Évolution des tentatives de suicide en population clinique tunisienne de 2005 à 2015 : de nouvelles modalités de passage à l’acte chez les jeunes ?

[Tentatives de suicide au Maroc: une revue systématique]

BACKGROUND

Suicide is a widespread phenomenon that affects persons of all ages, and it has become a major public health problem in Morocco.

OBJECTIVES

This study aims to describe the epidemiological profile of suicide attempters in Morocco, as well as the identification of associated factors.

METHODS

The present work is a systematic review that was conducted according to the recommendations of the "Preferred reporting items for systematic reviews and meta-analysis (2009)", including articles dealing with suicide attempts in Morocco that meet the usual inclusion criteria. The PubMed, ScienceDirect and Scopus databases were searched; articles had to be written in English or French. Additional studies were manually identified through via Google Scholar. Quality assessment of the included studies was carried out according to the NIH Assessment Tool. The review protocol was registered in PROSPERO (CRD42020165493).

RESULTS

Twenty studies were selected. Adults and adolescents are the age groups most affected by suicide. That said, the phenomenon mainly concerns children over 10 years of age. In some studies, more than 90% of the cases involve females, and they are more numerous in urban than in rural settings, and single individuals are more affected than married people. As for children and adolescents, most of them had divorced parents, and more than 50% of suicidal persons of all ages had a low socio-economic level. Although females are more likely than males to commit suicide, males are more exposed to death due to the violent means used.

CONCLUSIONS

Because of the alarming rate of suicide in our country, nationwide prevention strategies are called for.

Validation of the Hamilton Depression Rating Scale (HDRS) in the Tunisian dialect

OBJECTIVES

The Hamilton Depression Rating Scale (HDRS) is one of the most frequently used depression assessment scales. In Tunisia, psychiatrists commonly use this scale in a Tunisian dialect. However, to the best of our knowledge, this scale has never been validated in Tunisia. This study aims to investigate the reliability and the validity of the HDRS among Tunisian patients who have been hospitalised for a suicide attempt. A secondary objective is to describe the sociodemographic characteristics of the study population.

STUDY DESIGN

This is a cross-sectional study performed in the emergency department.

METHODS

Patients who were hospitalised for a suicide attempt were eligible for inclusion in this study. The Tunisian version of the HDRS was developed using a forward-backward translation procedure. Psychometric properties of the Tunisian version of the HDRS were tested, including (i) construct validity with a confirmatory one-factor analysis; (ii) internal validity with Pearson correlations and Cronbach alpha coefficients; and (iii) external validity by correlations with the Patient Health Quality-9 (PHQ-9) scale. We used the Receiver-Operating Characteristic (ROC) curve to analyse the correlation between the total HDRS score and the presence of depression according to the PHQ-9.

RESULTS

In total, 101 participants were enrolled in this study. The principal component analysis (PCA) type factor analysis with varimax rotation found a high-grade correlation between HDRS individual items and the total score. The total variance, explained by five factors, was 64.4%. Cronbach's standardised alpha coefficient was 0.86 for the overall scale. Correlations between the total HDRS score and the PHQ-9 score, and its various items, were significant. The ROC curve analysis showed good sensitivity (80.8%) and specificity (91.1%).

CONCLUSION

The Tunisian version of the HDRS is an acceptable instrument to screen depression in individuals who have attempted suicide.

Trends of juvenile and adolescent suicides in North Tunisia: a 12-year study

OBJECTIVES

The aim of our study was to analyze the epidemiological characteristics for suicide methods and factors over a 12-year period among child suicides in Northern Tunisia and to compare juvenile and adolescent suicides.

STUDY DESIGN

This is a cross-sectional study.

METHODS

We included all child and adolescent suicide cases that took place in the North of Tunisia over a 12 year period (2005-2016). Data were collected from medical records and judicial inquiries and were classified into three sections: sociodemographic data, the circumstances of suicide, and the autopsy findings. Data were then compared between the 'juvenile suicide group' and 'the adolescent suicide group', according to the WHO definition.

RESULTS

Casualties were equally males and females, mostly adolescents (74.5%), aged 15 years old on average. Hanging was the most frequent suicidal method. A peak of frequency was observed in 2014.

CONCLUSION

Our results suggested to focus, among other preventive measures, on the role of media coverage of child suicides.

[Epidemiological and clinical profile of suicide attempts in Tunisian children and adolescents after the revolution]

Introduction

Les conduites suicidaires sont en augmentation en Tunisie et touchent une population de plus en plus jeune. Le but de notre étude était de décrire le profil sociodémographique et clinique des tentatives de suicide chez l'enfant et l'adolescent.

Méthodes

Cette étude était transversale et descriptive, incluant 50 suicidants, recrutés au service de pédopsychiatrie de l'Hôpital Razi de la Manouba et dans deux services de réanimation et de pédiatrie de Tunis, entre juillet 2012 et juin 2013. Ont été relevés les facteurs sociodémographiques et cliniques, les antécédents de maltraitance, la scolarité, les caractéristiques de la TS, l'intentionnalité suicidaire évaluée par le Suicide Intent Scale, et les troubles psychopathologiques à l'aide du Mini-International Neuropsychiatric Interview.

Résultats

Le sex-ratio était de 0,56, la moyenne d'âge était de 12,4 ans avec des extrêmes de 7 à 16 ans. Un échec ou un fléchissement scolaire a concerné 86% des suicidants. Dans 38% des cas il s'agissait de récidive; des antécédents d'automutilations ont été retrouvés dans les mêmes proportions. Un contexte de maltraitance a été signalé dans 46% des cas. L'ingestion médicamenteuse était le moyen le plus fréquent, les psychotropes étant les plus représentés. Une différence significative entre le genre a été retrouvée dans le recours aux moyens suicidaires, ainsi les garçons ont eu davantage recours aux moyens physiques (p=0,04) et les filles aux intoxications (p=0,001). L'intentionnalité suicidaire était élevée dans 44%. Un épisode dépressif majeur et le trouble de l'adaptation étaient les troubles les plus fréquemment retrouvés dans respectivement 58% et 24% des cas.

Conclusion

Les troubles dépressifs et la maltraitance se dégagent comme des facteurs de risque des TS chez les enfants et les adolescents, ces facteurs doivent être pris en considération dans les stratégies de prévention du suicide dans cette population.