Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-05T08:32:47.344Z Has data issue: false hasContentIssue false
  • English
  • Français

Suicidal ideation and behaviour among community and health care seeking populations in five low- and middle-income countries: a cross-sectional study

Published online by Cambridge University Press:  16 February 2017

M. Jordans ,
S. Rathod ,
A. Fekadu ,
G. Medhin ,
F. Kigozi ,
B. Kohrt ,
N. Luitel ,
I. Petersen ,
R. Shidhaye  and
J. Ssebunnya
...Show all authors
M. Jordans*
Affiliation:
Research and Development Department, HealthNet TPO-Amsterdam, Netherlands Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
S. Rathod
Affiliation:
Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
A. Fekadu
Affiliation:
Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
G. Medhin
Affiliation:
Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
F. Kigozi
Affiliation:
Butabika National Referral and Teaching Mental Hospital, Makerere University, Kampala, Uganda
B. Kohrt
Affiliation:
Duke Global Health Institute, Duke University, Durham, USA Transcultural Psychosocial Organization (TPO), Kathmandu, Nepal
N. Luitel
Affiliation:
Transcultural Psychosocial Organization (TPO), Kathmandu, Nepal
I. Petersen
Affiliation:
Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
R. Shidhaye
Affiliation:
Centre for the Control of Chronic Conditions, Public Health Foundation of India, New Delhi, India; Sangath, India CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
J. Ssebunnya
Affiliation:
Butabika National Referral and Teaching Mental Hospital, Makerere University, Kampala, Uganda
V. Patel
Affiliation:
Center for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK Sangath, Goa, India
C. Lund
Affiliation:
Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
*
*Address for correspondence: Dr M. Jordans, Lizzy Ansinghstraat 163, 1072 RG Amsterdam, The Netherlands (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims

Suicidal behaviour is an under-reported and hidden cause of death in most low- and middle-income countries (LMIC) due to lack of national systematic reporting for cause-specific mortality, high levels of stigma and religious or cultural sanctions. The lack of information on non-fatal suicidal behaviour (ideation, plans and attempts) in LMIC is a major barrier to design and implementation of prevention strategies. This study aims to determine the prevalence of non-fatal suicidal behaviour within community- and health facility-based populations in LMIC.

Methods

Twelve-month prevalence of suicidal ideation, plans and attempts were established through community samples (n = 6689) and primary care attendees (n = 6470) from districts in Ethiopia, Uganda, South Africa, India and Nepal using the Composite International Diagnostic Interview suicidality module. Participants were also screened for depression and alcohol use disorder.

Results

We found that one out of ten persons (10.3%) presenting at primary care facilities reported suicidal ideation within the past year, and 1 out of 45 (2.2%) reported attempting suicide in the same period. The range of suicidal ideation was 3.5–11.1% in community samples and 5.0–14.8% in health facility samples. A higher proportion of facility attendees reported suicidal ideation than community residents (10.3 and 8.1%, respectively). Adults in the South African facilities were most likely to endorse suicidal ideation (14.8%), planning (9.5%) and attempts (7.4%). Risk profiles associated with suicidal behaviour (i.e. being female, younger age, current mental disorders and lower educational and economic status) were highly consistent across countries.

Conclusion

The high prevalence of suicidal ideation in primary care points towards important opportunities to implement suicide risk reduction initiatives. Evidence-supported strategies including screening and treatment of depression in primary care can be implemented through the World Health Organization's mental health Global Action Programme suicide prevention and depression treatment guidelines. Suicidal ideation and behaviours in the community sample will require detection strategies to identify at risks persons not presenting to health facilities.

Keywords

Low- and middle-income countriessuicidal behavioursuicidal ideation
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 27 , Issue 4 , August 2018 , pp. 393 - 402
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Babor, TF, Higgins-Biddle, JC, Saunders, JB, Monteiro, MG (2001). AUDIT: The Alcohol Use Disorders Identification Test Guidelines for Use in Primary Care. World Health Organization: Geneva.Google Scholar
Borges, G, Nock, M, Haro Abad, J, Hwang, I, Sampson, N, Alonso, J, Andrade, L, Angermeyer, M, Beautrais, A, Bromet, EJ (2010). Twelve-month prevalence of and risk factors for suicide attempts in the World Health Organization World Mental Health Surveys. Journal of Clinical Psychiatry 71, 1617–1628.CrossRefGoogle ScholarPubMed
De Silva, MJ, Rathod, SD, Hanlon, C, Breuer, E, Chisholm, D, Fekadu, A, Jordans, MJD, Kigozi, F, Petersen, I, Shidhaye, R (2015). Evaluation of district mental healthcare plans: the PRIME consortium methodology. British Journal of Psychiatry bjp. bp. 114.153858.Google ScholarPubMed
Demyttenaere, K, Bruffaerts, R, Posada-Villa, J, Gasquet, I, Kovess, V, Lepine, JP, Angermeyer, MC, Bernert, S, de Girolamo, G, Morosini, P, Polidori, G, Kikkawa, T, Kawakami, N, Ono, Y, Takeshima, T, Uda, H, Karam, EG, Fayyad, JA, Karam, AN, Mneimneh, ZN, Medina-Mora, ME, Borges, G, Lara, C, de Graaf, R, Ormel, J, Gureje, O, Shen, Y, Huang, Y, Zhang, M, Alonso, J, Haro, JM, Vilagut, G, Bromet, EJ, Gluzman, S, Webb, C, Kessler, RC, Merikangas, KR, Anthony, JC, Von Korff, MR, Wang, PS, Brugha, TS, Aguilar-Gaxiola, S, Lee, S, Heeringa, S, Pennell, BE, Zaslavsky, AM, Ustun, TB, Chatterji, S, Consortium. WWMHS. (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 291, 2581–2590.Google ScholarPubMed
Dupéré, V, Leventhal, T, Lacourse, E (2009). Neighborhood poverty and suicidal thoughts and attempts in late adolescence. Psychological Medicine 39, 1295–1306.Google Scholar
Fekadu, A, Hanlon, C, Medhin, G, Alem, A, Selamu, M, Giorgis, TW, Shibre, T, Teferra, S, Tegegn, T, Breuer, E (2016). Development of a scalable mental healthcare plan for a rural district in Ethiopia. British Journal of Psychiatry 208, s4–s12.Google Scholar
Fleischmann, A, Bertolote, JM, Wasserman, D, De Leo, D, Bolhari, J, Botega, NJ, De Silva, D, Phillips, M, Vijayakumar, L, Värnik, A, Schlebusch, L, Thanh, HT. (2008). Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries. Bulletin of the World Health Organization 86, 703–709.Google Scholar
Fleischmann, A, Arensman, E, Berman, A, Carli, V, De Leo, D, Hadlaczky, G, Howlader, S, Vijayakumar, L, Wasserman, D, Saxena, S (2016). Overview evidence on interventions for population suicide with an eye to identifying best-supported strategies for LMICs. Global Mental Health p. e5.Google Scholar
Hagaman, AK, Maharjan, U, Kohrt, BA (2016). Suicide surveillance and health systems in Nepal: a qualitative and social network analysis. International Journal of Mental Health Systems 10, 1.Google Scholar
Hanlon, C, Luitel, NP, Kathree, T, Murhar, V, Shrivasta, S, Medhin, G, Ssebunnya, J, Fekadu, A, Shidhaye, R, Petersen, I, Jordans, MJD, Kigozi, F, Thornicroft, G, Patel, V, Tomlinson, M, Lund, C, Breuer, E, De Silva, M, Prince, M (2014). Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries. PLoS ONE 9, e88437.Google Scholar
Jordans, MJD, Luitel, NP, Tomlinson, M, Komproe, IH (2013). Setting priorities for mental health care in Nepal: a formative study. BMC Psychiatry 13.Google Scholar
Jordans, MJD, Kohrt, BA, Luitel, NP, Komproe, IH, Lund, C (2015). Accuracy of pro-active case finding for mental disorders by community informants in Nepal. British Journal of Psychiatry 207, 1–6.Google Scholar
Jordans, MJD, Luitel, NP, Pokhrel, P, Patel, V (2016). Development and pilot testing of a mental healthcare plan in Nepal. British Journal of Psychiatry 208, s21–s28.CrossRefGoogle ScholarPubMed
Kigozi, FN, Kizza, D, Nakku, J, Ssebunnya, J, Ndyanabangi, S, Nakiganda, B, Lund, C, Patel, V (2015). Development of a district mental healthcare plan in Uganda. British Journal of Psychiatry bjp. bp. 114.153742.Google Scholar
Kroenke, K, Spitzer, RL, Williams, JBW (2001). The PHQ-9. Journal of General Internal Medicine 16, 606–613.Google Scholar
Lund, C, Tomlinson, M, De Silva, M, Fekadu, A, Shidhaye, R, Jordans, MJD, Petersen, I, Bhana, A, Kigozi, F, Prince, M, Thornicroft, G, Hanlon, C, Kakuma, R, McDaid, D, Saxena, S, Chisholm, D, Raja, S, Kippen-Wood, S, Honikman, S, Fairall, L, Patel, V (2012). PRIME: a programme to reduce the treatment gap for mental disorders in five low- and middle-income countries. PLoS Medicine 9, e1001359.Google Scholar
Lund, C, Tomlinson, M, Patel, V (2015). Integration of mental health into primary care in low- and middle-income countries: the PRIME mental healthcare plans. British Journal of Psychiatry.Google Scholar
Mann, JJ, Apter, A, Bertolote, JM, Beautrais, A, Currier, D, Haas, A, Hegerl, U, Lonnqvist, J, Malone, K, Marusic, A (2005). Suicide prevention strategies: a systematic review. JAMA 294, 2064–2074.CrossRefGoogle ScholarPubMed
Milner, A, Page, A, Lamontagne, AD (2014). Cause and effect in studies on unemployment, mental health and suicide: a meta-analytic and conceptual review. Psychological Medicine 44, 909–917.Google Scholar
Ng, N, Van Minh, H, Juvekar, S, Razzaque, A, Bich, TH, Kanungsukkasem, U, Ashraf, A, Ahmed, SM, Soonthornthada, K (2009). Using the INDEPTH HDSS to build capacity for chronic non-communicable disease risk factor surveillance in low and middle income countries. Global Health Action 2.CrossRefGoogle ScholarPubMed
Nock, MK, Borges, G, Bromet, E, Cha, C, Kessler, R, Lee, S (2008 a). Suicide and suicidal behavior. Epidemiologic Reviews 30, 133–154.Google Scholar
Nock, MK, Borges, G, Bromet, EJ, Alonso, J, Angermeyer, M, Beautrais, A, Bruffaerts, R, Chiu, WT, De Girolamo, G, Gluzman, S (2008 b). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry 192, 98–105.CrossRefGoogle ScholarPubMed
Ojagbemi, A, Oladeji, BD, Abiona, T, Gureje, O (2013). Suicidal behaviour in old age-results from the Ibadan Study of Ageing. BMC Psychiatry 13.CrossRefGoogle ScholarPubMed
Oladeji, BD, Gureje, O (2011). Parental mental disorders and suicidal behavior in the Nigerian survey of mental health and well-being. Archives of Suicide Research 15, 372–383.Google Scholar
Petersen, I, Fairall, L, Bhana, A, Kathree, T, Selohilwe, O, Brooke-Sumner, C, Faris, G, Breuer, E, Sibanyoni, N, Lund, C, Patel, V (2016). Integrating mental health into chronic care in South Africa: the development of a district mental healthcare plan. British Journal of Psychiatry 208, s29–s39.CrossRefGoogle ScholarPubMed
Rathod, SD, De Silva, MJ, Ssebunnya, J, Breuer, E, Murhar, V, Luitel, NP, Medhin, G, Kigozi, F, Shidhaye, R, Fekadu, A (2016). Treatment contact coverage for probable depressive and probable alcohol use disorders in four low-and middle-income country districts: the PRIME cross-sectional community surveys. PLoS ONE 11, e0162038.Google Scholar
Rehkopf, DH, Buka, SL (2006). The association between suicide and the socio-economic characteristics of geographical areas: a systematic review. Psychological Medicine 36, 145–157.Google Scholar
Robins, LN, Wing, J, Wittchen, HU, Helzer, JE, Babor, TF, Burke, J, Farmer, A, Jablenski, A, Pickens, R, Regier, DA (1988). The Composite International Diagnostic Interview: an epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry 45, 1069–1077.Google Scholar
Saunders, JB, Aasland, OG, Babor, TF, De La Fuente, JR, Grant, M (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction 88, 791–804.Google Scholar
Shidhaye, R, Shrivastava, S, Murhar, V, Samudre, S, Ahuja, S, Ramaswamy, R, Patel, V (2016). Development and piloting of a plan for integrating mental health in primary care in Sehore district, Madhya Pradesh, India. British Journal of Psychiatry 208, s13–s20.CrossRefGoogle ScholarPubMed
Streatfield, PK, Khan, WA, Bhuiya, A, Alam, N, Sié, A, Soura, AB, Bonfoh, B, Ngoran, EK, Weldearegawi, B, Jasseh, M (2014). Cause-specific mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites. Global Health Action 7.Google Scholar
Üstün, TB, Kostanjsek, N, Chatterji, S, Rehm, J (2010). Measuring Health and Disability: Manual for WHO Disability Assessment Schedule WHODAS 2.0. World Health Organization: Geneva.Google Scholar
Värnik, P (2012). Suicide in the world. International Journal of Environmental Research and Public Health 9, 760–771.Google Scholar
Vijayakumar, L, Nagaraj, K, Pirkis, J, Whiteford, HA (2005). Suicide in developing countries: frequency, distribution, and association with socioeconomic indicators. Crisis 26, 104–111.Google Scholar
Vijayakumar, L, Phillips, MR, Silverman, MM, Gunnell, D, Carli, V (2016). Suicide. In Disease Control Priorities: Mental, Neurological, and Substance Abuse Disorders. (ed. Patel, V, Chisholm, D, Dua, T, Laxminarayan, R and Medina-Mora, ME), pp. 163–181. World Bank: Washington.Google Scholar
Vyas, S, Kumaranayake, L (2006). Constructing socio-economic status indices: how to use principal components analysis. Health Policy and Planning 21, 459–468.Google Scholar
WHO (2010). mhGAP Intervention Guide for Mental, Neurological and Substance use Disorders in Non-Specialized Health Settings. World Health Organization: Geneva.Google Scholar
WHO (2012). Public Health Action for the Prevention of Suicide: a Framework. World Health Organization: Geneva.Google Scholar
WHO (2014). Preventing Suicide: A Global Imperative. World Health Organization: Geneva.Google Scholar
Zou, G (2004). A modified Poisson regression approach to prospective studies with binary data. American Journal of Epidemiology 159, 702–706.Google Scholar