Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya.
Syracuse University Department of Public Health, Syracuse, NY, USA.
BMC Psychiatry. 2022 Jan 4;22(1):7. doi: 10.1186/s12888-021-03649-6.
Suicide is an important contributor to the burden of mental health disorders, but community-based suicide data are scarce in many low- and middle-income countries (LMIC) including Kenya. Available data on suicide underestimates the true burden due to underreporting related to stigma and legal restrictions, and under-representation of those not utilizing health facilities.
We estimated the cumulative incidence of suicide via verbal autopsies from the Health and Demographic Surveillance System (HDSS) in Kisumu County, Kenya. We then used content analysis of open history forms among deaths coded as accidents to identify those who likely died by suicide but were not coded as suicide deaths. We finally conducted a case-control study of suicides (both verbal autopsy confirmed and likely suicides) compared to accident-caused deaths to assess factors associated with suicide in this HDSS.
A total of 33 out of 4306 verbal autopsies confirmed suicide as the cause of death. Content analysis of a further 228 deaths originally attributed to accidents identified 39 additional likely suicides. The best estimate of suicide-specific mortality rate was 14.7 per 100,000 population per year (credibility window = 11.3 - 18.0). The most common reported method of death was self-poisoning (54%). From the case-control study interpersonal difficulties and stressful life events were associated with increased odds of suicide in both confirmed suicides and confirmed combined with suspected suicides. Other pertinent factors such as age and being male differed depending upon which outcome was used.
Suicide is common in this area, and interventions are needed to address drivers. The twofold increase in the suicide-specific mortality rate following incorporation of misattributed suicide deaths exemplify underreporting and misclassification of suicide cases at community level. Further, verbal autopsies may underreport suicide specifically among older and female populations.
自杀是精神健康障碍负担的一个重要因素，但包括肯尼亚在内的许多低收入和中等收入国家（LMIC）缺乏基于社区的自杀数据。由于与耻辱和法律限制有关的漏报以及未利用卫生设施的人群代表性不足，现有的自杀数据低估了真实负担。
我们通过肯尼亚基苏木县卫生和人口监测系统（HDSS）的口头尸检估算了自杀的累积发病率。然后，我们通过对死因编码为意外的开放式病史表进行内容分析，确定了那些可能自杀但未被编码为自杀死亡的人。最后，我们对自杀（口头尸检确诊和可能自杀）与意外死亡进行了病例对照研究，以评估该 HDSS 中与自杀相关的因素。
共有 33 例口头尸检证实自杀为死因。对最初归因于意外的另外 228 例死亡的进一步内容分析确定了 39 例额外的可能自杀病例。自杀特定死亡率的最佳估计值为每年每 100000 人口 14.7 例（可信度区间为 11.3-18.0）。最常见的报告死亡方式是自伤（54%）。从病例对照研究中可以看出，人际困难和生活压力事件与确诊自杀和确诊合并疑似自杀的自杀几率增加有关。其他相关因素，如年龄和性别，取决于使用哪种结果而有所不同。
该地区自杀较为常见，需要采取干预措施来解决相关问题。在将归因错误的自杀死亡纳入后，自杀特定死亡率增加了一倍，这说明了社区层面自杀病例的漏报和分类错误。此外，口头尸检可能特别低估了老年和女性人群中的自杀情况。
