Suicidal ideation and behaviour among community and health care seeking populations in five low- and middle-income countries: a cross-sectional study

Jordans, Mark J. D.; Rathod, Sujit D; Fekadu, Abebaw; Medhin, Girmay; Kigozi, Fred; Kohrt, Brandon A.; Luitel, Nagendra P.; Petersen, Inge; Shidhaye, Rahul; Ssebunnya, Joshua; Patel, Vikram; Lund, Crick

doi:10.1017/s2045796017000038

Cited by 105 publications

(127 citation statements)

References 39 publications

(52 reference statements)

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“…In fact, only 23% mentioned that their loved one had shared their suicide ideation. In many other low-income settings, suicide ideation disclosure is rare, often due to fear and stigma (Hagaman, et al, 2013; Jordans, et al, 2017). Determining opportunities and appropriate strategies to encourage disclosure will be important for community prevention.…”

Section: Discussionmentioning

confidence: 99%

“…However, these findings are limited to women or to clinical-care settings so that little is known about male suicides as well as those that fail to emerge in the health system. Additionally, a recent five-country study found that Nepal community and clinical populations had high rates of suicide ideation, but the lowest amounts of ideation disclosure and help-seeking following an attempt (Jordans, et al, 2017). This underscores the importance of further research on why suicidal thoughts are not disclosed, as well as a better understanding of perceived drivers and meanings of suicidal deaths in Nepal (Jordans, et al, 2017; Jordans, et al, 2014; Pyakurel, et al, 2015; Marahatta, et al, 2016; Pradhan, et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

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Suicide in Nepal: Qualitative Findings from a Modified Case-Series Psychological Autopsy Investigation of Suicide Deaths

Hagaman

Khadka²,

Wutich

et al. 2018

Cult Med Psychiatry

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South Asia accounts for the majority of the world's suicide deaths, but typical psychiatric or surveillance-based research approaches are limited due to incomplete vital surveillance. Despite rich anthropological scholarship in the region, such work has not been used to address public health gaps in surveillance and nor inform prevention programs designed based on surveillance data. Our goal was to leverage useful strategies from both public health and anthropological approaches to provide rich narrative reconstructions of suicide events, told by family members or loved ones of the deceased, to further contextualize the circumstances of suicide. Specifically, we sought to untangle socio-cultural and structural patterns in suicide cases to better inform systems-level surveillance strategies and salient community-level suicide prevention opportunities. Using a mixed-methods psychological autopsy approach for cross-cultural research (MPAC) in both urban and rural Nepal, 39 suicide deaths were examined. MPAC was used to document antecedent events, characteristics of persons completing suicide, and perceived drivers of each suicide. Patterns across suicide cases include (1) lack of education (72% of cases); (2) life stressors such as poverty (54%), violence (61.1%), migrant labor (33% of men), and family disputes often resulting in isolation or shame (56.4%); (3) family histories of suicidal behavior (62%), with the majority involving an immediate family member; (4) gender differences: female suicides were attributed to hopeless situations, such as spousal abuse, with high degrees of social stigma. In contrast, male suicides were most commonly associated with drinking and resulted from internalized stigma, such as financial failure or an inability to provide for their family; (5) justifications for suicide were attributions to 'fate' and personality characteristics such as 'stubbornness' and 'egoism'; (5) power dynamics and available agency precluded some families from disputing the death as a suicide and also had implications for the condemnation or justification of particular suicides. Importantly, only 1 out of 3 men and 1 out of 6 women had any communication to family members about suicidal ideation prior to completion. Findings illustrate the importance of MPAC methods for capturing cultural narratives evoked after completed suicides, recognizing culturally salient warning signs, and identifying potential barriers to disclosure and justice seeking by families. These findings elucidate how suicide narratives are structured by family members and reveal public health opportunities for creating or supplementing mortality surveillance, intervening in higher risk populations such as survivors of suicide, and encouraging disclosure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Suicide in Nepal: Qualitative Findings from a Modified Case-Series Psychological Autopsy Investigation of Suicide Deaths

Hagaman

Khadka²,

Wutich

et al. 2018

Cult Med Psychiatry

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“…In Nepal, a recent study found suicide disclosure to family/friends and help-seeking to be very low, suggesting that active clinical screening maybe a useful strategy for prevention (69). Compared to depression, a more sensitive marker of risk in Nepal may include having a family member or close friend that recently engaged in suicidal behavior.…”

Section: Discussionmentioning

confidence: 99%

Suicide in Nepal: a modified psychological autopsy investigation from randomly selected police cases between 2013 and 2015

Hagaman

Khadka²,

Lohani

et al. 2017

Soc Psychiatry Psychiatr Epidemiol

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Purpose Yearly, 600,000 people complete suicide in low- and middle-income countries, accounting for 75% of the world’s burden of suicide mortality. The highest regional rates are in South and East Asia. Nepal has one of the highest suicide rates in the world; however, few investigations exploring patterns surrounding both male and female suicides exist. This study used psychological autopsies to identify common factors, precipitating events, and warning signs in a diverse sample. Methods Randomly sampled from 302 police case reports over 24 months, psychological autopsies were conducted for 39 completed suicide cases in one urban and one rural region of Nepal. Results In the total police sample (n=302), 57% of deaths were male. Over 40% of deaths were 25 years or younger, including 65% of rural and 51% of female suicide deaths. We estimate the crude urban and rural suicide rates to be 16.1 and 22.8 per 100,000 respectively. Within our psychological autopsy sample, 38.5% met criteria for depression and only 23.1% informants believed that the deceased had thoughts of self-harm or suicide before death. Important warning signs include recent geographic migration, alcohol abuse, and family history of suicide. Conclusions Suicide prevention strategies in Nepal should account for the lack of awareness about suicide risk among family members and early age of suicide completion, especially in rural and female populations. Given the low rates of ideation disclosure to friends and family, educating the general public about other signs of suicide may help prevention efforts in Nepal.

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“…It affects all people in all age groups worldwide(4). Depression has high impact at the individuals',family members', and at the country level (2,5,6). At the individual level, depression causes social and occupational functioning impairment (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

“…Informal help usually offered by friends, family, religious leaders (priests), or other non-health professionals. Individuals in the community have been found higher support from informal help providers than formal help providers (5,39). It is more di cult and a challenge to explore informal help as informal help occurs frequently and studies are limited (40).…”

Section: Introductionmentioning

confidence: 99%

Help Seeking Preferences to Informal and Formal Source of Care for Depression: a Community Based Study in Northwest Ethiopia

Shumet

Kassew

Azale

et al. 2020

Preprint

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Background: Depression is the leading cause of disability at a population level and globally 350 million people are suffering from depression. Many people suffer from depression use different sources of help for their mental health problems. People with different mental health problems seek help from formal and/or informal sources. This gives crucial information on community,s beliefs and perception regarding their preference for help if they faced depression. This study helps to guide effective planning and provision of mental health services and health policy of the country to explore the community,s preferences of help-seeking. Objective: The aim of this community based cross-sectional study was to contrast patterns of formal and informal help-seeking preferences for depression among residents of Aykel town, Northwest Ethiopia. Methods: This cross-sectional population based study included 832 participants. We used a major depressive disorder case vignette and general help-seeking questionnaire (GHSQ) to assess the preferences to seek help. Study participants were selected by multistage cluster sampling technique. Data were collected by face-to-face interviews. An independent- sample t- test and analysis of variance test (ANOVA) was performed to determine mean score difference in socio-demographic characteristics of the participants for informal sources of help.Results: A total of 656 subjects (78.8%) showed high propensity to intimate partner, and 655 (78.7%) of the study subjects had high propensity to mental health professional. The mean score of the residents’ preference to seek help from informal sources was 3.41±0.60.The mean score of preference to seek help from formal sources was 3.18±0.75. A total of 276 (33.2%) subjects showed high propensity to both informal and formal sources of help. The result also showed that there was mean score difference in preferences to informal help between subjects with strong social support and low and/ moderate social support (P<0.001).Conclusion: The result suggests that the majority of the residents had a higher preference to seek help from informal sources compared to formal sources of care. Mean score difference was observed in degree of social support and occupational status(student,housewife and jobless) for informal sources of help. Providing and strengthening both formal and informal sources of help in conjunction is crucial to get a more qualified and effective care of depressed patients.

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Suicidal ideation and behaviour among community and health care seeking populations in five low- and middle-income countries: a cross-sectional study

Cited by 105 publications

References 39 publications

Suicide in Nepal: Qualitative Findings from a Modified Case-Series Psychological Autopsy Investigation of Suicide Deaths

Suicide in Nepal: Qualitative Findings from a Modified Case-Series Psychological Autopsy Investigation of Suicide Deaths

Suicide in Nepal: a modified psychological autopsy investigation from randomly selected police cases between 2013 and 2015

Help Seeking Preferences to Informal and Formal Source of Care for Depression: a Community Based Study in Northwest Ethiopia

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