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

BMC Psychiatry

Research Article

Girmay Medhin¹  Derege Kebede²  Lars Jacobsson³  Gunnar Kullgren³  Atalay Alem⁴  Solomon Teferra⁴  Charlotte Hanlon⁵  Abebaw Fekadu⁶  Teshome Shibre⁷ 

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

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

DOI  :  10.1186/1471-244X-14-150

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

来源: Springer

【 摘 要 】

BackgroundPeople 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.MethodsA 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.ResultsOver 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.ConclusionIn 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】

Unknown   
© Shibre et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.