Self-harm with suicidal and non-suicidal intent in young people in sub-Saharan Africa: a systematic review

Abstract

Background Self-harm, whether attributed to suicidal or non-suicidal motives, is associated with several poor outcomes in young people, including eventual suicide. Much of our understanding of self-harm in young people is based on literature from Europe (particularly, the UK), North America, and Australia. We aimed to synthesise the available evidence on prevalence, the commonly reported self-harm methods, correlates, risk and protective factors, and reasons for self-harm, in adolescents (aged 10–25 years) in sub-Saharan Africa. Method We searched MEDLINE, PsycINFO, PubMed, African Journals OnLine, and African Index Medicus for records from 1950 through August 2019, without language restrictions. We supplemented the database searches by searching relevant portals for postgraduate theses, reference harvesting, contacting authors for unpublished studies, and hand searching relevant print sources. We applied narrative synthesis to the evidence. Results Seventy-four studies from 18 sub-Saharan African countries met the inclusion criteria. The median lifetime prevalence estimate was 10·3% (interquartile range [IQR] 4·6% – 16·1%); median 12-month prevalence estimate was 16·9% (IQR: 11·5% – 25·5%); median 6-month prevalence estimate was 18·2% (IQR: 12·7% – 21·8%); and the median 1-month prevalence estimate was 3·2% (IQR: 2·5–14·8%). Studies from Western sub-Saharan Africa reported the highest 12-month prevalence estimates (median = 24·3%; IQR = 16·9% – 27·9%). Clinical samples commonly reported overdose, whereas self-cutting was most commonly reported in non-clinical samples. Academic failure, sexual, emotional, and physical abuse, romantic relationship problems, family conflict, depression, and previous self-harm were identified as key correlates of self-harm. No study reported protective factors against self-harm. Conclusion Variation in estimates was explained by small sample sizes and variation in definitions and measures used. Exploration of associations, risks and protective factors was based upon concepts and measures derived from high income countries. More detailed and culturally sensitive research is needed to understand the context-specific risks and protective factors for self-harm in adolescents in sub-Saharan Africa.

Marijuana use and repeated attempted suicide among senior high school students in Ghana: Evidence from the WHO Global School-Based Student Health Survey, 2012

“…Evidence from LMICs suggests a strong positive association between marijuana use and attempted suicide among young people. 13 14 Our study has extended this evidence by indicating that marijuana use has a strong positive association with repeated attempted suicide among SHS students in Ghana. After controlling for confounding factors associated with marijuana use and adjusting for demographic covariates, this study found marijuana use to be significantly associated with repeated attempted suicide among SHS students in Ghana.…”

“…Thus, recent significant research efforts from low-income and middle-income countries (LMICs) have focused on examining the factors associated with attempted suicide among young people. 13 A recent study conducted by Carvalho and colleagues suggested a strong association between cannabis use and suicide attempts in adolescents living in LMICs. 14 However, as can be said of Ghana, whereas emerging evidence has underscored the key factors associated with marijuana use 6 and those related to the onset of attempted suicide among in-school adolescents, 3 15 there is a paucity of published studies providing evidence on the association between marijuana use and the repetition of attempted suicide among in-school adolescents.…”

Suicidal behaviors and sedentary lifestyles among adolescents: A cross-sectional epidemiological study in Latin American and Caribbean countries

“…In studies conducted in the United States and Southeast Asian countries, female suicidal ideation ranged from 15.1%-23.4% ( 12 - 13 , 23 ), suicidal planning was 19.4%, and suicidal attempts were between 9.1% and 11.6% during the past 12 months ( 13 , 23 ). In a study conducted in 18 sub-Saharan African countries the median estimate of 12-month prevalence of self-harm was 16.9% in adolescents and adults (aged 10-25 years) ( 27 ). Among males, the presence of suicidal ideation, planning, and attempts were 10.7%, 8.6%, and 9.3%, respectively, during the past 12 months.…”

Suicidal behaviours among adolescents in Liberia

“…of recent regional systematic reviews and meta-analyses indicates that compared to other low-and middleincome regions of the world, the 12-month prevalence estimates of suicidal ideation (20.4, 95% confidence interval [CI] = 17.3, 23.6), and suicidal planning (23.7,95%CI = 19.1,28.3) are higher among school-going adolescents in sub-Saharan Africa [10,11], while the pooled 12-month prevalence estimates of suicidal attempt among school-going adolescents in sub-Saharan Africa (19.3,95%CI = 14.2,24.4) is comparable to what is reported in other LAMICs within the Western Pacific region (20.5, 95%CI = 14.3, 26.7) [11]. The most recent systematic review of primary studies involving school-going, household and 'out-of-school' adolescents in sub-Saharan Africa has reported a comparable pooled 12-month prevalence estimates of suicidal attempt (median = 17.1%, interquartile range [IQR] = 11.5-25.6%) [12]. In Western sub-Saharan Africa, where Liberia is located, the pooled 12month prevalence estimates of suicidal attempt is relatively higher (Median = 24.3%, IQR = 16.9-27.9) [12].…”