Research and Development Department,HealthNet TPO-Amsterdam,Netherlands.
Department of Population Health,London School of Hygiene and Tropical Medicine,London,UK.
Epidemiol Psychiatr Sci. 2018 Aug;27(4):393-402. doi: 10.1017/S2045796017000038. Epub 2017 Feb 16.
UNLABELLED: AimsSuicidal 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.
目的:自杀行为是大多数中低收入国家(LMIC)报告不足且隐藏的死因,这是由于缺乏针对特定死因的国家系统报告、高污名化水平以及宗教或文化制裁。LMIC 中缺乏关于非致命性自杀行为(意念、计划和尝试)的信息,这是设计和实施预防策略的主要障碍。本研究旨在确定 LMIC 社区和医疗机构人群中非致命性自杀行为的流行率。
方法:通过社区样本(n=6689)和来自埃塞俄比亚、乌干达、南非、印度和尼泊尔的初级保健就诊者(n=6470),使用复合国际诊断访谈自杀模块确定自杀意念、计划和尝试的 12 个月患病率。参与者还接受了抑郁和酒精使用障碍的筛查。
结果:我们发现,在初级保健机构就诊的人群中,每 10 人中有 1 人(10.3%)在过去 1 年内报告了自杀意念,每 45 人中有 1 人(2.2%)在同一时期报告了自杀尝试。社区样本中的自杀意念发生率为 3.5-11.1%,而卫生保健机构样本中的自杀意念发生率为 5.0-14.8%。就诊者报告自杀意念的比例高于社区居民(分别为 10.3%和 8.1%)。南非医疗机构的成年人最有可能报告自杀意念(14.8%)、计划(9.5%)和尝试(7.4%)。与自杀行为相关的风险特征(即女性、年龄较小、当前精神障碍以及较低的教育和经济地位)在各国之间高度一致。
结论:初级保健中自杀意念的高患病率表明有重要机会实施减少自杀风险的举措。可以通过世界卫生组织精神卫生全球行动计划自杀预防和抑郁治疗指南实施包括初级保健中的抑郁筛查和治疗在内的证据支持策略。社区样本中的自杀意念和行为需要采用检测策略来识别未到医疗机构就诊的高危人群。
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