Mars Becky, Burrows Stephanie, Hjelmeland Heidi, Gunnell David
School of Social and Community Medicine, University of Bristol, Oakfield House, Bristol BS8 2BN, United Kingdom.
BMC Public Health. 2014 Jun 14;14:606. doi: 10.1186/1471-2458-14-606.
Suicide is a major cause of premature mortality worldwide, but data on its epidemiology in Africa, the world's second most populous continent, are limited.
We systematically reviewed published literature on suicidal behaviour in African countries. We searched PubMed, Web of Knowledge, PsycINFO, African Index Medicus, Eastern Mediterranean Index Medicus and African Journals OnLine and carried out citation searches of key articles. We crudely estimated the incidence of suicide and suicide attempts in Africa based on country-specific data and compared these with published estimates. We also describe common features of suicide and suicide attempts across the studies, including information related to age, sex, methods used and risk factors.
Regional or national suicide incidence data were available for less than one third (16/53) of African countries containing approximately 60% of Africa's population; suicide attempt data were available for <20% of countries (7/53). Crude estimates suggest there are over 34,000 (inter-quartile range 13,141 to 63,757) suicides per year in Africa, with an overall incidence rate of 3.2 per 100,000 population. The recent Global Burden of Disease (GBD) estimate of 49,558 deaths is somewhat higher, but falls within the inter-quartile range of our estimate. Suicide rates in men are typically at least three times higher than in women. The most frequently used methods of suicide are hanging and pesticide poisoning. Reported risk factors are similar for suicide and suicide attempts and include interpersonal difficulties, mental and physical health problems, socioeconomic problems and drug and alcohol use/abuse. Qualitative studies are needed to identify additional culturally relevant risk factors and to understand how risk factors may be connected to suicidal behaviour in different socio-cultural contexts.
Our estimate is somewhat lower than GBD, but still clearly indicates suicidal behaviour is an important public health problem in Africa. More regional studies, in both urban and rural areas, are needed to more accurately estimate the burden of suicidal behaviour across the continent. Qualitative studies are required in addition to quantitative studies.
自杀是全球过早死亡的主要原因，但在世界第二人口大国非洲，其流行病学数据有限。
我们系统回顾了关于非洲国家自杀行为的已发表文献。我们检索了PubMed、Web of Knowledge、PsycINFO、非洲医学索引、东地中海医学索引和非洲在线期刊，并对关键文章进行了引文检索。我们根据各国的具体数据粗略估计了非洲的自杀率和自杀未遂率，并将这些数据与已发表的估计数据进行了比较。我们还描述了各项研究中自杀和自杀未遂的共同特征，包括与年龄、性别、使用的方法和风险因素相关的信息。
区域或国家自杀率数据仅在不到三分之一（16/53）的非洲国家可得，这些国家约占非洲人口的60%；自杀未遂数据仅在不到20%的国家（7/53）可得。粗略估计表明，非洲每年有超过34000例（四分位间距为13141至63757例）自杀，总体发病率为每10万人3.2例。最近全球疾病负担（GBD）估计的49558例死亡人数略高，但仍在我们估计的四分位间距范围内。男性自杀率通常至少是女性的三倍。最常用的自杀方法是上吊和农药中毒。报告的自杀和自杀未遂风险因素相似，包括人际关系困难、身心健康问题、社会经济问题以及药物和酒精使用/滥用。需要进行定性研究，以确定更多与文化相关的风险因素，并了解在不同社会文化背景下风险因素与自杀行为之间的联系。
我们的估计略低于全球疾病负担，但仍清楚表明自杀行为是非洲一个重要的公共卫生问题。需要在城市和农村地区开展更多的区域研究，以更准确地估计整个非洲大陆自杀行为的负担。除了定量研究外，还需要进行定性研究。
