Our review found exposure to violence as a risk factor for suicide and suicidal behaviour. The participants were predominantly female in the articles we reviewed. We found that females are more commonly the victims of domestic violence, and across all studies, suicidal behaviours such as suicidal thoughts and ideation were the most common findings. Suicide is one of the leading causes of morbidity in women worldwide, although little is known about its prevalence and modifiable risk factors in Asian countries.
In our review, the most common risk factor associated with suicide and/or suicidal behaviour due to domestic violence was mental illness and/or psychological distress [27, 29, 30, 33]. Domestic violence has significant health consequences for women, children, and families. It adds to the global disease burden regarding women’s morbidity and mortality, including psychological trauma, depression, suicide, and murder. The mental health repercussions of violence against women include behavioural difficulties, sleeping issues, eating disorders, depression, anxiety, post-traumatic stress disorder, self-harm, suicide attempts, low self-esteem, and substance use disorder .
Most of the included studies  were conducted in Southeast Asia, where the domestic violence rate is relatively high. A South Indian study found that nearly 80% of the women studied were exposed to domestic violence, which occurs in the sociocultural context of dowry and endowments . Domestic violence against women and girls is the most widespread human rights violation globally, affecting approximately one-third of women in their lives, with most cases stemming from intimate relationships . Women’s empowerment, gender equality, and achieving sustainable development goals are all hampered by domestic violence. Domestic violence wreaks havoc on people’s lives, shatters families and communities, and stops personal growth. Age, race, caste, poverty, class, sexual orientation, gender identity, disabilities, religion, indigeneity, nationality, immigration status, and other factors make women vulnerable to assault .
Sexual violence was significantly associated with depression and psychological abuse and the risk of femicide with suicidal behaviour . In Asia, many cultural factors affect suicidal behaviour, such as lack of opportunities for education, poverty, migrant labour, and family disputes causing shame . These cultural attributes persist even in-migrant South Asian populations in the West . The method of attempting suicide varies in different Asian regions, from self-immolation in Iran to self-poisoning in Sri Lanka [27, 28]. Domestic violence is associated with depressive disorder in women . Early screening for psychological distress and mental disorders and improving access to services are essential in preventing suicides in women exposed to violence.
Limitations of the review include the small number of studies from Asia, heterogeneity of methodology, and the potential effect of confounders. Also, the relationship between specific aspects of violence and suicidal behaviour was not evident, as many of the participants had experienced physical, emotional, and sexual trauma. Furthermore, as most included research, self-report methods are subjective to recall bias and underreporting violence [20, 38]. Future studies would have to focus on relevant ethnic, religious belief systems, and types of violence to produce relevant data for developing prevention strategies. Furthermore, one study was of a South Asian community in the UK, and local cultural and legal factors may have affected the outcomes. Finally, since there are far fewer studies with male participants than with females, this finding should not be generalised to both genders.
Many Asian countries lack structured mental health legislation, and governments have allocated limited funds for psychiatric services . Healthcare workers need to use culturally validated tools to detect conditions that link violence and suicidal behaviour in Asia, such as depression, anxiety, and general psychological stress [23, 24, 27, 29, 30]. For example, the Edinburgh Postnatal Depression Scale (EPDS) has been used widely in many Asian regions and is deemed appropriately sensitive and specific to the required task .
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