Developing a Community-based Suicide Prevention Program in Primary Health Care

A Qualitative Examination of the Impact of Suicidal Thoughts and Behavior on Help-Seeking Among University Students in Colombia and Mexico

This study examined descriptions of suicidal thoughts and behavior (STB) to identify risk and protective factors that may present in clinical settings among university students from Latin America. Our focus was on answering the following key questions: How are suicidal thoughts and behavior described? What are reasons for wanting to die and for living? What impact do STBs have on motivations to seek or avoid psychological treatment? To this end, 55 qualitative interviews were completed with university students from Colombia and Mexico who recently endorsed emotional difficulties in the World Mental Health International College Student (WMH-ICS) surveys. Interviews were coded to identify themes specific to STBs. Findings revealed insight on symptom presentations and consequences of STBs. Participants described uncontrollable somatic symptoms during periods of high suicide risk, which serves as a relevant clinical marker for health providers. An important reason for living was to avoid suffering for family, which was protective against suicide and motivates familial involvement in treatment planning. Participants sought solutions to emotional problems after experiencing STBs, including psychological treatment. Cultural stigma of mental illness induced feelings of shame and burden, which led to avolition, avoidance, and nondisclosure of symptom severity. This study provides insight into the utility of evaluating cultural context in (a) detecting antecedents to STBs frequently reported as somatic symptoms, (b) identifying protective factors against suicide, and (c) recognizing how stigma of mental illness and suicide, shame avoidance, and familism might influence personal motivations to seek or avoid help for emotional distress.

Effective suicide prevention strategies in primary healthcare settings: a systematic review

Background

There is a fundamental need for health systems, health managers, and policymakers to identify effective components of suicide prevention strategies (SPS) and programs in primary healthcare (PHC) settings. Accordingly, this systematic review aimed to identify and summarize effective and significant evidence on suicide prevention in PHC setting. We systematically searched the published literature in English from PubMed, Web of Science, Scopus, CINAHL, PsychoINFO, and Embase up to 31 July 2022. The study searched all records reporting effective and significant strategies and programs on suicide prevention in PHC settings. A content analysis approach was carried out to extract major components of suicide prevention strategies in PHC settings.

Results

A total of 10 records (8 original articles and 2 reports) with 1,199,986 samples were included. In all the included articles, SPS decreased suicide rates. The majority of studies were conducted among the general population. The content analysis approach emerged five major components to SPS in PHC setting: (1) training and educating healthcare providers, (2) screening and suicide risk assessment, (3) managing depression symptoms and mental disorders, (4) managing suicide attempters and at-risk cases, and (5) prevention strategies at the general population.

Conclusions

This review provided reliable evidence for health systems to develop SPS in PHC and practitioners who are eager to provide brief and effective contact interventions for suicide risk to well-serve their patients.

Developing a Community-based Suicide Prevention Program in Primary Health Care

Currently, suicide has become one of the most critical public health challenges in low-and middle-income countries facing community mental health more broadly. However, most healthcare systems haven't efficient Suicide Prevention Programs (SPP), and only 18% of countries have a suicide registry system. In Malekan County of Iran, suicidal behaviors were recognized as a serious public health issue via a health community assessment. This study was aimed to describe the developing steps of a community-based SPP in Malekan County including review of systematic reviews, expert testimony, report to the health system, improving suicide registry coverage, conducting research, follow upping of suicide attempters, training gatekeepers, and public education campaign in the hot spots. These suggested the need to reinforce evaluate the effectiveness of the national health perspective in addressing the issues of suicide and suicidal behavior.

Early marriage, stressful life events and risk of suicide and suicide attempt: a case-control study in Iran

BACKGROUND

Early Marriage (EM) and associated Stressful Life Events (SLEs) and consequences such as psychological and physical well-being issues can lead to suicide and suicide attempts (SA). The study aimed to investigate the risk of suicide and SA among early married people who experienced SLEs.

METHODS

A case-control study was conducted based on the registry for suicide in Malekan county in Iran during 2016-18. Cases included 154 SAs and 32 suicides. Simultaneously, 201 outpatients from the emergency department were chosen as controls. Holms and Rahe life event questionnaire was used to assess SLEs. Sub-group analysis (Mantel-Haenszel) by sex and age groups and multiple logistic regression were used to calculate adjusted Odds Ratios (ORs) with 95% Confidence Intervals (CIs) for the association between EM and suicide risk after adjusting for the potential confounders.

RESULTS

The proportion (female vs male) of EM among suicides, controls, and SAs was 31.25% (18.7 vs 12.5%), 15.92% (11.9 vs 4.0%), and 13.0% (11.7 vs 1.3%), respectively. In subgroup analyses by sex, EM was associated with an increased risk of suicide in both females and males 2.64 and 2.36 times, respectively. Likewise, subgroup analysis by age groups revealed that EM increased suicide risk in subjects aged 10-15 years, while no association was found for age groups of 26-40 and > 40. After adjusting for the potential confounders, EM (OR: 3.01; 95% CI: 1.15 -7.29), financial problems (OR = 4.50; 95% CI: 1.83 -9.07), and family problems (OR = 2.60; 95% CI: 1.19-9.59), were associated with an increased risk of suicide. However, no association was found between EM, various types of SLEs, and the risk of SA.

CONCLUSIONS

We found EM and SLEs were correlated with suicide risk, while no evidence found that EM increased the risk of SA. Progress in reducing EM and addressing its serious consequences can occur by a stronger political commitment and by sharing the experiences and voices of the early married. Our study provided preliminary findings to guide future studies; however, methodological and longitudinal studies are needed to understand and address the effect of EM on suicidal behaviors.

A longitudinal study of suicide and suicide attempt in northwest of Iran: incidence, predictors, and socioeconomic status and the role of sociocultural status

Background

A detailed community-level understanding of socioeconomic status (SES) and sociocultural status (SCS) of suicides and suicide attempters (SAs) in a prospective design could have significant implications for policymakers at the local prevention and treatment levels. The effect of SCS and SES on SAs is poorly understood and investigated in Iran. The present study aimed to investigate the incidence, trend, and role of SES and SCS on suicide and SAs.

Methods

A longitudinal study was conducted based on the registry for SAs in Malekan County, Iran, from 2015 to 2018. Demographic characteristics, SES, SCS, incidence rates, and predictors of suicidal behaviors were measured via structured instruments. Simple and multiple logistic regressions were used to estimate crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

Results

A total of 853 SAs (32 suicides and 821 attempts) were identified during the study. Trend analysis revealed that the suicide rate significantly decreased from 2014 (10.28) to 2018 (1.75) per 100,000. In the final multiple variable models, age (26–40), male sex, unemployment, antisocial activities, history of SA, hanging method, and season (spring) increased the suicide risk while religious commitment had protective effects on suicide.

Conclusions

Our findings indicated that demographic characteristics, low SES, and SCS are associated with suicide. In this county, trend of suicide and SA were decreased from 2014 to 2018. This study findings highlight the need to consider a wide range of contextual variables, socio-demographic, SES, and SCS in suicide prevention strategies. Improving inter-sectoral collaborations and policymakers’ attitudes are imperative for SA reduction.