Suicidal ideation and behaviour among community and health care seeking populations in five low- and middle-income countries: a cross-sectional study
Suicidal ideation and behaviour among community and health care seeking populations in five low- and middle-income countries: a cross-sectional study
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DOI：
10.1017/s2045796017000038
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发表时间：
2018-08-01
影响因子：
8.1
通讯作者：
Lund, C.
中科院分区：
文献类型：
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作者：
Jordans, M.;Rathod, S.;Lund, C.
在大多数低收入和中等收入国家（LMIC），自杀行为是一种未被充分报告和隐藏的死亡原因，原因是缺乏针对特定原因死亡率的国家系统报告，高度的耻辱感和宗教或文化制裁。在低收入中等收入国家，缺乏关于非致命性自杀行为（意念、计划和企图）的信息是设计和实施预防战略的主要障碍。本研究的目的是确定非致命性自杀行为的患病率在社区和卫生设施为基础的人群中LMIC.Methods的自杀意念，计划和企图的12个月患病率通过社区样本建立（n = 6689）和初级保健参与者（n = 6470）来自埃塞俄比亚，乌干达，南非，印度和尼泊尔的地区使用复合国际诊断面试自杀模块。参与者还筛选抑郁症和酒精使用disorder.Results，我们发现，在初级保健设施提出的10人（10.3%）报告自杀意念在过去的一年中，和1的45（2.2%）报告企图自杀在同一时期。自杀意念的范围在社区样本中为3.5-11.1%，在卫生机构样本中为5.0-14.8%。较高比例的设施参加者报告自杀意念比社区居民（分别为10.3%和8.1%）。南非设施中的成年人最有可能赞同自杀意念（14.8%），计划（9.5%）和企图（7.4%）。与自杀行为（即女性，年龄较小，目前的精神障碍和较低的教育和经济地位）的风险配置文件是高度一致的countries.Conclusion自杀意念的高患病率在初级保健点对实施自杀风险降低措施的重要机会。可以通过世界卫生组织的精神卫生全球行动方案自杀预防和抑郁症治疗准则，实施有证据支持的战略，包括在初级保健中筛查和治疗抑郁症。社区样本中的自杀意念和行为将需要检测战略，以确定未到卫生设施就诊的高危人群。
Aims Suicidal behaviour is an under-reported and hidden cause of death in most low- and middle-income countries (LMIC) due to lack of national systematic reporting for cause-specific mortality, high levels of stigma and religious or cultural sanctions. The lack of information on non-fatal suicidal behaviour (ideation, plans and attempts) in LMIC is a major barrier to design and implementation of prevention strategies. This study aims to determine the prevalence of non-fatal suicidal behaviour within community- and health facility-based populations in LMIC.Methods Twelve-month prevalence of suicidal ideation, plans and attempts were established through community samples (n = 6689) and primary care attendees (n = 6470) from districts in Ethiopia, Uganda, South Africa, India and Nepal using the Composite International Diagnostic Interview suicidality module. Participants were also screened for depression and alcohol use disorder.Results We found that one out of ten persons (10.3%) presenting at primary care facilities reported suicidal ideation within the past year, and 1 out of 45 (2.2%) reported attempting suicide in the same period. The range of suicidal ideation was 3.5-11.1% in community samples and 5.0-14.8% in health facility samples. A higher proportion of facility attendees reported suicidal ideation than community residents (10.3 and 8.1%, respectively). Adults in the South African facilities were most likely to endorse suicidal ideation (14.8%), planning (9.5%) and attempts (7.4%). Risk profiles associated with suicidal behaviour (i.e. being female, younger age, current mental disorders and lower educational and economic status) were highly consistent across countries.Conclusion The high prevalence of suicidal ideation in primary care points towards important opportunities to implement suicide risk reduction initiatives. Evidence-supported strategies including screening and treatment of depression in primary care can be implemented through the World Health Organization's mental health Global Action Programme suicide prevention and depression treatment guidelines. Suicidal ideation and behaviours in the community sample will require detection strategies to identify at risks persons not presenting to health facilities.