Suicidal Ideation and Behavior Among Congolese Refugees in Rwanda: Contributing Factors, Consequences, and Support Mechanisms in the Context of Culture
Suicidal Ideation and Behavior Among Congolese Refugees in Rwanda: Contributing Factors, Consequences, and Support Mechanisms in the Context of Culture
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DOI：
10.3389/fpsyt.2020.00299
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发表时间：
2020-04-24
影响因子：
4.7
通讯作者：
Richters, Annemiek
中科院分区：
文献类型：
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作者：
Ingabire, Chantal Marie;Richters, Annemiek
卢旺达五个难民营中的一个难民营对2017年自杀企图和死亡的关切，以及研究数据表明该难民营和同一时期的第二个难民营自杀意念的发生率相对较高，为这项探索性定性研究提供了动力。这项研究探讨了导致自杀念头、企图和死亡的因素；现有的支持和转介机制；以及关于预防和护理战略的建议。2018年7月至9月，与难民和在难民营工作的利益攸关方代表进行了10次焦点小组讨论，并对在上一次量化调查中报告有自杀想法的难民、两名企图自杀的难民以及报告有自杀想法、自杀未遂或自杀的难民的家人进行了21次深入访谈。调查结果表明，虽然所有难民在抵达卢旺达之前都在刚果遭受过战争和暴力，并经历过创伤事件，但自杀念头的产生往往是由难民身份背景下与他们目前处境有关的情况引发的。几乎所有有过自杀念头和/或试图自杀的受访者都报告说，他们的精神健康状况不佳，连接感/归属感较低，感觉到的负担很高，这超过了他们的生存愿望。家庭冲突被认为是导致自杀念头以及在某些情况下导致自杀企图和死亡的一个重要起点。对于成年人口来说，家庭冲突往往是由于逃离本国后经历的文化和法律变化、对卢旺达两性平等政策的误解以及关于家庭收入管理的分歧造成的。对于青年来说，男孩和女孩对未来缺乏希望，对一些女孩来说，自杀的想法是由于意外怀孕而导致的人际/家庭关系不佳引发的。据报告，家庭、社区和基于信仰的支助机制是可用的，但并不总是对文化敏感。应改进和扩大心理社会支助服务，以确保有效的心理社会康复。在处理与缺乏家庭沟通和对两性平等政策的误解有关的家庭冲突时，应注意所涉及的文化因素。
Concern in one of the five camps for Congolese refugees in Rwanda about suicide attempts and death in 2017 as well as research data pointing to a relatively high incidence of suicidal ideation in this and a second camp in the same period provided the impetus for this exploratory qualitative study. The study explored factors contributing to suicidal ideation, attempts and death; existing support and referral mechanisms; and recommendations regarding prevention and care strategies. Between July and September 2018, 10 focus group discussions were conducted with refugees and representatives of stakeholders working in the camp, and 21 in-depth interviews with refugees who reported suicidal ideations in a previous quantitative survey, two refugees who attempted suicide, and family members of those who reported suicidal ideas, attempted suicide or committed suicide. Findings suggest that while all refugees have suffered from war and violence in Congo and experienced traumatic events before arriving in Rwanda, the pathway to suicidal ideations was often triggered by the circumstances related to their current situation in the context of refugeehood. Almost all respondents who experienced suicide ideations and/or attempted to commit suicide reported poor mental health, a low sense of connectedness/belonging and a high level of perceived burden, which were greater than their desire to live. Family conflicts were found to be an important starting point leading to suicidal ideations and in some cases to suicide attempts and deaths. For the adult population, family conflicts often resulted from the cultural and legal changes experienced after fleeing their home country, misunderstandings of Rwandan gender equality policies, and disagreements about family income management. For youth, a lack of hope for the future was found among boys and girls, and for some girls, suicidal ideations were triggered by poor interpersonal/family relationships due to unwanted pregnancies. Family, community and faith-based support mechanisms were reported as being available but not always culturally sensitive. Psychosocial support services should be improved and expanded to ensure effective psychosocial recovery. Family conflicts related to a lack of family communication and a misconception of gender equality policies should be tackled with attention to the cultural factors involved.