors for the total sample. NR Total sample size n=146460 (GSHS) and n=8820 Chinese young adolescents survey; aged 12 - 18 years. Reliance on self-reported SA, differing years of data collection compared, the GSHS only targets adolescents in school which may be low in LMICs. 18 (High)
Peiris-John et al., 2013 [39] The annual crude rate of non-fatal intentional poisoning hospitalisation was 12.9 per 100,000. Indians, females and those aged 15-29. Out of 1/3 of documented substances, 41.2% were chemicals, 35.3% drugs and 23.5% pesticides. Out of all poisoning hospitalisations, the proportion of intentional poisoning was higher in Fijian Indians than Fijians (66.4% vs 23.4%). Only poisoning cases over one year, substances involved recorded only in 1/3 of cases. 17 (High)
Peltzer & Pengpid, 2015 [58] Prevalence of SA in last 12 months: Kiribati - 31.5%; Samoa - 62%; Solomon Islands - 35%, Vanuatu - 23.5% in total sample (overall % in 34.9%, N = 6540). Preadolescent and adolescent (<12 years vs non-initiators) initiation of cigarette smoking. Initiation of alcohol and drug use at ages <12 and ≥12 were both associated with suicide attempts. Substance use initiation <12 years for two or more substances. Association between adolescent alcohol initiation and suicide attempts in girls but not in boys. NR NA Cross-sectional, self-report. 18 (High)
Pengpid & Peltzer, 2020 [59] SA in previous 12-months 16.5% at least once, 7.6% twice or more. SA was associated with several factors, including female sex, loneliness, frequently bullied, not having close friends, frequent fights, frequent school truancy, amphetamine use. For girls specifically, there was the addition of anxiety. NR NA Cross-sectional, self-report. 14 (Medium)
Pengpid & Peltzer, 2020 [60] 5.1 % (n= 101) reported a lifetime history of SA. In adjusted analyses, a lifetime history of SA was associated with psychological distress, cohabiting, and physical problems (e.g., heart attack, stroke). In unadjusted analyses, alcohol problems (family and self), a family member having attempted suicide, and sedentary behaviour was also associated. The main methods of SA were hanging (67%) and overdose of medication (11%). Lifetime suicide attempt was analysed separately whereas suicide attempt in the previous 12-months was grouped with suicidal ideation and planning during the last 12-months. Cross-sectional, relatively low response rate of 55%, reliance on self-report. 16 (Medium)
Pinhey & Millman, 2004 [47] 28.2% of girls and 14.5% of boys reported suicide attempt in the past 12 months. Same-sex orientation, especially for boys. SA was also associated with increased alcohol abuse and hopelessness. NA Independent variables included measures of hopelessness, relationship, physical abuse, and binge alcohol use. All suicide attempt data reported in the survey were incomplete owing to the self-reported nature of data. A response rate of 96.6%. 14 (Medium)
Pridmore, 1997 [52] An annual suicide attempt rate 36 per 100,000 (123 cases over the study period). Females Majority by chloroquine ingestion, except for one case. NA Possibility of missing cases, particularly from more isolated areas. 12 (Low)
Pridmore et al., 1995 [42] An annual non-fatal injury by self rate 12.0 (11.4- 13.8) per 100,000 in 1969-89; the rate rose from 7.1 (6.5-7.8) to 16.4 (15.5-17.4) (increase statistically significant). Indians and females (although the authors grouped suicide and self-inflicted injury together). NA Male and female violence by self increased at a parallel rate over the 20 year period. Subgroup data by ethnicity and sex provided for violence by self in total (authors do not indicate but seem to include fatal and non-fatal). 12 (Low)
Ran et al., 2015 [48] 8.2% of students with lifetime suicide attempts (n = 17). NR for attempts, only for ideation. NR Survey captured demographics, information on suicide ideation and suicide attempts. The analysis focused more on suicide ideation rather than a suicide attempt. The response rate was 82.1%. 16 (Medium)
Roberts et al., 2007 [44] NA Mainly females, Indians, young, single or married (those who married, mainly arranged marriage), main triggers: family, marital or relationship problems. NA NA Descriptive study, with no comparison group. Did not include prevalence. 13 (Medium)
Sakamoto et al., 2020 [54] 13.6% of youth reported suicide attempt in the previous year SA was associated with the experience of violence and substance use for both girls and boys; girls were more likely to have attempted suicide than boys. NA NA Cross-sectional, self-reported data. 18 (High)
Sharma et al., 2017 [57] Prevalence of SA was 31% in Kiribati, 37% in the Solomon Islands, and 23% in Vanuatu (30.9% overall) SA was associated with being bullied and experiencing violence, and suicide attempts increased with increased length of exposure. NA NA Cross-sectional, self-reported data. 17 (High)
Tavite & Tavite, 2009 [53] 40/1500 as per official records, attempted suicide in 1980-2004 (3% of the population). As per a cross-sectional survey in 2004 - 14% reported a lifetime suicide attempt, and 63% reported having relatives who have attempted suicide. Mainly males by the official records, but females by the survey; the main triggers were different relationship problems. The predominant method of attempt was hanging (40%). Increasing trend of suicide attempts between 1980-2004 as per official records. Very little information available from hospital records, and only recorded those who needed medical attention. Members of the public were aware of several other cases that were not recorded. The cross-sectional study had a low response rate (38%). 12 (Low)
Vignier et al., 2011 [50] 12% of the total sample reported lifetime suicide attempt. Higher self-reported SA in female youth, associated with early substance use, possibly associated with Kava use in the Kanak peoples of New Caledonia. NA Paper focused on kava use among youth in Kanak and other ethnic communities. Cross-sectional, self-reported data. 13 (Medium)
Wainiqolo et al., 2012 [45] An annual self-inflicted injury rate 22.1 per 100 000 (18.5-25.7) (144 cases over the study period). The Indian-Fijians self-inflicted injury rate was almost five times higher than Indigenous Fijians. NR The study does focus more widely on injuries, not specific to suicidal behaviour. Potential misclassification of some variables was noted. 15 (Medium)

Note: SA = suicide attempt; NFSB = non-fatal suicidal behaviour; NA = not applicable; NR = not reported; DSP = deliberate self-poisoning; TAU = treatment as usual; BIC = brief intervention component; ED = emergency department.