Depression, suicidal ideation, and associated factors: a cross-sectional study in rural Haiti

Abstract

BackgroundSince the 2010 earthquake in Haiti, there has been increased international attention to mental health needs throughout the country. The present study represents one of the first epidemiologic studies of depression symptomatology, suicidal ideation, and associated factors in Haiti’s Central Plateau.MethodsWe conducted a cross-sectional, zone-stratified household survey of 408 adults in Haiti’s Central Plateau. Depression symptomatology was assessed with a culturally-adapted Kreyòl version of the Beck Depression Inventory (BDI). Multivariable linear and logistic regression models were built using backward elimination, with the outcomes being continuous BDI scores and endorsing suicidal ideation, respectively.ResultsThe mean BDI score was 20.4 (95% confidence interval [CI]: 19.3-21.5), and 6.13% (N = 25) of participants endorsed current suicidal ideation. Factors associated with BDI scores were: continuous age (adjusted beta [aβ]: 0.14, CI: 0.06-0.22), female gender (aβ: 2.1, CI: 0.18-4.0), suicidal ideation (aβ: 11.1, CI: 7.3-14.9), death in family (aβ: 2.7, CI: 0.57-4.9), and prior life-threatening illness (aβ: 2.6, CI: 0.77-4.5). Education was a risk factor for depression among women but not among men, and employment was a risk factor for both genders. Factors associated with endorsing suicidal ideation were: BDI score (ten point change) (adjusted odds ratio [aOR]: 2.5, CI: 1.7-3.6), lack of care if sick (aOR: 5.5, CI: 1.1-28.6), alcohol use (aOR: 3.3, CI: 1.3-8.2), and ever having been to a Vodou priest (aOR: 3.2, CI: 1.1-9.5).ConclusionsA large proportion of Haiti’s Central Plateau may be experiencing high levels of depression symptomatology and/or current suicidal ideation. Screening could be conducted in biomedical, religious, and Vodou healing contexts. For prevention, poverty reduction and improved healthcare access are key elements. For treatment, general psychiatric services, psychosocial services for the medically ill and their families, and substance abuse interventions should be explored. Paradoxical associations related to education and employment require further exploration.

Sintomas de depressão em mulheres rurais: fatores sociodemográficos, econômicos, comportamentais e reprodutivos

“…(22) This fact is confirmed in a study with the rural population in Lithuania that observed that women presenting older age and lower educational level presented a significant association with depression symptoms (7) (data not identified in the present study).…”

Task sharing in rural Haiti

“…These individuals were identified by our concurrent epidemiological survey (Wagenaar et al, 2012) as having depressive symptomology. These case visits included referral to local mental health professionals if the counsellor deemed it necessary.…”

“…The present project is part of mixed methods research examining perceptions, experiences, care seeking and supports available for persons with mental illness in Haiti’s Central Plateau (Hagaman et al, 2013; Kaiser, Kohrt, Keys, Khoury, & Brewster, 2013; Kaiser et al, 2014; Keys et al, 2012; Khoury et al, 2012; Wagenaar, Hagaman, Kaiser, McLean, & Kohrt, 2012; Wagenaar et al, 2013). …”

Formas utilizadas para tentativa de suicídio e características sociodemográficas de pacientes atendidos no serviço de emergência de um hospital de ensino

“…Outros estudos encontraram situação diferente, com predominância das tentativas de suicídio em moradores das áreas rurais. Esses autores conjeturam que os cuidados de saúde em zonas rurais é baixo e que a maioria das pessoas não possui acesso a cuidados de saúde primários, principalmente aos serviços de saúde mental, o que poderia atuar como fator de risco para a tendência suicida [14,24,25].…”