Catastrophic Health Expenditure in Mental Health as Coercion in Post–Suicide Attempt Care: A Population-Based Study in Latin America

Abstract

Background:

Despite an increase in mental health problems, there is low implementation of mental health services, high catastrophic health spending, and a high incidence of coercive mental health practices. This could hinder recovery after a suicide attempt.

Aims:

To analyze catastrophic spending and coercive practices, and their relationship with variables associated with recovery (depression and well-being) and with the functioning of health services (continuity of care), in people who attempted suicide during 2024 and 2025 in Caldas, Colombia.

Method:

A cross-sectional and population-based was conducted with stratified random sampling in Colombia. Validated instruments were applied to determine subjective well-being, depressive symptoms and continuity of care in health services. To determine the perception of coercive practices in the care of suicidal behaviors in health services, an instrument was used that divided coercive practices into formal (physical abuse, isolation, forced hospitalization) and informal (involuntary medication, lack of participation in treatment planning).

Results:

A multiple linear regression was calculated for formal and informal coercion. The model for formal coercion explained 21% of the variance, and the model for informal coercion explained 63.2%, both with high coefficients for catastrophic health expenditures. Compared to those who did not report coercion, those who did reported it presented with more depressive symptoms, worse continuity of care, catastrophic health expenditures, and a lower socioeconomic status.

Conclusions:

There is a relationship between the coercive practices perceived and catastrophic spending on mental health services for psychosocial recovery. Those subjected to any coercive practice may have worse outcomes in terms of catastrophic mental health spending and depressive symptoms. Catastrophic spending is proposed as a form of structural coercion that could hinder psychosocial recovery.