1
|
Arafat SMY, Menon V, Khan MAS, Htay MNN, Singh R, Biyyala D, Krishnamoorthy Y, Mynampally K. Marital status and suicidal behavior in South Asia: A systematic review and meta-analysis. Health Sci Rep 2023; 6:e1781. [PMID: 38130329 PMCID: PMC10733573 DOI: 10.1002/hsr2.1781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/18/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
Background and Aims The connection between marital status and suicidal behavior has been poorly assessed in South Asia. We aimed to see the proportion of marital status in individuals with suicidal behavior in South Asian countries. Methods We followed PRISMA guidelines and registered the protocol in advance (PROSPERO 2023 CRD42023399906). A systematic search was conducted in Medline, Embase, and PsycINFO. Meta-analyses were performed to pool the proportion of married individuals with suicidal behavior (total [suicide + suicide attempts], suicide, and suicide attempt) in South Asian countries. We considered suicidal behavior consist of suicide and suicide attempts (nonfatal). Results Our search identified 47 studies for this review from 6 countries published from 1999 to 2022 with a sample size ranging from 27 to 89,178. The proportion of married individuals was 55.4% (95% CI: 50.1-60.5) for suicidal behavior, 52.7% (95% CI: 44.5-60.7) for suicides, and 43.1 (95% CI: 32.9-53.9) for suicide attempts. The proportion of married persons among suicide attempts varied significantly across countries (p = 0.016) which was highest (61.8%; 95% CI: 57.2-66.2) in India, followed by Bangladesh (52.5%; 95% CI: 41.8%-62.9%) and Pakistan (45.1%; 95% CI: 30.9-59.9). The pooled proportions did not differ significantly in relation to the quality of the studies (p = 0.633). Conclusion This review identified married persons died more than others by suicide in South Asian countries while single persons attempted suicide than married. As the current study did not assess any cause-and-effect association, a cautious interpretation is warranted while considering married marital status as a risk factor.
Collapse
Affiliation(s)
- S. M. Yasir Arafat
- Department of PsychiatryEnam Medical College and HospitalDhakaBangladesh
| | - Vikas Menon
- Department of PsychiatryJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
| | - Md Abdullah Saeed Khan
- Department of Community MedicineNational Institute of Preventive and Social Medicine (NIPSOM)DhakaBangladesh
| | - Mila Nu Nu Htay
- Department of Community MedicineManipal University College Malaysia, Faculty of MedicineMelakaMalaysia
| | - Rakesh Singh
- Department of Research – Transcultural Psychosocial Organization NepalKathmanduNepal
| | | | | | - Keerthana Mynampally
- Department of PsychiatryJawaharlal Institute of Postgraduate Medical Education and ResearchPuducherryIndia
| |
Collapse
|
2
|
Canetto SS, Menger-Ogle AD, Subba UK. Studying Scripts of Women, Men and Suicide: Qualitative-Method Development and Findings from Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6032. [PMID: 37297636 PMCID: PMC10253003 DOI: 10.3390/ijerph20116032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/01/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
Information about suicidal behavior in Nepal is limited. According to official records, suicide rates were high until the year 2000 and declined thereafter. Official records are considered unreliable and a gross undercounting of suicide cases, particularly female cases. Suicide research in Nepal has been mostly epidemiologic and hospital-based. Little is known about how suicide is understood by Nepali people in general-including dominant suicide attitudes and beliefs in Nepal. Suicide attitudes and beliefs, which are elements of a culture's suicide scripts, predict actual suicidality. Drawing on suicide-script theory, we developed and used a semi-structured survey to explore Nepali beliefs about female and male suicide. The informants were adult (Mage = 28.4) university students (59% male). Female suicide was believed to be a response to the society-sanctioned oppression and abuse that women are subjected to, in their family and community. The prevention of female suicide was viewed as requiring dismantling ideologies, institutions, and customs (e.g., child marriage, dowry) that are oppressive to women, and ensuring that women are protected from violence and have equal social and economic rights and opportunities. Male suicide was believed to be a symptom of societal problems (e.g., unemployment) and of men's psychological problems (e.g., their difficulties in managing emotions). The prevention of male suicide was viewed as requiring both societal (e.g., employment opportunities) and individual remedies (e.g., psychological counseling). This study's findings suggest that a semi-structured survey can be a fruitful method to access the suicide scripts of cultures about which there is limited research.
Collapse
Affiliation(s)
- Silvia Sara Canetto
- Department of Psychology, Colorado State University, Fort Collins, CO 80523, USA
| | | | - Usha Kiran Subba
- Department of Psychology, Trichandra College, Kathmandu 44600, Nepal
| |
Collapse
|
3
|
Pandey P, Chakole S, Wanjari MB, Prasad R. A Bibliometric Analysis of Scientific Research Publications Related to Pesticide Poisoning in the South Asian Countries. Cureus 2023; 15:e38134. [PMID: 37252514 PMCID: PMC10224716 DOI: 10.7759/cureus.38134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Pesticide self-intoxication leading to suicide is a widespread phenomenon in India. Implementing regulations prohibiting the use of highly toxic pesticides in agriculture has proven effective in reducing the overall suicide rate in various South Asian countries without compromising agricultural production. In this study, we conducted a bibliometric analysis of scientific publications on pesticide poisoning in South Asian countries using various databases, including PubMed, Scopus, and Web of Science, using relevant Medical Subject Heading (MeSH) terms. To analyze the data, we employed R Studio and Microsoft Excel 2019, which enabled us to collect information on the number of scientific publications, citation frequency, and keyword trends. Our analysis involved 417 articles, and the results indicated a crucial need for greater awareness and improved management of pesticide poisoning in South Asian countries. Our findings provide valuable insights for policymakers and offer guidelines for pesticide control.
Collapse
Affiliation(s)
- Prateek Pandey
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swarupa Chakole
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur B Wanjari
- Department of Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Roshan Prasad
- Department of Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
4
|
Pedersen GA, Lam C, Hoffmann M, Zajkowska Z, Walsh A, Kieling C, Mondelli V, Fisher HL, Gautam K, Kohrt BA. Psychological and contextual risk factors for first-onset depression among adolescents and young people around the globe: A systematic review and meta-analysis. Early Interv Psychiatry 2023; 17:5-20. [PMID: 35388612 PMCID: PMC10084304 DOI: 10.1111/eip.13300] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 02/28/2022] [Accepted: 03/13/2022] [Indexed: 01/21/2023]
Abstract
AIM Identifying predictors for future onset of depression is crucial to effectively developing preventive interventions. We conducted a systematic review and meta-analysis to identify risk factors for first-onset depression among adolescents and young people. METHODS We searched MEDLINE (Ovid), PsycINFO, Cochrane Database, Web of Science, Lilacs, African Journals Online and Global Health (July 2009 to December 2020) for longitudinal studies assessing risk factors for first-onset depression among adolescents and young people aged 10-25 years. Meta-analyses generated summary odds ratio (OR) estimates. REGISTRATION PROSPERO CRD42018103973. RESULTS Nineteen studies representing 21 unique populations were included in the meta-analysis. Among studies reporting race/ethnicity, 79% of participants were of White/European descent. Seventeen studies were from high-income countries, with only two from an upper-middle-income country (China). Odds for first-onset depression were significantly greater for girls compared to boys (n = 13; OR = 1.78 [1.78, 2.28], p < 0.001) and for youth with other mental health problems at baseline (n = 4; OR = 3.20 [1.95, 5.23], p < 0.001). There were non-significant associations for negative family environment (n = 8; OR = 1.60 [0.82, 3.10], p = 0.16) and parental depression (n = 3; OR = 2.30 [0.73, 7.24], p = 0.16). CONCLUSIONS Most longitudinal studies do not report risk factors specifically for first-onset depression. Moreover, predictive data are limited to predominantly White populations in high-income countries. Future research must be more ethnically and geographically representative. Recommendations are provided for consistent and comprehensive reporting of study designs and analyses of risk factors for first-onset depression.
Collapse
Affiliation(s)
- Gloria A Pedersen
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Crystal Lam
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Megan Hoffmann
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Zuzanna Zajkowska
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Annabel Walsh
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Christian Kieling
- Child & Adolescent Psychiatry Division, Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Helen L Fisher
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Kamal Gautam
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA
| |
Collapse
|
5
|
Carvajal-Velez L, Ahs JW, Lundin A, van den Broek M, Simmons J, Wade P, Chorpita B, Requejo JH, Kohrt BA. Validation of the Kriol and Belizean English Adaptation of the Revised Children's Anxiety and Depression Scale for Use With Adolescents in Belize. J Adolesc Health 2023; 72:S40-S51. [PMID: 36400635 DOI: 10.1016/j.jadohealth.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To validate a culturally-adapted Kriol and Belizean English version of the Revised Children's Anxiety and Depression Scale (RCADS) through comparison with clinical diagnoses made using the Kiddie Schedule of Affective Disorders and Schizophrenia. METHODS Participants comprised of 256 adolescents aged 10-14 years and 15-19 years, who completed the adapted RCADS (10 depression items, 12 anxiety items) in one-on-one interviews, followed by a diagnostic assessment using Kiddie Schedule of Affective Disorders and Schizophrenia administered by trained clinicians. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic odds ratios, area under the curve (AUC), and Youden's Index were calculated for RCADS cutoffs and scores on the total scale and anxiety and depression subscales. RESULTS For adolescents aged 10-14 years (n = 161), the AUC was 0.72 for the full scale, 0.67 for anxiety subscale, and 0.76 for depression subscale. For adolescents aged 15-19 years (n = 95), the AUCs were 0.82, 0.77, and 0.83. Most depression items performed well in discriminating those with and without diagnoses. Separation anxiety items performed poorly. "Thoughts of death" were common even among adolescents not meeting diagnostic criteria. The RCADS depression subscale presented the strongest psychometric properties with adolescents aged 15-19 years (at cutoff of 13, sensitivity = 0.83, specificity = 0.77, positive predictive value = 0.47, negative predictive value = 0.95, odds ratio = 15.96). CONCLUSION The adapted RCADS-22 had acceptable categorization for adolescents aged 10-14 years and excellent categorization for adolescents aged 15-19 years; therefore, the tool is recommended for use among the latter age group. Based on sensitivity and specificity values at different cutoffs, guidance is provided to select different thresholds to suit clinical, public health, or other uses to detect and quantify adolescent depression and anxiety in Belize.
Collapse
Affiliation(s)
- Liliana Carvajal-Velez
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Jill W Ahs
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, Swedish Red Cross University, Stockholm, Sweden
| | - Andreas Lundin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Myrthe van den Broek
- War Child Holland and Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, Netherlands
| | - Juliet Simmons
- Department of Mental Health, Ministry of Health and Wellness, Belize City, Belize
| | | | - Bruce Chorpita
- Department of Psychology, University of California, Los Angeles, California
| | - Jennifer Harris Requejo
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York
| | - Brandon A Kohrt
- Department of Psychiatry, George Washington University, Washington, District of Columbia
| |
Collapse
|
6
|
Shoib S, Khan S, Baiou A, Chandradasa M, Swed S, Turan S, Yusha’u Armiya’u A. Exposure to violence and the presence of suicidal and self-harm behaviour predominantly in Asian females: scoping review. MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-022-00225-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Exposure to violence is associated with psychological distress, mental disorders such as depression, and suicidal behaviour. Most of the studies are conducted in the West, with limited publications from Asia. Thus, we conducted a scoping review of studies investigating the association between experiences of violence and later suicidal ideation/attempts from Asia in the twenty-first century.
Results
Many studies focused on domestic violence toward women in the Southeast Asian region. Sociocultural factors such as family disputes, public shaming, dowry, lack of education opportunities, and marriage life perceptions mediated the association. Many women exposed to violence and attempted suicide suffered from mental disorders such as depression, anxiety, and post-traumatic stress. The small number of suitable studies and the possible effect of confounders on participants were limitations in the review. Future studies would have to focus on specific types of violence and ethnoreligious beliefs.
Conclusion
Women in Asia exposed to violence appear to have an increased risk of suicidal behaviour and mental disorders. The early screening of psychological distress with culturally validated tools is essential for preventing suicides in Asian victims of violence.
Collapse
|
7
|
Kohrt BA, Turner EL, Gurung D, Wang X, Neupane M, Luitel NP, Kartha MR, Poudyal A, Singh R, Rai S, Baral PP, McCutchan S, Gronholm PC, Hanlon C, Lempp H, Lund C, Thornicroft G, Gautam K, Jordans MJD. Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial. Implement Sci 2022; 17:39. [PMID: 35710491 PMCID: PMC9205129 DOI: 10.1186/s13012-022-01202-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/10/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There are increasing efforts for the integration of mental health services into primary care settings in low- and middle-income countries. However, commonly used approaches to train primary care providers (PCPs) may not achieve the expected outcomes for improved service delivery, as evidenced by low detection rates of mental illnesses after training. One contributor to this shortcoming is the stigma among PCPs. Implementation strategies for training PCPs that reduce stigma have the potential to improve the quality of services. DESIGN In Nepal, a type 3 hybrid implementation-effectiveness cluster randomized controlled trial will evaluate the implementation-as-usual training for PCPs compared to an alternative implementation strategy to train PCPs, entitled Reducing Stigma among Healthcare Providers (RESHAPE). In implementation-as-usual, PCPs are trained on the World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) with trainings conducted by mental health specialists. In RESHAPE, mhGAP-IG training includes the added component of facilitation by people with lived experience of mental illness (PWLE) and their caregivers using PhotoVoice, as well as aspirational figures. The duration of PCP training is the same in both arms. Co-primary outcomes of the study are stigma among PCPs, as measured with the Social Distance Scale at 6 months post-training, and reach, a domain from the RE-AIM implementation science framework. Reach is operationalized as the accuracy of detection of mental illness in primary care facilities and will be determined by psychiatrists at 3 months after PCPs diagnose the patients. Stigma will be evaluated as a mediator of reach. Cost-effectiveness and other RE-AIM outcomes will be assessed. Twenty-four municipalities, the unit of clustering, will be randomized to either mhGAP-IG implementation-as-usual or RESHAPE arms, with approximately 76 health facilities and 216 PCPs divided equally between arms. An estimated 1100 patients will be enrolled for the evaluation of accurate diagnosis of depression, generalized anxiety disorder, psychosis, or alcohol use disorder. Masking will include PCPs, patients, and psychiatrists. DISCUSSION This study will advance the knowledge of stigma reduction for training PCPs in partnership with PWLE. This collaborative approach to training has the potential to improve diagnostic competencies. If successful, this implementation strategy could be scaled up throughout low-resource settings to reduce the global treatment gap for mental illness. TRIAL REGISTRATION ClinicalTrials.gov, NCT04282915 . Date of registration: February 25, 2020.
Collapse
Affiliation(s)
- Brandon A. Kohrt
- grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington D.C., USA
| | - Elizabeth L. Turner
- grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC USA
| | - Dristy Gurung
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Pokhara, Nepal
| | - Xueqi Wang
- grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC USA
| | - Mani Neupane
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Pokhara, Nepal
| | - Nagendra P. Luitel
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Muralikrishnan R. Kartha
- grid.13097.3c0000 0001 2322 6764King’s Health Economics, IOPPN, King’s College London, London, UK
| | - Anubhuti Poudyal
- grid.21729.3f0000000419368729Department of Sociomedical Sciences, Columbia University, New York, NY USA ,grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, D.C., 20036 USA
| | - Ritika Singh
- grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, D.C., 20036 USA
| | - Sauharda Rai
- grid.34477.330000000122986657Jackson School of International Studies and Department of Global Health, University of Washington, Seattle, USA
| | - Phanindra Prasad Baral
- grid.500537.4Non-communicable Disease and Mental Health Section, Epidemiology and Disease Control Division (EDCD), Department of Health Services (DoHS), Ministry of Health and Population (MoHP), Kathmandu, Nepal
| | - Sabrina McCutchan
- grid.26009.3d0000 0004 1936 7961Duke Global Health Institute, Duke University, Durham, NC USA
| | - Petra C. Gronholm
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Charlotte Hanlon
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine and Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Heidi Lempp
- grid.13097.3c0000 0001 2322 6764Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Crick Lund
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.7836.a0000 0004 1937 1151Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Graham Thornicroft
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kamal Gautam
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Mark J. D. Jordans
- grid.13097.3c0000 0001 2322 6764Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Center for Global Mental Health, King’s College London, London, UK
| |
Collapse
|
8
|
Acharya B, Subedi K, Acharya P, Ghimire S. Association between COVID-19 pandemic and the suicide rates in Nepal. PLoS One 2022; 17:e0262958. [PMID: 35073377 PMCID: PMC8786170 DOI: 10.1371/journal.pone.0262958] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Past works have linked the COVID-19 pandemic and subsequent public health responses such as isolation, quarantine, and lockdown to increased anxiety, sleep disorders, depressive symptoms, and suicidal ideation. Only a few studies, mostly carried out in high-income countries, have investigated the association between the pandemic and suicide rate. We seek to investigate the changes in the monthly suicide rates during the COVID-19 pandemic in Nepal, compared to the pre-pandemic suicide rates. METHODS AND FINDINGS This is a retrospective study investigating the changes in suicide rates in Nepal during the COVID-19 pandemic period (April 2020 to June 2021), compared to the pre-pandemic period (July 2017 to March 2020), adjusted for seasonality and long-term trend in the suicide rate. We performed analysis for the entire country as well as sub-sample analyses stratified by gender and provinces. A total of 24350 suicides deaths during four years of the study window were analyzed. We found an overall increase in the monthly suicide rate in Nepal with an average increase of 0.28 (CI: 0.12,0.45) suicide per 100,000 during the pandemic months. The increase in suicide rate was significant both among males (increase in rate = 0.26, CI: 0.02,0.50) and females (increase in rate = 0.30, CI: 0.18,0.43). The most striking increments in suicide rates were observed in June, July, and August 2020. The pattern of increased suicide rates faded away early on among males, but the effect was sustained for a longer duration among females. Sudurpaschim and Karnali provinces had the highest increase in suicide rates associated with the COVID-19 pandemic. CONCLUSIONS The COVID-19 pandemic is associated with an increased suicide rate in Nepal. The findings may inform policymakers in designing appropriate public health responses to the pandemic that are considerate of the potential impact on mental health and suicide.
Collapse
Affiliation(s)
- Binod Acharya
- Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Keshab Subedi
- iREACH, ChristianaCare Health Systems, Wilmington, Delaware, United States of America
| | | | - Shweta Ghimire
- Center for Bioinformatics and Computational Biology, University of Delaware, Newark, Delaware, United States of America
| |
Collapse
|
9
|
Depression and suicidal behavior in South Asia: a systematic review and meta-analysis. Glob Ment Health (Camb) 2022; 9:181-192. [PMID: 36618741 PMCID: PMC9806989 DOI: 10.1017/gmh.2022.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/16/2022] [Accepted: 03/06/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Estimates of depression in suicidal behavior in South Asia would help to formulate suicide prevention strategies in the region that hasn't been assessed yet. OBJECTIVES We aimed to systematically assess the prevalence of depression in fatal and non-fatal attempts of suicide in eight South Asian countries. METHODS We searched Medline, Embase, and PsychINFO by specific search terms to identify articles assessing depression in fatal and non-fatal attempts of suicide in South Asian countries published between 2001 and 2020. Two separate meta-analyses were conducted for fatal and non-fatal attempts. Due to the high heterogeneity of studies (96-98%), random-effects models were used to calculate pooled prevalence rates. RESULTS A total of 38 studies was identified from five south Asian countries (India [27], Pakistan [6], Sri Lanka [3], Nepal [1], and Bangladesh [1]). The majority of studies (n = 27) were published after 2010. Twenty-two studies reported non-fatal attempts, and sixteen reported suicide. The prevalence of depression among non-fatal attempts ranged from 14% to 78% where the pooled prevalence rate was 32.7% [95% CI 26-39.3%]. The prevalence of depression among suicides ranged from 8% to 79% where the pooled prevalence estimate was 37.3% [95% CI 26.9-47.6%]. CONCLUSIONS This review revealed the pooled prevalence of depression among fatal and non-fatal suicidal attempts in South Asian countries, which seems to be lower when comparedto the Western countries. However, a cautious interpretation is warranted due to the heterogeneity of study methods, sample size, and measurement of depression.
Collapse
|
10
|
Abstract
BACKGROUND Psychiatric disorders have been identified as an important risk factor for suicide. However, different psychological autopsy studies have revealed different prevalences at different times and places. OBJECTIVE We aimed to see the distribution of psychological autopsy studies and the prevalence of mental disorders among suicides and identify major risk factors in Southeast Asian countries. METHOD We scrutinized psychological autopsy studies published in the World Health Organization (WHO) South-East Asia (SEA) region countries. We also searched the available bibliographies to identify the studies in the region so that all the possible articles could be included. RESULTS Out of the 11 countries, 14 psychological autopsy studies were identified in five SEA countries (Bangladesh [1], India [9], Indonesia [1], Nepal [1], and Sri Lanka [2]). Seven studies (50%) used a case-control study design, and eight (57.1%) were carried out in urban settings. The prevalence of psychiatric disorders in case-control studies was from 37% to 88%. Stressful life event was identified as a major risk factor in all the case-control studies. CONCLUSION Psychological autopsy studies have not been conducted in 6 out of 11 countries of the SEA region. The presence of pre-existing psychiatric morbidity and stressful life events were the two most common risk factors noted across settings, even though there is wide heterogeneity in samples, study design, instruments, and study settings.
Collapse
Affiliation(s)
- S M Yasir Arafat
- Dept. of Psychiatry, Enam Medical College and Hospital, Savar, Dhaka, Bangladesh
| | - Vikas Menon
- Dept. of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Natarajan Varadharajan
- Dept. of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sujita Kumar Kar
- Dept. of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
11
|
Kasaju SP, Krumeich A, Van der Putten M. Suicide and deliberate self-harm among women in Nepal: a scoping review. BMC Womens Health 2021; 21:407. [PMID: 34886837 PMCID: PMC8656007 DOI: 10.1186/s12905-021-01547-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 11/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Suicide is a growing public health problem globally. Suicide accounts for 70% of violent deaths among women in low and middle income countries. In Nepal suicide is the single leading cause of death among women of reproductive age. The aim of this scoping review is to explore and understand the various contexts related to vulnerability of Nepalese woman towards suicide and deliberate self-harm. Methods A scoping review based on Arksey and O’Malley’s methodological framework including a combination of peer-reviewed publications and grey literature was conducted. The National Library of Medicine’s PubMed and Google Scholar search engines were used during July 2019 applying a Boolean search strategy. Results Suicide incidence was found to be higher among younger age group and married women, with poisoning as the most common means of suicide. Psychosocial and economic factors such as abuse, interpersonal conflicts, marital disputes, relationship problems, adjustment problems, unpaid loans and financial losses; and mental health conditions such as mood disorder, adjustment disorder and substance abuse disorder were found to be contributing factors for suicide and deliberate self-harm among women in Nepal. Conclusion Socio-cultural and economic factors shape family and marital relationships which impacts psycho-social and mental wellbeing of women in Nepal inciting suicidal attempts and deliberate self-harm. However, very few studies were found that explore the context of poverty, social exclusion, gender inequality, education, traditional/cultural and patriarchal system in which suicide among women in Nepal occurs.
Collapse
|
12
|
Arafat SMY, Ali SAEZ, Menon V, Hussain F, Ansari DS, Baminiwatta A, Saleem T, Singh R, Varadharajan N, Biyyala D, Kar SK, Khan MM. Suicide methods in South Asia over two decades (2001-2020). Int J Soc Psychiatry 2021; 67:920-934. [PMID: 34027683 DOI: 10.1177/00207640211015700] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Suicide is a global preventable public health problem. About a quarter of all suicides in the world occur in South Asia. As means restriction is an important suicide prevention strategy, gaining knowledge of the common suicide methods and their changing trends in each country and region is crucial. AIMS We aimed to assess the suicide methods in South Asian countries over the last two decades. METHODS A search was performed in PubMed, PubMed Central, Scopus, and Google Scholar with the search terms. Original articles of quantitative studies, published in the English language, from 2001 to 2020, with full-accessible text, that rank different methods of suicide in eight South Asian countries, were included. RESULTS A total of 68 studies were found eligible for review. The Maximum number of studies were found from India (n = 38), followed by Bangladesh (n = 12), Pakistan (n = 9), Sri Lanka (n = 6), and Nepal (n = 3). Hanging (n = 40, 55.8%) and poisoning (n = 24, 35.3%) were the two most common suicide methods reported, in that order. Hanging followed by poisoning were the commonest suicide methods in Bangladesh, India, and Pakistan while in Sri Lanka, poisoning was the preferred method to hanging. There is a decline in suicide by poisoning and an increase in suicide by hanging in Sri Lanka, Bangladesh, and India. Although hanging is still the commonest method in Pakistan, the use of firearms is growing in recent years (2011-2020). CONCLUSIONS There is a steady decline in the incidence of suicides by poisoning following pesticide regulations in South Asian countries. However, there is heterogeneity of study methods, probable under-reporting of suicide, and lack of robust suicide data.
Collapse
Affiliation(s)
- S M Yasir Arafat
- Department of Psychiatry, Enam Medical College and Hospital, Savar, Dhaka, Bangladesh
| | | | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, PY, India
| | - Fahad Hussain
- Department of Pharmacy, Noakhali Science and Technology University, Noakhali, Bangladesh
| | - Daniyal Shabbir Ansari
- Department of Critical Care Unit (Anesthesia and ICU), Civil Hospital, Bahawalpur, Pakistan
| | | | - Tamkeen Saleem
- Department of Psychology, International Islamic University, Islamabad, IS, Pakistan
| | - Rakesh Singh
- Department of Community Health Sciences, PatanAcademy of Health Sciences, Lalitpur, BA, Nepal
| | - Natarajan Varadharajan
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, PY, India
| | - Deepika Biyyala
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, PY, India
| | - Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India
| | - Murad M Khan
- Department of Psychiatry, Aga Khan University, Karachi, SD, Pakistan
| |
Collapse
|
13
|
Development and Evaluation of a Community Surveillance Method for Estimating Deaths Due to Injuries in Rural Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178912. [PMID: 34501502 PMCID: PMC8430737 DOI: 10.3390/ijerph18178912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 01/22/2023]
Abstract
Almost 10% of global deaths are secondary to injuries, yet in the absence of routine injury surveillance and with few studies of injury mortality, the number and cause of injury deaths in many countries are not well understood. This study aimed to develop and evaluate the feasibility of a method to identify injury deaths in rural Nepal. Working with local government authorities, health post staff and female community health volunteers (FCHVs), we developed a two-stage community fatal injury surveillance approach. In stage one, all deaths from any cause were identified. In stage two, an interview with a relative or friend gathered information about the deceased and the injury event. The feasibility of the method was evaluated prospectively between February 2019 and January 2020 in two rural communities in Makwanpur district. The data collection tools were developed and evaluated with 108 FCHVs, 23 health post staff and two data collectors. Of 457 deaths notified over one year, 67 (14.7%) fatal injury events were identified, and interviews completed. Our method suggests that it is feasible to collect data on trauma-related deaths from rural areas in Nepal. These data may allow the development of injury prevention interventions and policy.
Collapse
|
14
|
Utyasheva L, Sharma D, Ghimire R, Karunarathne A, Robertson G, Eddleston M. Suicide by pesticide ingestion in Nepal and the impact of pesticide regulation. BMC Public Health 2021; 21:1136. [PMID: 34120596 PMCID: PMC8201746 DOI: 10.1186/s12889-021-11155-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nepal recorded 5754 suicides in 2018-19 - a high number for a relatively small country. Over 24% of these suicides were by poisoning, most by ingestion of highly concentrated agricultural pesticides. Nepal has actively regulated pesticides to reduce their health impacts since 2001. We aimed to analyse Nepal's history of pesticide regulation, pesticides responsible for poisonings, and relate them to national suicide rates. METHODS Information on pesticide regulation was collected from the Plant Quarantine and Pesticide Management Centre of the Ministry of Agriculture and Livestock Development. National data on suicides from 1980 to 2019 were obtained from the National Statistical Bureau and Nepal Police. Data on the pesticides responsible for self-poisoning and pesticide suicides over time were obtained from a systematic literature review. RESULTS As of June 2020, 171 pesticides were registered for use in Nepal, of which one was extremely hazardous (WHO Class Ia), one other highly hazardous (WHO Class Ib), and 71 moderately hazardous (WHO Class II). Twenty-four pesticides have been banned since 2001, with eight (including five WHO Class I compounds) banned in 2019. Although the suicide rate has increased more than twelve-fold since 1980, particularly for hanging (15-fold increase from 1980 to 2018), fatal pesticide self-poisoning has increased by 13-fold. Methyl-parathion is reported to be the key pesticide responsible for pesticide self-poisoning in Nepal, despite being banned in 2006. CONCLUSION The full effect of the recent pesticide policy reform in Nepal remains to be seen. Our analysis shows a continuing increase in suicide numbers, despite bans of the most important pesticide in 2006. This may indicate smuggling across the border and the use of the brand name (Metacid) for pesticides in general making it difficult to identify the responsible pesticide. More information is required from forensic toxicology labs that identify the individual compounds found. The effect of recent bans of common suicide pesticides needs to be monitored over the coming years. Evidence from other Asian countries suggests that HHPs bans will lead to a marked reduction in suicides, as well as fewer cases of occupational poisoning.
Collapse
Affiliation(s)
- Leah Utyasheva
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Dilli Sharma
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Rakesh Ghimire
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Ayanthi Karunarathne
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Gael Robertson
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Michael Eddleston
- Centre for Pesticide Suicide Prevention, University of Edinburgh, QMRI E3.22a, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK. .,Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
15
|
Maharjan SM, Poudyal A, van Heerden A, Byanjankar P, Thapa A, Islam C, Kohrt BA, Hagaman A. Passive sensing on mobile devices to improve mental health services with adolescent and young mothers in low-resource settings: the role of families in feasibility and acceptability. BMC Med Inform Decis Mak 2021; 21:117. [PMID: 33827552 PMCID: PMC8025381 DOI: 10.1186/s12911-021-01473-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 03/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Passive sensor data from mobile devices can shed light on daily activities, social behavior, and maternal-child interactions to improve maternal and child health services including mental healthcare. We assessed feasibility and acceptability of the Sensing Technologies for Maternal Depression Treatment in Low Resource Settings (StandStrong) platform. The StandStrong passive data collection platform was piloted with adolescent and young mothers, including mothers experiencing postpartum depression, in Nepal. METHODS Mothers (15-25 years old) with infants (< 12 months old) were recruited in person from vaccination clinics in rural Nepal. They were provided with an Android smartphone and a Bluetooth beacon to collect data in four domains: the mother's location using the Global Positioning System (GPS), physical activity using the phone's accelerometer, auditory environment using episodic audio recording on the phone, and mother-infant proximity measured with the Bluetooth beacon attached to the infant's clothing. Feasibility and acceptability were evaluated based on the amount of passive sensing data collected compared to the total amount that could be collected in a 2-week period. Endline qualitative interviews were conducted to understand mothers' experiences and perceptions of passive data collection. RESULTS Of the 782 women approached, 320 met eligibility criteria and 38 mothers (11 depressed, 27 non-depressed) were enrolled. 38 mothers (11 depressed, 27 non-depressed) were enrolled. Across all participants, 5,579 of the hour-long data collection windows had at least one audio recording [mean (M) = 57.4% of the total possible hour-long recording windows per participant; median (Mdn) = 62.6%], 5,001 activity readings (M = 50.6%; Mdn = 63.2%), 4,168 proximity readings (M = 41.1%; Mdn = 47.6%), and 3,482 GPS readings (M = 35.4%; Mdn = 39.2%). Feasibility challenges were phone battery charging, data usage exceeding prepaid limits, and burden of carrying mobile phones. Acceptability challenges were privacy concerns and lack of family involvement. Overall, families' understanding of passive sensing and families' awareness of potential benefits to mothers and infants were the major modifiable factors increasing acceptability and reducing gaps in data collection. CONCLUSION Per sensor type, approximately half of the hour-long collection windows had at least one reading. Feasibility challenges for passive sensing on mobile devices can be addressed by providing alternative phone charging options, reverse billing for the app, and replacing mobile phones with smartwatches. Enhancing acceptability will require greater family involvement and improved communication regarding benefits of passive sensing for psychological interventions and other health services. Registration International Registered Report Identifier (IRRID): DERR1-10.2196/14734.
Collapse
Affiliation(s)
- Sujen Man Maharjan
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, 44600, Nepal
| | - Anubhuti Poudyal
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, 2120 L St NW Suite 600, Washington, DC, 20037, USA
| | - Alastair van Heerden
- Center for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Prabin Byanjankar
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, 44600, Nepal
| | - Ada Thapa
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, 2120 L St NW Suite 600, Washington, DC, 20037, USA
| | - Celia Islam
- George Washington School of Medicine and Health Sciences, Washington, DC, 20037, USA
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, 2120 L St NW Suite 600, Washington, DC, 20037, USA.
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
| |
Collapse
|
16
|
Roche GC, Fung P, Ransing R, Noor IM, Shalbafan M, El Hayek S, Koh EBY, Gupta AK, Kudva KG. The state of psychiatric research in the Asia Pacific region. Asia Pac Psychiatry 2021; 13:e12432. [PMID: 33145988 DOI: 10.1111/appy.12432] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/10/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION This study aims to review recent scientific publications and research output in the field of psychiatry, from a series of countries in the Asia-Pacific region (Australia, India, Indonesia, Iran, Lebanon, Malaysia, and Nepal), with a view to identify themes and similarities across regions, as well as to examine the barriers and challenges in mental health research faced by countries in the region. METHODS Seven psychiatrists from seven countries reviewed recent published and ongoing research in psychiatry in their respective nations, with respect to themes, as well as any barriers or challenges faced by mental health researchers. RESULTS While the seven nations included in this review vary in terms of research capabilities and economic development level, they share many similarities both in terms of research direction, and with regards to challenges faced. Limitations in the form of sociocultural differences from the West, and a lack of funding were some of the barriers identified. DISCUSSION Mental health research in the region has been progressing well. However, more varied research in the form of qualitative or economic studies are lacking, as are multi-center studies. The similar issues that nations face with regards to research could perhaps benefit from collaborative efforts and initiatives for the furtherance of research in the region.
Collapse
Affiliation(s)
- Glen Cedric Roche
- Department of Psychological Medicine, Changi General Hospital, Singapore
| | - Paul Fung
- Paramatta Mission, Parramatta, New South Wales, Australia.,Health Education and Training Institute Higher Education, North Paramatta, New South Wales, Australia
| | - Ramdas Ransing
- Department of Psychiatry, BKL Walawalkar Rural Medical College, Ratnagiri, Maharashtra, India
| | - Isa Multazam Noor
- Department of Psychiatry, Dr. Soeharto Heerdjan Mental Hospital, Jakarta, Indonesia
| | - Mohammadreza Shalbafan
- Mental Health Research Center, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Samer El Hayek
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Eugene Boon Yau Koh
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | | | - Kundadak Ganesh Kudva
- Early Psychosis Intervention Programme and East Region, Institute of Mental Health, Singapore
| |
Collapse
|
17
|
Leahy D, Larkin C, Leahy D, McAuliffe C, Corcoran P, Williamson E, Arensman E. The mental and physical health profile of people who died by suicide: findings from the Suicide Support and Information System. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1525-1533. [PMID: 32656640 DOI: 10.1007/s00127-020-01911-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 06/30/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE There is limited research on the associations between factors relating to mental and physical health in people who died by suicide. METHODS Consecutive suicide cases were included in a psychological autopsy study as part of the Suicide Support and Information System in southern Ireland. Chi-square tests and logistic regression analysis were used to examine factors associated with recorded presence or absence of mental and physical health problems. RESULTS The total sample comprised 307 suicide cases, the majority being male (80.1%). Sixty-five percent had a history of self-harm and 34.6% of these cases had not been seen or treated following previous self-harm, although most (80.3%) had a history of recent GP attendance. Mental health diagnoses were present in 84.8% of cases where this variable was documented, and among these, 60.7% had a history of substance misuse and 30.6% had physical health problems. Variables associated with mental illness included gender, older age, previous self-harm episode(s), and presence of drugs in toxicology at time of death. Variables associated with physical illness included older age, death by means other than hanging, and previous self-harm episode(s). CONCLUSIONS Different factors associated with suicide were identified among people with mental and physical illness and those with and without a diagnosis, and need to be taken into account in suicide prevention. The identified factors highlight the importance of integrated care for dual-diagnosis presentations, restricting access to means, and early recognition and intervention for people with high-risk self-harm.
Collapse
Affiliation(s)
- Daniel Leahy
- Department of Child and Adolescent Psychiatry, North Lee North, Unit 9, St Stephen's Hospital, Glanmire, Cork, Ireland
| | - Celine Larkin
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Dorothy Leahy
- School of Public Health, College of Medicine and Health, University College Cork, 4.28 Western Gateway Building, Cork, Ireland.,National Suicide Research Foundation, University College Cork, Cork, Ireland
| | | | - Paul Corcoran
- School of Public Health, College of Medicine and Health, University College Cork, 4.28 Western Gateway Building, Cork, Ireland.,National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Eileen Williamson
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Ella Arensman
- School of Public Health, College of Medicine and Health, University College Cork, 4.28 Western Gateway Building, Cork, Ireland. .,National Suicide Research Foundation, University College Cork, Cork, Ireland.
| |
Collapse
|
18
|
Vijayakumar L, Daly C, Arafat Y, Arensman E. Suicide Prevention in the Southeast Asia Region. CRISIS 2020; 41:S21-S29. [PMID: 32208757 DOI: 10.1027/0227-5910/a000666] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
This chapter provides an update on suicide and suicide prevention in the Southeast Asia Region, which covers 11 low- and middle-income countries, accounting for 26% of the world's population. More than one third (39%) of all suicides globally, occur in this region, with the highest suicide rate of 17.7 per 100,000, which is likely to be an underestimate due to differences in study populations, research methodology, and uncomprehensive data registration systems. The risk profile of people who die by suicide and the characteristics of suicides in Southeast Asia are distinctly different from other regions in many ways. In this region the male-female ratio for suicide is closer to 1, compared with 3:5 in higher-income countries, and the overall reported prevalence of mental disorders, such as depression or other psychiatric conditions, is lower. Both older people and adolescents show the highest rates of suicide. Suicide involving pesticide poisoning is the most common method used in both rural and urban areas in countries in this region. Updates are provided on national and regional suicide prevention activities in Bangladesh, Bhutan, Nepal, India, Sri Lanka, and Thailand.
Collapse
Affiliation(s)
- Lakshmi Vijayakumar
- Department of Psychiatry, Voluntary Health Services Multi-Specialty Hospital and Research Institute, Chennai, India
| | - Caroline Daly
- National Suicide Research Foundation, Cork, Ireland
- International Association for Suicide Prevention, Washington DC, USA
| | - Yasir Arafat
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Ella Arensman
- National Suicide Research Foundation, Cork, Ireland
- International Association for Suicide Prevention, Washington DC, USA
- School of Public Health, College of Medicine and Health, University College Cork, Ireland
- The Australian Institute for Suicide Research and Prevention, Griffith University, Mount Gravatt, QLD, Australia
| |
Collapse
|
19
|
Knipe D, Williams AJ, Hannam-Swain S, Upton S, Brown K, Bandara P, Chang SS, Kapur N. Psychiatric morbidity and suicidal behaviour in low- and middle-income countries: A systematic review and meta-analysis. PLoS Med 2019; 16:e1002905. [PMID: 31597983 PMCID: PMC6785653 DOI: 10.1371/journal.pmed.1002905] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/23/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Psychiatric disorders are reported to be present in 80% to 90% of suicide deaths in high-income countries (HIC), but this association is less clear in low- and middle-income countries (LMIC). There has been no previous systematic review of this issue in LMIC. The current study aims to estimate the prevalence of psychiatric morbidity in individuals with suicidal behaviour in LMIC. METHODS AND FINDINGS PubMed, PsycINFO, and EMBASE searches were conducted to identify quantitative research papers (any language) between 1990 and 2018 from LMIC that reported on the prevalence of psychiatric morbidity in suicidal behaviour. We used meta-analytic techniques to generate pooled estimates for any psychiatric disorder and specific diagnosis based on International classification of disease (ICD-10) criteria. A total of 112 studies (154 papers) from 26 LMIC (India: 25%, China: 15%, and other LMIC: 60%) were identified, including 18 non-English articles. They included 30,030 individuals with nonfatal suicidal behaviour and 4,996 individuals who had died by suicide. Of the 15 studies (5 LMIC) that scored highly on our quality assessment, prevalence estimates for psychiatric disorders ranged between 30% and 80% in suicide deaths and between 3% and 86% in those who engaged in nonfatal suicidal behaviour. There was substantial heterogeneity between study estimates. Fifty-eight percent (95% CI 46%-71%) of those who died by suicide and 45% (95% CI 30%-61%) of those who engaged in nonfatal suicidal behaviour had a psychiatric disorder. The most prevalent disorder in both fatal and nonfatal suicidal behaviour was mood disorder (25% and 21%, respectively). Schizophrenia and related disorders were identified in 8% (4%-12%) of those who died by suicide and 7% (3%-11%) of those who engaged in nonfatal suicidal behaviour. In nonfatal suicidal behaviour, anxiety disorders, and substance misuse were identified in 19% (1%-36%) and 11% (7%-16%) of individuals, respectively. This systematic review was limited by the low number of high-quality studies and restricting our searches to databases that mainly indexed English language journals. CONCLUSIONS Our findings suggest a possible lower prevalence of psychiatric disorders in suicidal behaviour in LMIC. We found very few high-quality studies and high levels of heterogeneity in pooled estimates of psychiatric disorder, which could reflect differing study methods or real differences. There is a clear need for more robust evidence in order for LMIC to strike the right balance between community-based and mental health focussed interventions.
Collapse
Affiliation(s)
- Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - A. Jess Williams
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | | | | | | | - Piumee Bandara
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences and Department of Public Health, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Nav Kapur
- University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| |
Collapse
|
20
|
Poudyal A, van Heerden A, Hagaman A, Maharjan SM, Byanjankar P, Subba P, Kohrt BA. Wearable Digital Sensors to Identify Risks of Postpartum Depression and Personalize Psychological Treatment for Adolescent Mothers: Protocol for a Mixed Methods Exploratory Study in Rural Nepal. JMIR Res Protoc 2019; 8:e14734. [PMID: 31512581 PMCID: PMC6746061 DOI: 10.2196/14734] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND There is a high prevalence of untreated postpartum depression among adolescent mothers with the greatest gap in services in low- and middle-income countries. Recent studies have demonstrated the potential of nonspecialists to provide mental health services for postpartum depression in these low-resource settings. However, there is inconsistency in short-term and long-term benefits from the interventions. Passive sensing data generated from wearable digital devices can be used to more accurately distinguish which mothers will benefit from psychological services. In addition, wearable digital sensors can be used to passively collect data to personalize care for mothers. Therefore, wearable passive sensing technology has the potential to improve outcomes from psychological treatments for postpartum depression. OBJECTIVE This study will explore the use of wearable digital sensors for two objectives: First, we will pilot test using wearable sensors to generate passive sensing data that distinguish adolescent mothers with depression from those without depression. Second, we will explore how nonspecialists can integrate data from passive sensing technologies to better personalize psychological treatment. METHODS This study will be conducted in rural Nepal with participatory involvement of adolescent mothers and health care stakeholders through a community advisory board. The first study objective will be addressed by comparing behavioral patterns of adolescent mothers without depression (n=20) and with depression (n=20). The behavioral patterns will be generated by wearable digital devices collecting data in 4 domains: (1) the physical activity of mothers using accelerometer data on mobile phones, (2) the geographic range and routine of mothers using GPS (Global Positioning System) data collected from mobile phones, (3) the time and routine of adolescent mothers with their infants using proximity data collected from Bluetooth beacons, and (4) the verbal stimulation and auditory environment for mothers and infants using episodic audio recordings on mobile phones. For the second objective, the same 4 domains of data will be collected and shared with nonspecialists who are delivering an evidence-based behavioral activation intervention to the depressed adolescent mothers. Over 5 weeks of the intervention, we will document how passive sensing data are used by nonspecialists to personalize the intervention. In addition, qualitative data on feasibility and acceptability of passive data collection will be collected for both objectives. RESULTS To date, a community advisory board comprising young women and health workers engaged with adolescent mothers has been established. The study is open for recruitment, and data collection is anticipated to be completed in November 2019. CONCLUSIONS Integration of passive sensing data in public health and clinical programs for mothers at risk of perinatal mental health problems has the potential to more accurately identify who will benefit from services and increase the effectiveness by personalizing psychological interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14734.
Collapse
Affiliation(s)
- Anubhuti Poudyal
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, Washington, DC, United States
| | - Alastair van Heerden
- Human and Social Development, Human Sciences Research Council, Pietermaritzburg, South Africa
- Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
- Center for Methods in Implementation and Prevention Science, Yale University, New Haven, CT, United States
| | | | | | | | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, Washington, DC, United States
| |
Collapse
|
21
|
Langer JA, Ramos JV, Ghimire L, Rai S, Kohrt BA, Burkey MD. Gender and Child Behavior Problems in Rural Nepal: Differential Expectations and Responses. Sci Rep 2019; 9:7662. [PMID: 31113970 PMCID: PMC6529428 DOI: 10.1038/s41598-019-43972-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 04/27/2019] [Indexed: 11/17/2022] Open
Abstract
Whereas epidemiologic studies consistently identify different rates and types of problematic behavior in boys and girls, there has been little research examining the ecocultural context in which these gender differences in child behavior problems develop, especially in non-Western settings. This qualitative study in rural Nepal explored how behavioral expectations differed based on gender role, gender discrimination, inequity, and treatment of children based on their gender identity. We conducted semi-structured interviews with a total of 14 parents, school workers, and community leaders from a village in rural Nepal. Interview transcripts were coded by two authors using predetermined and emergent codes to identify expectations, behavior problems, and responses to behavior problems, stratified by gender. Authors then arranged codes into categories based on emergent themes. Four major themes in the interviews were identified: (1) self-reported gender non-bias; (2) differentiated role expectations; (3) gender, "goodness", and differential thresholds for problem behaviors; and (4) boys and girls require different responses for misbehavior. Results from our study in Nepal reflect nearly universal models of gender differences in behavior. Of particular importance in South Asia, patrilocal marital practices were used to frame gender differences in expectations. To protect girls' future potential to marry, local cultural practices provide girls with lesser opportunities and less cultural space to conduct themselves in a disruptive manner than boys. Greater understanding of differential expectations and responses to disruptive behaviors by gender will be important for culturally-appropriate equitable programming in child development.
Collapse
Affiliation(s)
- Julia A Langer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Julia V Ramos
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - Lajina Ghimire
- Transcultural Psychosocial Organization - Nepal, Kathmandu, Nepal
| | - Sauharda Rai
- Transcultural Psychosocial Organization - Nepal, Kathmandu, Nepal
- University of Washington, Jackson School of International Studies, Seattle, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, USA
| | - Matthew D Burkey
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.
| |
Collapse
|
22
|
Hagaman AK, Khadka S, Wutich A, Lohani S, Kohrt BA. Suicide in Nepal: Qualitative Findings from a Modified Case-Series Psychological Autopsy Investigation of Suicide Deaths. Cult Med Psychiatry 2018; 42:704-734. [PMID: 29881930 PMCID: PMC6286252 DOI: 10.1007/s11013-018-9585-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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.
Collapse
Affiliation(s)
- Ashley K. Hagaman
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Corresponding author information: Ashley Hagaman, PhD MPH, Address: Carolina Population Center, University of North Carolina at Chapel Hill, CB #8120, Chapel Hill, NC, 27599-8120, USA, , Phone: 01.919.962.6252
| | - Seema Khadka
- Transcultural Psychosocial Organization Nepal, Research Department, Kathmandu, Nepal
| | - Amber Wutich
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, USA
| | - Shyam Lohani
- Nobel College, Pokhara University, Kathmandu, Nepal
| | - Brandon A. Kohrt
- Department of Psychiatry, George Washington University, Washington, DC, USA
| |
Collapse
|
23
|
Interpersonal violence and suicidality among former child soldiers and war-exposed civilian children in Nepal. Glob Ment Health (Camb) 2018; 5:e9. [PMID: 29507745 PMCID: PMC5827420 DOI: 10.1017/gmh.2017.31] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 10/20/2017] [Accepted: 10/25/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Suicide risk reduction is crucial for 15-29-year-old youth, who account for 46% of suicide deaths in low- and middle-income countries. Suicide predictors in high-resource settings, specifically depression, do not adequately predict suicidality in these settings. We explored if interpersonal violence (IPV) was associated with suicidality, independent of depression, in Nepal. METHODS A longitudinal cohort of child soldiers and matched civilian children, enrolled in 2007 after the People's War in Nepal, were re-interviewed in 2012. The Depression Self-Rating Scale and Composite International Diagnostic Interview assessed depression and suicidality, respectively. Non-verbal response cards were used to capture experiences of sexual and physical IPV. RESULTS One of five participants (19%) reported any lifetime suicidal ideation, which was associated with sexual IPV, female gender, former child soldier status and lack of support from teachers. Among young men, the relationship between sexual IPV and suicidality was explained by depression, and teacher support reduced suicidality. Among young women, sexual IPV was associated with suicidality, independent of depression; child soldier status increased suicidality, and teacher support decreased suicidality. Suicide plans were associated with sexual IPV but not with depression. One of 11 female former child soldiers (9%) had attempted suicide. CONCLUSION Sexual IPV is associated with suicidal ideation and plans among conflict-affected young women, independent of depression. Reducing suicide risk among women should include screening, care, and prevention programs for sexual IPV. Programs involving teachers may be particularly impactful for reducing suicidality among IPV survivors.
Collapse
|
24
|
Rai S, Adhikari SB, Acharya NR, Kaiser BN, Kohrt BA. Elucidating adolescent aspirational models for the design of public mental health interventions: a mixed-method study in rural Nepal. Child Adolesc Psychiatry Ment Health 2017; 11:65. [PMID: 29299056 PMCID: PMC5740935 DOI: 10.1186/s13034-017-0198-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 12/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescent aspirational models are sets of preferences for an idealized self. Aspirational models influence behavior and exposure to risk factors that shape adult mental and physical health. Cross-cultural understandings of adolescent aspirational models are crucial for successful global mental health programs. The study objective was elucidating adolescent aspirational models to inform interventions in Nepal. METHODS Twenty qualitative life trajectory interviews were conducted among adolescents, teachers, and parents. Card sorting (rating and ranking activities) were administered to 72 adolescents aged 15-19 years, stratified by caste/ethnicity: upper caste Brahman and Chhetri, occupational caste Dalit, and ethnic minority Janajati. RESULTS Themes included qualities of an ideal person; life goals, barriers, and resources; emotions and coping; and causes of interpersonal violence, harmful alcohol use, and suicide. Education was the highest valued attribute of ideal persons. Educational attainment received higher prioritization by marginalized social groups (Dalit and Janajati). Poverty was the greatest barrier to achieving life goals. The most common distressing emotion was 'tension', which girls endorsed more frequently than boys. Sharing emotions and self-consoling were common responses to distress. Tension was the most common reason for alcohol use, especially among girls. Domestic violence, romantic break-ups, and academic pressure were reasons for suicidality. CONCLUSION Inability to achieve aspirational models due to a range of barriers was associated with negative emotions-notably tension-and dysfunctional coping that exacerbates barriers, which ultimately results in the triad of interpersonal violence, substance abuse, and suicidality. Interventions should be framed as reducing the locally salient idiom of distress tension and target this triad of threats. Regarding intervention content, youth-endorsed coping mechanisms should be fortified to counter this distress pathway.
Collapse
Affiliation(s)
- Sauharda Rai
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Anek Marga, Baluwatar, Kathmandu, Nepal
| | - Safar Bikram Adhikari
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Anek Marga, Baluwatar, Kathmandu, Nepal
| | - Nanda Raj Acharya
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Anek Marga, Baluwatar, Kathmandu, Nepal
| | | | - Brandon A. Kohrt
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Anek Marga, Baluwatar, Kathmandu, Nepal
- Duke Global Health Institute, Duke University, Durham, NC USA
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC USA
- Department of Psychiatry, Duke University, Durham, NC USA
| |
Collapse
|