Effects of social protection programs on suicide mortality: a study in 81 LMICs between 2000-2019

Abstract By 2019, LMICs bore more than 77% of the global suicide burden worldwide. In addition, the consequences of the COVID-19 pandemic exacerbated the existing inequalities and social protection gap between high- and low- and middle-income countries (LMICs). The United Nations’ Sustainable Development Goals 2021 Agenda targeted, both, the promotion of social protection for all (target 1.3) and the reduction of suicide mortality by one-third (target 3.4) by 2030. These targets will not be met if current trends maintain. There is a lack of studies investigating the link between social protection and suicide in LMICs. This study aimed to help fill this knowledge gap by assessing the effects of social protection (SP) programs on the suicide mortality rates in 81 low- and middle-income countries (LMICs), over the period 2000-2019. Multivariable regression analyses using Poisson models were performed adjusting for relevant socioeconomic and healthcare factors. Robust standard errors and fixed-effects specifications were included to estimate the relationship between SP coverage and suicide rates. Our results showed that a 1% increase in the population covered by SP programs could reduce by 0.19% (IRR:0.83;95%CI:0.74-0.94) the suicide rates of the 81 LMICs over the 20 years studied. By disaggregating, the strongest suicide reductions were found among the youngest population of 10-24 years (a 0.21% suicide reduction when increasing SP coverage by 1%: IRR:0.81;95%CI:0.69-0.95). To our knowledge, this study shows for the first time in a large sample of LMICs, that social protection programs could reduce the suicide mortality in LMICs, especially among the youngest populations. Understanding the potential benefits that SP programs could have on reducing health inequalities in LMICs could guide policymakers to target more efficient interventions to prevent suicide and associated factors, quantify its public health cost, and create strategies to tackle stigma-related behaviors. Key messages • Promoting the expansion of social protection interventions could be an effective strategy to reduce the suicide burden over the next years in LMICs, especially among the youngest populations. • Advocating for the de-stigmatization and promotion of standardized methods to classify suicide should be a public health priority.