1 Sneha, Chennai, India.
2 Voluntary Health Services (VHS), Chennai, India.
Int J Soc Psychiatry. 2017 Nov;63(7):589-597. doi: 10.1177/0020764017723940. Epub 2017 Aug 4.
Refugees are at risk of psychiatric morbidity because of forced migration, traumatic events and resettlement in unfamiliar environments. Many live in low- and middle-income countries (LAMIC) under stressful conditions contributing to increased suicide risk.
This study assessed the feasibility of regular contact and use of safety planning cards (CASP) by community volunteers (CVs) in reducing suicidal behaviour among Sri Lankan refugees residing in camps in Tamil Nadu, South India.
A household survey was carried out on consenting adults in two refugee camps - one intervention and one control - randomly selected using lottery method. The primary outcome was reduction in suicidal behaviour. Experience of trauma during war and migration, depression, post-traumatic stress and alcohol use were documented. Individuals scoring >16 on Centre for Epidemiological Studies Depression (CESD) or >30 on Post-traumatic Stress Disorder (PTSD) or with active/passive suicidal ideation or a history of previous suicidal attempts were considered as high risk. CVs were trained to deliver CASP intervention to high-risk individuals. Change from baseline to follow-up was computed for intervention and control groups, and the difference between changes in suicide rates was compared using proportion test.
In total, 639 refugees from intervention and 664 from control camps participated. Of the 288 high-risk refugees in intervention camp, 139 completed the intervention. In the control camp, 187 were categorised as high risk. Prevalence of suicide attempts was 6.1%. Following intervention, differences between sites in changes in combined suicide (attempted suicides and suicides) rates per 100,000 per year were 519 (95% confidence interval (CI): 136-902; p < .01).
CASP, an intervention involving contact by CVs and use of safety planning cards, is feasible to implement and can reduce suicidal behaviour among refugees. Its replication in more settings will enhance validity.
由于被迫迁移、创伤事件和在陌生环境中重新安置，难民面临精神疾病发病的风险。许多人生活在中低收入国家（LAMIC），生活条件紧张，自杀风险增加。
本研究评估了社区志愿者（CV）定期联系和使用安全规划卡（CASP）在减少居住在印度南部泰米尔纳德邦难民营的斯里兰卡难民自杀行为的可行性。
使用彩票法随机选择两个难民营（一个干预营和一个对照营）中的同意成年人进行家庭调查。主要结果是减少自杀行为。记录战争和迁移期间的创伤经历、抑郁、创伤后应激和酒精使用情况。得分>16 的人中心流行病学研究抑郁量表（CESD）或>30 的创伤后应激障碍（PTSD）或有主动/被动自杀意念或有自杀未遂史的人被认为是高危人群。对 CV 进行培训，以便向高危人群提供 CASP 干预。计算干预组和对照组从基线到随访的变化，并使用比例检验比较自杀率变化之间的差异。
共有 639 名来自干预营和 664 名来自对照营的难民参与了研究。在干预营的 288 名高危难民中，有 139 人完成了干预。在对照营中，有 187 人被归类为高危人群。自杀企图的发生率为 6.1%。干预后，两个地点之间每年每 10 万人自杀（自杀未遂和自杀）综合发生率变化的差异为 519（95%置信区间（CI）：136-902；p<.01）。
CASP，一种涉及 CV 联系和使用安全规划卡的干预措施，是可行的，可以减少难民的自杀行为。在更多的环境中复制将提高其有效性。
