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




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BMC Psychiatry

, 14:150

Psychotic disorders

Abstract

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.

KeywordsSuicide Schizophrenia Major depression Bipolar I disorder Developing countries sub-Saharan Africa Ethiopia AbbreviationsSDMSevere mental disorders

OROdds ratio

LMICsLow income countries

MDDMajor depressive disorder

CIDI 2.1Composite international diagnostic interview version 2.1

SCAN 2.1Schedule for clinical interview in neuropsychiatry version 2.1

DSM-IVDiagnostic statistical manual of mental disorders version IV

ICD-10International classification of diseases version 10

GAFGlobal assessment of functioning

FISFamily interview schedule

LIFELongitudinal interval follow-up evaluation

SPSSStatistical packages for social sciences

CIConfidence interval.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-244X-14-150 contains supplementary material, which is available to authorized users.

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