Suicide and suicide attempts in people with severe mental disorders in Butajira, Ethiopia: 10 year follow-up of a population-based cohort

BMC Psychiatry

Abebaw Fekadu⁵  Lars Jacobsson¹  Gunnar Kullgren¹  Solomon Teferra⁷  Derege Kebede²  Atalay Alem⁷  Girmay Medhin⁶  Charlotte Hanlon³  Teshome Shibre⁴ 

[1] Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umea, Sweden;WHO Regional Office for Africa, Brazzaville, Republic of Congo;Health Services and Population Research Department, King’s College London, Institute of Psychiatry, Centre for Global Mental Health, London, UK;Ontario Shores Centre for Mental Health Sciences, University of Toronto, Toronto, Canada;College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia;Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia;Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia

关键词: Ethiopia;    sub-Saharan Africa;    Developing countries;    Bipolar I disorder;    Major depression;    Schizophrenia;    Suicide;   

Others  :  1123563
DOI  :  10.1186/1471-244X-14-150

 received in 2013-12-12, accepted in 2014-05-15,  发布年份 2014

【 摘 要 】

Background

People with severe mental disorders (SMD) are at higher risk of suicide. However, research into suicide attempts and completed suicide in people with SMD in low- and middle-income countries is mostly limited to patients attending psychiatric facilities where selection bias is likely to be high.

Methods

A population-based cohort of 919 people with SMD from rural Ethiopia (who received standardized clinician diagnoses of schizophrenia (n = 358) major depressive disorder (n = 216) and bipolar I disorder (n = 345)) were followed up annually for an average of 10 years. The Longitudinal Interval Follow-up Evaluation chart was administered by psychiatrists and used to evaluate systematically suicidal behavior and risk factors, which may be amenable to intervention.

Results

Over the follow-up period, the cumulative risk of suicide attempt was 26.3% for major depression, 23.8% for bipolar I disorder and 13.1% for schizophrenia, (p < 0.001). The overall incidence of completed suicide was 200.2/100,000 person-years (CI = 120.6, 312.5). Hanging was the most frequent method used (71.5%) for both attempters and completers. Most people who completed suicide were successful on the first attempt (84.2%), but the case-fatality rate for suicide attempt was 9.7%. In the adjusted logistic regression model, being currently married (Adjusted OR) =2.17, 95% CI = 1.21, 3.91), and having a diagnosis of bipolar I disorder (Adjusted OR = 2.59, 95% CI = 1.57, 4.26) or major depression (Adjusted OR = 2.71, 95% CI = 1.60, 4.58) were associated significantly with increased risk of suicide attempts.

Conclusion

In this sample of people with SMD from a rural setting, the rate of suicide was high. Initiatives to integrate mental health service into primary care need to focus on limiting access to suicide methods in people with SMD in addition to expanding access to mental health care.

【 授权许可】

   
2014 Shibre et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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