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Parasuicide in a low income country: results from a three year hospital surveillance in Nicaragua.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
2004 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 32, no 5, 349-355 p.Article in journal (Refereed) Published
Abstract [en]

Aims: A study was undertaken to assess the incidence of parasuicide in Nicaragua, to identify groups at risk, and to describe the characteristics of parasuicides, such as methods used and seasonal and diurnal patterns. Method: All hospital-admitted parasuicide cases in the area of León, Nicaragua, were assessed over a three-year period using standardized instruments. Results: Two hundred and thirty-three parasuicide cases were identified in the catchment area giving a parasuicide rate of 66.3/100,000 inhabitants per year based on the population 10 years and older. Corresponding figure for 15 years and older was 71.3. A majority were females (68.8%), who were significantly younger than the males (mean 20.8 years vs. mean 24.6 years). The highest rates were found in the age group 15 - 19 years with a female rate three times higher than the male rate (302.9 vs. 98.9). Pesticides, a highly lethal substance, were used as method in 19.1% of the attempts. Consistent seasonal variation with peaks in May - June and September - October were found over the years. Among parasuicide cases, 46.5% had been in contact with the healthcare system within 6 months before attempting suicide. Conclusions: Parasuicides represent a significant health problem among young people in Nicaragua. Preventive efforts should be directed especially towards the life situation for young girls, limitation of availability of suicide means, increased awareness in schools concerning suicidal problems, as well as improved management of patients with mental health problems within primary healthcare.

Place, publisher, year, edition, pages
2004. Vol. 32, no 5, 349-355 p.
Keyword [en]
hospital surveillance, Nicaragua, parasuicide, seasonal pattern, sociodemographic characteristics
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-5586DOI: 10.1080/14034940410029496PubMedID: 15513667OAI: oai:DiVA.org:umu-5586DiVA: diva2:145145
Available from: 2006-11-23 Created: 2006-11-23 Last updated: 2011-05-16Bibliographically approved
In thesis
1. Heaven can wait: studies on suicidal behaviour among young people in Nicaragua
Open this publication in new window or tab >>Heaven can wait: studies on suicidal behaviour among young people in Nicaragua
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In developed countries, suicidal behaviour is recognised as a significant public health problem among young people, but there are few studies from developing countries on this subject. The present thesis aims at estimating the extent of the problem and at exploring factors related to suicidal behaviour among young people in a developing country, Nicaragua, using a combined quantitative and qualitative approach. Three studies were conducted between 1999 and 2006. In the first study, all hospital admitted suicide attempt cases in the area of León were assessed over a three year period. Secondly, a qualitative study using individual in-depth interviews was conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. Thirdly, a study using the Attitudes Towards Suicides (ATTS) questionnaire was conducted in a community based sample of 278 young people aged 15-24 years to assess own suicidal behaviours, attitudes towards suicide as well as exposure to suicidal behaviour among significant others.

The hospital surveillance showed that suicide attempt rates were highest among females in the age group 15-19 years with a female rate three times that of males (302.9 versus 98.9 per 100,000 inhabits per year). Drug intoxication and pesticides were the most commonly used methods for the attempts. A consistent seasonal variation with peaks in May-June and September-October was found in each of the three years, possibly related to exam periods in schools.

Findings in the qualitative approach led to a tentative model for pathways to suicidal behaviour based on four main categories: Structuring conditions, triggering events, emotions and action taken. Dysfunctional families, lack of confidential and trustworthy contacts and interpersonal conflicts followed by emotions of shame and anger were some important components in the model.

The community studies showed that suicidal expressions (life-weariness, death wishes, suicidal ideation, suicide plans and suicide attempts) were common among young people where more than 44.8% of males and 47.4% of females reported some kind of suicidal expression. Gender differences were small. Exposure to suicidal behaviour among others was associated with higher levels of self-reported suicidal behaviour. The attitude study showed that boys had less pro-preventive attitudes than girls, possibly indicating their higher risk for completed suicide. Exposure to suicidal behaviour and own suicidal behaviour showed an association with specific patterns of attitudes.

The findings should be taken into consideration when planning for prevention of suicidal behaviour among young people in a developing country like Nicaragua.

Place, publisher, year, edition, pages
Umeå: Klinisk vetenskap, 2006. 41 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1067
Keyword
suicide attempts, suicidal expressions, attitudes towards suicide, young people, Nicaragua
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-944 (URN)91-7264-213-0 (ISBN)
Public defence
2006-12-14, Sal A, By 23 NUS, Psykiatriska kliniken NUS, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2006-11-23 Created: 2006-11-23 Last updated: 2010-05-06Bibliographically approved
2. Mental health in Nicaragua: with special reference to psychological trauma and suicidal behaviour
Open this publication in new window or tab >>Mental health in Nicaragua: with special reference to psychological trauma and suicidal behaviour
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis explores mental health problems relating to war and natural disaster and suicidal behaviour in the Nicaraguan population. The more specific aims of the study were to assess the prevalence and sociodemographic correlates of mental disorder in a community-based study during time of war (Paper I), to assess the mental health impact of Hurricane Mitch in 1998 (Paper II), to assess the incidence of hospitalized parasuicide cases and groups at risk (Paper III), and to examine suicide intent among attempters relating to gender, suicide method and sociodemographic factors and identify predictors for repetition of an attempt (Paper IV).

Method: Based on 4453 family food ration books for families living in an urban area of León, Subtiava, 219 families including 746 adults were selected through a systematic sampling procedure. The study was conducted in 1987 during the war. We were able to reach 584 adults for interview according to the Present State Examination for ICD-9 diagnoses and Self-Report Questionnaire (Paper I). In Paper II, 496 adult primary health care attendees were interviewed six months after Hurricane Mitch according to the Harvard Trauma Questionnaire and were diagnosed for post-traumatic stress disorder (PTSD) according to DSM-IV. In Papers III and IV, all cases from León city admitted to HEODRA Hospital for a suicide attempt over a three-year period (n=233) were interviewed regarding sociodemographic factors and method, time and place of the suicide attempt. A subgroup of 204 cases was interviewed using the Suicide Intent Scale (SIS). Out of those 106 cases were followed-up regarding repetition of attempt or completed suicide after a mean period of 1172 days.

Results: In the Paper I study, the one-month prevalence of any mental disorder was 28.8% for men and 30.8% for women. Among men, alcoholism was the most common diagnosis, whereas neurosis, crisis reaction and depression were dominant among women. Alcoholism was scored as the second most severe disorder after psychosis in terms of functional level. In the Mitch study six months after the hurricane, traumatic events were common and 39% reported death or serious injury of a close relative as a result of the hurricane. The prevalence of PTSD ranged from 4.5% in the least damaged area to 9.0% in the worst damaged area. At the prolonged follow-up six months later, half of the cases still retained their diagnosis. Trauma-related symptoms were common and death of a relative, destroyed house, female sex, illiteracy and previous mental health problems were associated with a higher level of symptoms. Suicidal ideation was reported among 8.5% and was significantly associated with previous mental health problems and illiteracy. The studies regarding hospitalized parasuicides showed the highest rate among girls aged 15–19 years (302 attempts per 100 000 inhabitants and year). After drug intoxication, pesticide was the second most common method and most often used by men (23%). Half of the women had recent contact with health care services before attempting suicide. There were significant peaks regarding time of attempt in terms of seasonal and diurnal distribution. Overall scores regarding seriousness of the intent (SIS) were equal between the sexes, but the pattern of SIS items showed significant gender differences in terms of relation to background factors and method used. For women, having a child was one factor associated with higher seriousness. Factor analysis of SIS items revealed a four-factor solution, explaining 59% of the variance. Risk for fatal repetition was 3.2% after three years and for non-fatal repetition 4.8%. During follow-up, three men (11%) had completed suicide but no women. We failed to identify any predictors for repetition from background factors or SIS.

Conclusion: The studies have identified different groups at risk for mental health problems relating to war and disasters. Parasuicide rates equalled those from European countries. Whereas young girls dominated, attempts among men were more severe in terms of the methods used and completed suicide at follow-up. SIS seemed to give a meaningful pattern among women but not for men. In our study, seriousness of attempt in terms of method or suicide intent did not predict repetition. Overall non-fatal repetition rate was very low as compared to other studies.

Publisher
22 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 915
Keyword
mental disorder, prevalence, post-traumatic stress, parasuicide
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-346 (URN)91-7305-726-6 (ISBN)
Public defence
2004-11-05, Psykiatriska klinikens föreläsningssal A, SV-planet, By 23, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Available from: 2004-11-02 Created: 2004-11-02 Last updated: 2010-03-02Bibliographically approved

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Salander Renberg, EllinorKullgren, Gunnar

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