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Paiva de Araujo JA, Fialho É, Oliveira Alves FJ, Cardoso AM, Yamall Orellana JD, Naslund JA, Barreto ML, Patel V, Machado DB. Suicide among Indigenous peoples in Brazil from 2000 to 2020: a descriptive study. LANCET REGIONAL HEALTH. AMERICAS 2023; 26:100591. [PMID: 37732137 PMCID: PMC10507632 DOI: 10.1016/j.lana.2023.100591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/28/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023]
Abstract
Background Previous studies in Australia, Canada, and Brazil, found that suicide among ethnic minority groups is higher than in the general population. Indigenous peoples in Brazil have been reported to have a high suicide rate, with reports of suicide clusters occurring in several communities. The objective of this study was to report trends in countrywide suicide rates among Indigenous peoples in Brazil between 2000 and 2020, and to compare these with the non-Indigenous population. Methods This ecological study used Indigenous suicide data collected from all regions of Brazil during a 21-year period, between 2000 and 2020. We used suicide estimates from the Mortality Information System (SIM), available at the Brazilian Health Ministry website (DATASUS). Suicide mortality rates by state and region were calculated using the estimated Indigenous population from the 2010 census, and estimated population proportions for the other years. We performed a trend analysis and compared trends in suicide between the Indigenous and non-Indigenous population during the period studied. Findings Suicide rates among Indigenous Brazilians have reached more than two and a half times the levels for the overall Brazilian population in 2020 (17.57 suicide deaths versus 6.35 suicide deaths per 100,000 inhabitants, respectively). The Central-West region of Brazil had the highest suicide rates among Indigenous Brazilians over the study period, reaching 58.8 deaths/100,000 inhabitants in 2008. The younger age group (10-24 years old) had the highest suicide rates for all the years studied. Time-series analyses showed a trend of statistically significant increases in suicide rates in Brazil for both the Indigenous and non-Indigenous population during the study period. The North region, and specifically Amazonas state, has shown a decisive increase in suicide rates among the Indigenous populations. The suicide rate for Indigenous people in Brazil, excluding cases in Amazonas and Mato Grosso do Sul states, were similar to those for the entire Brazilian population, showing that the Indigenous peoples who are the most vulnerable to suicide reside in these locations. Interpretation While there were statistically significant increases in suicide rates for all Brazilians over the study period, they remained alarmingly high among Indigenous people, compared to their non-Indigenous counterparts. The high suicide rates among Indigenous people, and younger individuals in particular (aged between 10 and 24), reinforces the need for specific prevention strategies for these populations. Further studies should be concentrated on determining risk factors in distinct ethnic groups, specifically within regions experiencing an elevated risk, such as the states of Amazonas and Mato Grosso do Sul. Funding Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under award number R01MH128911-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Affiliation(s)
| | - Érika Fialho
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz, R. Mundo, 121. Salvador, Bahia, Brazil
| | - Flávia Jôse Oliveira Alves
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz, R. Mundo, 121. Salvador, Bahia, Brazil
| | - Andrey Moreira Cardoso
- National School of Public Health, Oswaldo Cruz Foundation (ENSP/FIOCRUZ), Rua Leopoldo Bulhões, 1480, Rio de Janeiro, Brazil
| | - Jesem Douglas Yamall Orellana
- Leônidas and Maria Deane Institute (ILMD), Oswaldo Cruz Foundation (FIOCRUZ), Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, Brazil
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, United States of America
| | - Mauricio L. Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz, R. Mundo, 121. Salvador, Bahia, Brazil
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, United States of America
| | - Daiane Borges Machado
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz, R. Mundo, 121. Salvador, Bahia, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, United States of America
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de Souza RSB, de Oliveira JC, Alvares-Teodoro J, Teodoro MLM. [Suicide and indigenous populations in Brazil: systematic reviewEl suicidio y los pueblos indígenas brasileños: revisión sistemática]. Rev Panam Salud Publica 2020; 44:e58. [PMID: 32612644 PMCID: PMC7323757 DOI: 10.26633/rpsp.2020.58] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/28/2020] [Indexed: 01/07/2023] Open
Abstract
Objective To describe the frequency, characteristics, and factors contributing to suicide in indigenous populations in Brazil. Method A systematic review of the literature was performed in PubMed, SciELO, PsycINFO, and LILACS. All population-based studies focusing on suicide among indigenous populations in Brazil were included. Results The search identified 111 articles, of which nine met the inclusion criteria. Three of these studies were performed in the Midwest and four in the North of Brazil, while two covered all Brazilian regions. The ethnic groups investigated were specified in three studies (Terena, Kadiweu, Guato, Ofaie-Xavante, Guarani, Guarani-Kaiowá, and Guarani-Nandeva). Suicide rates were highest among males, single individuals, those with 4 to 11 years of schooling, and those aged 15 to 24 years. Suicides occurred most often in the home and on weekends, mostly by hanging. The main risk factors for suicide identified in the articles were poverty, historical and cultural factors, poor wellbeing indicators, family disintegration, social vulnerability, and lack of life or future perspective. Conclusions All the studies indicated the need to engage communities in developing strategies, considering their cosmovision and the social, historic, and cultural view of each ethnic group to minimize risk factors and reduce suicide rates.
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Affiliation(s)
- Ronaldo Santhiago Bonfim de Souza
- Universidade Federal de Minas Gerais (UFMG) Programa de Pós-Graduação em Psicologia: Cognição e Comportamento (CogCom) Belo HorizonteMG Brasil Universidade Federal de Minas Gerais (UFMG), Programa de Pós-Graduação em Psicologia: Cognição e Comportamento (CogCom), Belo Horizonte (MG), Brasil
| | - Júlia Costa de Oliveira
- Universidade Federal de Minas Gerais (UFMG) Programa de Pós-Graduação em Psicologia Belo HorizonteMG Brasil Universidade Federal de Minas Gerais (UFMG), Programa de Pós-Graduação em Psicologia, Belo Horizonte (MG), Brasil
| | - Juliana Alvares-Teodoro
- Universidade Federal de Minas Gerais (UFMG) Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica Belo HorizonteMG Brasil Universidade Federal de Minas Gerais (UFMG), Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Belo Horizonte (MG), Brasil
| | - Maycoln Leôni Martins Teodoro
- Universidade Federal de Minas Gerais (UFMG) Programa de Pós-Graduação em Psicologia: Cognição e Comportamento (CogCom) Belo HorizonteMG Brasil Universidade Federal de Minas Gerais (UFMG), Programa de Pós-Graduação em Psicologia: Cognição e Comportamento (CogCom), Belo Horizonte (MG), Brasil
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Souza MLPD. [Mortality from suicide in indigenous children in Brazil]. CAD SAUDE PUBLICA 2019; 35Suppl 3:e00019219. [PMID: 31433029 DOI: 10.1590/0102-311x00019219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/17/2019] [Indexed: 11/22/2022] Open
Abstract
This study aimed to describe the characteristics, distribution, and mortality rates from suicide in indigenous children in Brazil compared to non-indigenous children. This descriptive study covered the years from 2010 to 2014, using national databases. The study collected deaths in individuals 10 to 14 years of age whose underlying cause was "inentional self-inflicted injury". Hanging was the most frequently used means in both indigenous and non-indigenous children, although it was more frequent in the former. Among indigenous children, suicides in hospitals or other healthcare establishments were less common than in non-indigenous. Approximately three-fourths of suicides in indigenous children occurred in just 17 municipalities. The mortality rate from suicide among indigenous children was 11.0/100,000 (8.4-14.3), or 18.5 times higher (10.9-31.6) than in non-indigenous, which was 0.6/100,000 (0.5-0.6), with no differences between boys and girls. This study showed for the first time on a national scale the specific characteristics of suicide in indigenous children, with high rates, and also identified priority areas for interventions.
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Descriptive epidemiology of suicide attempts and suicide in the remote villages of French Guiana. Soc Psychiatry Psychiatr Epidemiol 2018; 53:1197-1206. [PMID: 30132021 DOI: 10.1007/s00127-018-1570-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The overall rate of suicide in French Guiana is estimated at 6 per 100,000, a rate that is lower than in mainland France. Given the frequent reports of suicide in Amerindian communities, our hypothesis was that this figure fails to capture a more contrasted reality. Our objective was to refine estimates and determine suicide rates in remote villages of French Guiana. METHODS We included patients for whom a suicide attempt or suicide was mentioned in medical records. The Health centers were grouped into two zones according to geographical remoteness. RESULTS The highest suicide rates observed in the remote Amerindian villages of Camopi and Trois Sauts were, respectively, 118 and 78/100,000. The median age at the time of suicide was significantly younger in remote zones [23 years (95% CI 21.59-25.06)] than in non-remote zones-[27 years (95% CI 24.47-29.31)]. The most frequent methods were hanging (78%) and intoxication (22%). CONCLUSIONS The suicide rate in remote areas in French Guiana was eight times higher than in France. The suicide of young people in remote areas in French Guiana and specifically in Amerindian villages must be better understood and prevented with contextualized and adapted care.
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Lazzarini TA, Gonçalves CCM, Benites WM, Silva LFD, Tsuha DH, Ko AI, Rohrbaugh R, Andrews JR, Croda J. Suicide in Brazilian indigenous communities: clustering of cases in children and adolescents by household. Rev Saude Publica 2018; 52:56. [PMID: 29791676 PMCID: PMC5958965 DOI: 10.11606/s1518-8787.2018052000541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/20/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To estimate age and sex-specific suicide rates, compare suicide rates between indigenous communities, and quantify the frequency of intrafamilial suicide clustering. METHODS We performed a retrospective cohort study involving 14,666 indigenous individuals in reservations in Dourados, state of Mato Grosso do Sul, Brazil, from 2003 through 2013 using national and local census. RESULTS The overall suicide rate was 73.4 per 100,000 person-years. Adolescent males aged 15-19 and girls aged 10-14 had the highest rates for each sex at 289.3 (95%CI 187.5-391.2) and 85.3 (95%CI 34.9-135.7), respectively. Comparing the largest reservations, Bororo had a higher suicide rate than Jaguapiru (RR = 4.83, 95%CI 2.85-8.16) and had significantly lower socioeconomic indicators including income and access to electricity. Nine of 19 suicides among children under 15 occurred in household clusters. Compared with adult suicides, a greater proportion of child (OR = 5.12, 95%CI 1.89-13.86, p = 0.001) and adolescent (OR = 3.48, 95%CI 1.29-9.44, p = 0.017) suicides occurred within household clusters. CONCLUSIONS High rates of suicide occur among children and adolescents in these indigenous reservations, particularly in poor communities. Nearly half of child suicides occur within household clusters. These findings underscore the need for broad public health interventions and focused mental health interventions in households following a suicide.
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Affiliation(s)
| | | | | | | | - Daniel Henrique Tsuha
- Faculdade de Computação, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brasil
| | | | - Robert Rohrbaugh
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Jason Randolph Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Julio Croda
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brasil
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Azuero AJ, Arreaza-Kaufman D, Coriat J, Tassinari S, Faria A, Castañeda-Cardona C, Rosselli D. Suicide in the Indigenous Population of Latin America: A Systematic Review. ACTA ACUST UNITED AC 2017; 46:237-242. [PMID: 29122231 DOI: 10.1016/j.rcp.2016.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/16/2016] [Accepted: 12/27/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Due to the high rates of suicide reported among many ethnic minorities, a systematic review is presented on suicide in indigenous populations of Latin America. METHODS Systematic review in PubMed, Scopus, PsycNET, Scielo and Scholar Google. RESULTS From an initial total of 1862 articles, 41 were included for data extraction. They include 21 from Brazil, 13 from Colombia, 2 from Chile, 1 from Peru, and 4 articles grouped from different countries. Suicide is a public health issue in many communities. Lifestyle changes, industrialisation, environmental degradation, and alcohol have led the indigenous population experiencing what has been described as "cultural death."
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Affiliation(s)
- Andres J Azuero
- Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Jeanette Coriat
- Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Stefano Tassinari
- Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Annette Faria
- Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Diego Rosselli
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia.
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Issues on Luck Egalitarianism, Responsibility, and Intercultural Healthcare Policies. Camb Q Healthc Ethics 2016; 25:186-96. [DOI: 10.1017/s0963180115000493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract:This article analyzes the criteria for the distribution of healthcare services through different justice theories such as utilitarianism and liberalism, pointing out the problems that arise when providing services to a culturally diverse population. The international epidemiological setting is a favorable one for discussing personal responsibility and luck egalitarianism; however, some provisions have to be made so that healthcare institutions do not treat ethnic, cultural, religious, and linguistic minorities unfairly. The article concludes by proposing that accommodations and culturally sensible attention should be provided when possible, without affecting the equal opportunity of others to access these services.
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Orellana JD, Balieiro AA, Fonseca FR, Basta PC, Souza MLPD. Spatial-temporal trends and risk of suicide in Central Brazil: an ecological study contrasting indigenous and non-indigenous populations. ACTA ACUST UNITED AC 2016; 38:222-30. [PMID: 26786195 PMCID: PMC7194261 DOI: 10.1590/1516-4446-2015-1720] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/01/2015] [Indexed: 11/22/2022]
Abstract
Objective: To examine spatial-temporal distribution and risk of suicide, as well as trends in suicide mortality rates, in the indigenous and non-indigenous population of the state of Mato Grosso do Sul, Brazil. Methods: Data were obtained from the Information Department of the Brazilian Unified Health System. Deaths recorded as voluntary self-inflicted injuries (ICD-10 codes X60.0 to X84.9) were considered suicide. Suicide rates were estimated and adjusted by age in the population > 9 years of age. Kernel analysis was used to assess the spatial distribution of suicide cases, while trend analysis was carried out using a non-parametric test (Mann-Kendall). Results: The suicide risk among the indigenous population was 8.1 (95%CI 7.2-9.0) times higher than in the non-indigenous population. For indigenous residents in the 15-24 age group, the risk was 18.5 (95%CI 17.5-19.6) times higher than in the non-indigenous population. The majority of indigenous cases were concentrated in a few villages in reservation areas, mainly occupied by Guarani-Kaiowá and Guarani-Ñandeva groups. Rate patterns remained stable over time in both groups. Conclusion: Suicide is a serious public health problem in Mato Grosso do Sul, and has had an alarming and disproportionate impact on the indigenous population for more than a decade.
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Affiliation(s)
- Jesem D Orellana
- Instituto Leônidas e Maria Deane (ILMD), Fundação Oswaldo Cruz (FIOCRUZ), Manaus, AM, Brazil
| | - Antônio A Balieiro
- Instituto Leônidas e Maria Deane (ILMD), Fundação Oswaldo Cruz (FIOCRUZ), Manaus, AM, Brazil
| | - Fernanda R Fonseca
- Instituto Leônidas e Maria Deane (ILMD), Fundação Oswaldo Cruz (FIOCRUZ), Manaus, AM, Brazil
| | - Paulo C Basta
- Escola Nacional de Saúde Pública Sergio Arouca (ENSP), FIOCRUZ, Rio de Janeiro, RJ, Brazil
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