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Heaven can wait: studies on suicidal behaviour among young people in Nicaragua
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
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 [en]
suicide attempts, suicidal expressions, attitudes towards suicide, young people, Nicaragua
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:umu:diva-944ISBN: 91-7264-213-0 (print)OAI: oai:DiVA.org:umu-944DiVA: diva2:145149
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
List of papers
1. Parasuicide in a low income country: results from a three year hospital surveillance in Nicaragua.
Open this publication in new window or tab >>Parasuicide in a low income country: results from a three year hospital surveillance in Nicaragua.
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.

Keyword
hospital surveillance, Nicaragua, parasuicide, seasonal pattern, sociodemographic characteristics
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-5586 (URN)10.1080/14034940410029496 (DOI)15513667 (PubMedID)
Available from: 2006-11-23 Created: 2006-11-23 Last updated: 2011-05-16Bibliographically approved
2. Pathways to suicidal behaviour among adolescent girls in Nicaragua
Open this publication in new window or tab >>Pathways to suicidal behaviour among adolescent girls in Nicaragua
2006 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 62, no 4, 805-814 p.Article in journal (Refereed) Published
Abstract [en]

Adolescent girls are the most frequent suicide attempters worldwide. However, there is little knowledge about pathways leading to suicidal behaviour among young people, in particular in low-income countries. This study explores the motives and processes related to suicidal behaviour among young girls in Nicaragua. Individual in-depth interviews were conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. The audio-taped interviews lasted 2–4 h and were transcribed, translated into English and coded for content. Grounded theory and content analysis were used to construct a theory of the mechanisms behind their suicidal behaviour.

A tentative model exploring pathways to suicidal behaviour is described with four main categories: structuring conditions, triggering events, emotions and actions taken. The model illustrates the dialectic interplay between structure and actions taken. Actions taken were categorized as problem solving or various forms of escape where failure with either of these strategies resulted in a suicide attempt.

Dysfunctional families, absent fathers and lack of integration into society were some of the structuring conditions that lead to emotional distress. Abuse, deaths in the family, break-up with boyfriends or suicide among friends acted as triggering events. A striking finding was the obvious narrative competence of the girls.

Our findings indicate that suicide prevention programmes for young people must offer support from professionals, independent of their family and social networks. Institutions in the community in contact with young people with suicidal behaviour must develop communicative skills to offer a trusting environment mobilising the resources that young people have.

Keyword
suicidal behaviour, adolescent girls, Nicaragua, perceived causes of suicide, grounded theory, content analysis
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-13687 (URN)10.1016/j.socscimed.2005.06.055 (DOI)16098648 (PubMedID)
Available from: 2007-05-16 Created: 2007-05-16 Last updated: 2015-04-29Bibliographically approved
3. Suicidal expressions among young people in Nicaragua: a community-based study
Open this publication in new window or tab >>Suicidal expressions among young people in Nicaragua: a community-based study
2006 (English)In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 41, no 9, 692-697 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-5588 (URN)10.1007/s00127-006-0083-x (DOI)16752049 (PubMedID)
Available from: 2006-11-23 Created: 2006-11-23 Last updated: 2011-05-16Bibliographically approved
4. Attitudes towards suicide among young people in Nicaragua: a community-based study
Open this publication in new window or tab >>Attitudes towards suicide among young people in Nicaragua: a community-based study
Show others...
(English)Manuscript (Other academic)
Identifiers
urn:nbn:se:umu:diva-5589 (URN)
Available from: 2006-11-23 Created: 2006-11-23 Last updated: 2011-05-16Bibliographically approved

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