Suicide attempts are among the most serious public health challenges facing Colombia, a country where social vulnerability, economic strain, and deeply unequal access to care shape both who ends up at risk and who manages to recover. Globally, the burden is staggering: recent estimates from the Global Burden of Disease study and the Lancet Commission on self-harm have documented hundreds of thousands of suicide deaths each year, with nonfatal attempts many times more common. Each attempt carries direct medical costs, lost productivity, and long shadows of psychosocial disability that can persist for years after the crisis passes. Yet in low- and middle-income countries, where most suicides occur, the economics of surviving an attempt have rarely been studied at the level of individual households.

The research team, led by Felipe Agudelo-Hernández of the Universidad de Manizales together with colleagues at the Universidad Nacional de Colombia and a peer support worker with lived experience of suicidality, set out to fill that gap. They conducted a descriptive, cross-sectional, population-based study in Caldas using stratified random sampling, recruiting 622 participants who had attempted suicide. Rather than relying on hospital records alone, the researchers measured recovery from multiple angles, combining validated instruments with detailed questions about sociodemographic circumstances, service use, and money spent out of pocket on mental health care.

The measurement battery was deliberately comprehensive. Participants completed the Patient Health Questionnaire-9, or PHQ-9, a widely validated screen for depressive symptoms; the UCLA Loneliness Scale, capturing social isolation; the EBS-8, a short measure of subjective well-being; the CD-RISC-10, a brief resilience scale; and two instruments with particular relevance to the Colombian context. The Caldas Psychosocial Disability Scale, developed and validated by members of the same team, quantifies the functional impairment associated with mental disorders across daily life domains. The Alberta Continuity of Mental Health Services Scale, translated and adapted for Latin American populations by the researchers, assesses how well services connect and follow patients over time, a factor widely regarded as crucial after a suicide attempt.

Using multiple linear regression, the team identified a set of significant predictors of total psychosocial disability. Depressive symptoms emerged as a central driver, alongside educational level, age, perceived access to services, and, notably, out-of-pocket spending on individual psychotherapy. Together these variables explained roughly forty percent of the variance in psychosocial disability scores, an adjusted R-squared of .401 that is substantial for research of this kind. The model paints a coherent picture: younger people, those with more education, those with fewer depressive symptoms, those who perceive services as accessible, and those who can afford private therapy all tend to report less disability in the aftermath of an attempt.

The most striking and politically charged result concerns money. Across the analyses, private spending was associated with lower psychosocial disability and better recovery-related indicators, including greater well-being and resilience. At the same time, people who paid privately reported poorer perceived access to formal public services. In other words, paying out of pocket appears to function simultaneously as a recovery resource and as a signal of system failure. Those with the means to bypass the public pathway seem to obtain faster, more continuous, and more personalized care, while those without such means remain dependent on a system they experience as difficult to navigate.

This structural paradox sits uneasily with Colombia’s legal framework. Law 1751 of 2015 established health as a fundamental right and mandated access to mental health services without financial barriers. Yet earlier work by members of the same research group has documented persistent paradoxes in the implementation of Colombian mental health policy, and national data on household health spending show that out-of-pocket payments remain a significant burden, sometimes pushing families into catastrophic expenditure. The new findings extend that economic concern to one of the most vulnerable populations imaginable: people who have recently survived a suicide attempt and are navigating the fragile period in which the risk of a further attempt is highest.

The international literature reinforces the stakes. Systematic reviews have linked poverty, unemployment, and financial hardship to elevated suicide risk, and costing studies from low- and middle-income countries show that the economic burden of suicidality falls heavily on households as well as health systems. Research on continuity of care after self-harm consistently finds that structured follow-up reduces repeat attempts, which makes the Colombian pattern of fragmented public access and compensatory private spending particularly concerning. If the people most likely to die by suicide are also those least able to purchase the continuity of care that protects them, the health system is effectively concentrating risk among its poorest users.

The authors argue that the answer is not to normalize private payment but to close the implementation gaps it reveals. Improving the real-world availability of public mental health services, strengthening continuity between hospital discharge and community follow-up, and addressing the financing mechanisms that leave room for out-of-pocket charges are, they contend, essential to reducing inequities in post-attempt recovery. The inclusion of a co-author with lived experience of suicidality, and the involvement of the Caldas Territorial Health Directorate, reflect a growing movement to ground suicide prevention in the realities of survivors rather than in administrative statistics alone.

For a department like Caldas, and for Colombia more broadly, the study offers both a warning and a roadmap. The warning is that a legally guaranteed right means little when the pathways to exercise it are opaque, slow, or unavailable, and when recovery becomes a commodity that families must buy. The roadmap lies in the study’s own variables: reducing depressive symptoms through timely treatment, supporting educational attainment, combating loneliness, building resilience, and ensuring that perceived access reflects genuine access for everyone, not just those who can pay. As global health authorities push for national suicide prevention strategies, this research is a reminder that the economics of recovery, the small monthly sums families hand over for a therapy session, can be as decisive for survival as any clinical protocol. Recovery after a suicide attempt should never depend on a wallet, and this study shows exactly what happens when, in practice, it does.

Subject of Research: Out-of-pocket mental health spending and recovery among suicide attempt survivors in Colombia

Article Title: Recovery and pay out-of-pocket on mental health services among people who attempted suicide in Colombia

Article References: Agudelo-Hernández, F., Vélez-Botero, H., Aldana-Naranjo, C., Marín, S., Mejía-Chaves, M., & Vega, K. (2026). Recovery and pay out-of-pocket on mental health services among people who attempted suicide in Colombia. Current Psychology, 45(18), Article 1522. https://doi.org/10.1007/s12144-026-10080-1

Image Credits: AI Generated

DOI: 10.1007/s12144-026-10080-1

Keywords: suicide attempt, out-of-pocket payment, mental health services, psychosocial disability, Colombia, recovery, access to care, depressive symptoms, resilience, continuity of care, public health policy, health inequity